The effects of biological sex and cardiovascular disease on COVID-19 mortality

Abstract

Cardiovascular disease (CVD) is a common comorbidity observed in patients with COVID-19 that is associated with increased severity and mortality. However, the effects of biological sex on CVD associated mortality in COVID-19 patients is poorly established particularly among Hispanic/Latin Americans. We examined the association of preexisting CVD with COVID-19 mortality in hospitalized Latin American men and women. This multicenter study included hospitalized Mexican patients with a positive diagnosis of COVID-19. The main outcome was in-hospital mortality. Multivariable regression analyses were used to calculate the adjusted odd ratios with 95% confidence interval for mortality in women and men. Of 81,400 patients with a positive diagnosis for SARS-CoV-2 infection, 28,929 (35.54%) hospitalized patients were evaluated. Of these, the 35.41% (10,243) were women. In-hospital death was higher in men than in women. In relation to CVD between the sexes, women had a higher incidence of CVD than men (4.69% vs 3.93%. P=0.0023). The adjusted logistic regression analyses showed that CVD was significantly associated with COVID-19 mortality in women but not men. We then stratified by sex according to age <52 and ≥52 years old. Similar significant association was also found in pre-specified analysis in women ≥52 years old but not in men of similar age. We conclude that CVD's effect on mortality among COVID-19 hospitalized patients is dependent on biological sex and age in this Latin American cohort. These results suggest that therapeutic strategies for Latin American women with CVD and COVID-19 should include particular attention to their cardiovascular health.

Sex, cardiovascular disease, and the inequities of COVID-19

“…The study by Hernandez-Hernandez et al ( 2 ) bolsters the arguments for the role of estrogens in COVID-19 mortality in women. The correlation between the decline in ovarian estrogens in women around the expected age of menopause and a rise in COVID-19 mortality that is exacerbated by cardiovascular disease reinforces the importance of these steroid hormones as protective agents.…”

“…It is fitting that in a special call for papers dedicated to sex differences, this issue of American Journal of Physiology-Heart and Circulatory Physiology includes a paper by Hernandez-Hernandez et al ( 2 ) on how cardiovascular disease differentially impacts COVID-19 mortality in males and females, with intriguing findings about a possible role for menopause. Work like this study is crucial to understand the inequities of this global health challenge and develop solutions that balance the scales of care.…”

“…As individual risks, cardiovascular disease and male sex have been firmly established, but the combination of cardiovascular risk and patient sex has only been specifically examined in a few small-scale studies. The work by Hernandez-Hernandez et al ( 2 ) is a significantly larger study; it included 28,929 patients hospitalized for COVID-19 in Mexico between 27 February 2020 and 28 May 2020. Reflective of the lower hospitalization rates in women, only 35.41% of patients were women.…”

“…Hernandez-Hernandez et al ( 2 ) show that in a Mexican population of hospitalized patients with COVID-19, women have higher rates of most cardiovascular conditions or risk factors than men, with the exception of smoking. These data reflect the overall Mexican population where women have slightly higher rates of cardiovascular disease.…”

“…One interesting point that is presented in the study by Hernandez-Hernandez et al ( 2 ) is the lower rates of intensive care unit (ICU) care and intubation in female patients overall. With lower mortality in women, it is expected they have lower rates of ICU admission and intensive care options like intubation.…”