Sex differences in cardiovascular complications and mortality in hospital patients with covid-19: registry based observational study

Abstract

ObjectiveTo assess whether the risk of cardiovascular complications of covid-19 differ between the sexes and to determine whether any sex differences in risk are reduced in individuals with pre-existing cardiovascular disease.DesignRegistry based observational study.Setting74 hospitals across 13 countries (eight European) participating in CAPACITY-COVID (Cardiac complicAtions in Patients With SARS Corona vIrus 2 regisTrY), from March 2020 to May 2021ParticipantsAll adults (aged ≥18 years), predominantly European, admitted to hospital with highly suspected covid-19 disease or covid-19 disease confirmed by positive laboratory test results (n=11 167 patients).Main outcome measuresAny cardiovascular complication during admission to hospital. Secondary outcomes were in-hospital mortality and individual cardiovascular complications with ≥20 events for each sex. Logistic regression was used to examine sex differences in the risk of cardiovascular outcomes, overall and grouped by pre-existing cardiovascular disease.ResultsOf 11 167 adults (median age 68 years, 40% female participants) included, 3423 (36% of whom were female participants) had pre-existing cardiovascular disease. In both sexes, the most common cardiovascular complications were supraventricular tachycardias (4% of female participants, 6% of male participants), pulmonary embolism (3% and 5%), and heart failure (decompensated or de novo) (2% in both sexes). After adjusting for age, ethnic group, pre-existing cardiovascular disease, and risk factors for cardiovascular disease, female individuals were less likely than male individuals to have a cardiovascular complication (odds ratio 0.72, 95% confidence interval 0.64 to 0.80) or die (0.65, 0.59 to 0.72). Differences between the sexes were not modified by pre-existing cardiovascular disease; for the primary outcome, the female-to-male ratio of the odds ratio in those without, compared with those with, pre-existing cardiovascular disease was 0.84 (0.67 to 1.07).ConclusionsIn patients admitted to hospital for covid-19, female participants were less likely than male participants to have a cardiovascular complication. The differences between the sexes could not be attributed to the lower prevalence of pre-existing cardiovascular disease in female individuals. The reasons for this advantage in female individuals requires further research.

Nursing Students’ Motivation, Awareness, and Knowledge of Women’s Health: A Norwegian Quasi-Experimental Study

“…Sci. 2024, 14, 273 2 of 16 complications, in a large registry-based study of 11,167 adults admitted to hospitals with COVID-19 between March 2020 and May 2021 [10]. Sex differences exist regarding body composition, sex hormones, and lipid levels, where women have a higher body fat percentage [11] and higher HDL cholesterol compared to men [12].…”

Major cardiovascular events after COVID-19, event rates post-vaccination, antiviral or anti-inflammatory therapy, and temporal trends: Rationale and methodology of the CORONA-VTE-Network study

“…1 and 2). Early in the pandemic, seminal studies evaluating short-term outcomes found that patients with COVID-19 who were hospitalized had a high incidence of fatal and nonfatal cardiovascular complications [ 5 , 6 , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , 21 , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] ] ( Table 1A , Table 1B ). The risk of VTE was particularly high in the intensive care unit, with pooled incidence rate of 27 % in a meta-analysis of early studies [ 38 ].…”

“… Daniels et al [ 29 ], 2021 Myocarditis 1597 39.6 N/A Multicenter Outpatient Prospective patient enrollment Myocarditis occurred in 2.3 % of athletes diagnosed with COVID-19 and screened using cardiac magnetic resonance imaging. Hockham et al [ 32 ], 2023 Cardiovascular complications (myocarditis, pericarditis, endocarditis, myocardial ischemia, arrhythmia, stroke, HF, PE) 11,167 40.0 68.0 ‡ Multicenter Inpatient Detailed review of EHRs Hospitalized female patients with COVID-19 were at lower risk of cardiovascular complications (13 %) compared with men (17 %). Venturelli et al [ 33 ], 2021 Cardiovascular complications (cardiac ischemia, cardiac arrhythmia) 767 32.9 63.0 † Single center Inpatient Detailed review of EHRs Hospitalized COVID-19 patients had a higher incidence of cardiac complications such as arrhythmia, ischemia, and myocarditis.…”

A double-blind, randomised, placebo-controlled parallel study to investigate the effect of sex and dietary nitrate on COVID-19 vaccine-induced vascular dysfunction in healthy men and women: protocol of the DiNOVasc-COVID-19 study

“…Additionally, there has been increasing recognition of specific cardiovascular complications of COVID-19 including acute coronary syndromes and myocarditis, amongst others [ 5 – 9 ]. Importantly, the incidence of such cardiovascular complications is greater in men than in women [ 10 , 11 ]. The mechanisms underlying these cardiovascular manifestations might be secondary to the severe inflammatory response induced by COVID-19, as well as the virus itself.…”