CV complications in COVID-19 more common in men than women, not explained by prior CVD
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Among patients hospitalized with COVID-19, men were more likely than women to have CV complications, but the difference was not explained by lower rates of past CVD in women, researchers reported in BMJ Medicine.
“Most research into the differential impact of COVID-19 on men and women has focused on outcomes such as hospital admission, ICU admission and death, which are important but, of course, only tell part of the story,” Carinna Hockham, DPhil, MSc, BA, research associate in and U.K. program manager of the Global Women’s Health Program of The George Institute for Global Health, Imperial College London, told Healio. “We wanted to see whether similar differences existed for different cardiovascular complications, particularly given the potential for long-term effects that these complications might have on cardiovascular health. We also wanted to examine whether differences were modified by the presence or absence of preexisting CVD, as this could point toward different explanations for why males have a higher risk.”
Hockham and colleagues conducted a registry-based observational study of 11,167 adults (median age, 68 years; 40% women) from 74 hospitals in 13 countries participating in the CAPACITY-COVID registry who were hospitalized with highly suspected or confirmed COVID-19 between March 2020 and May 2021.
Among the cohort, 3,423 patients (36% women) had preexisting CVD.
Most common complications
Hockham and colleagues found that the most common CV complications were supraventricular tachycardia (women, 4%; men, 6%), pulmonary embolism (women, 3%; men, 5%) and HF (both sexes, 2%). Endocarditis was the least common CV complication in both sexes.
After adjustment for age, ethnic group, preexisting CVD and CVD risk factors, women were less likely than men to have a CV complication (adjusted OR = 0.72; 95% CI, 0.64-0.8) or to die in the hospital (aOR = 0.65; 95% CI, 0.59-0.72).
In addition, compared with men, women had lower odds of arrhythmia (aOR = 0.68; 95% CI, 0.58-0.8), supraventricular tachycardia (aOR = 0.73; 95% CI, 0.61-0.88), cardiac ischemia (aOR = 0.56; 95% CI, 0.4-0.79) and PE (aOR = 0.6; 95% CI, 0.49-0.74).
There were no differences by sex in odds of HF or stroke.
Sex differences and preexisting CVD
In analyses by preexisting CVD, point estimates for the ratio of the OR by sex were all less than 1, and did not significantly differ from 1 (for example, the female-to-male ratio of the OR for overall CV complications was 0.84; 95% CI, 0.67-1.07), meaning the sex differences in CV complications were not explained by differences in preexisting CVD, the researchers wrote.
“The higher risk of severe COVID-19 in men is not solely explained by their higher prevalence of preexisting cardiovascular disease,” Hockham told Healio. “Further research is needed that specifically looks at the pathophysiological mechanisms of COVID-19 and whether these differ between the sexes. We also saw that, for most complications where a sex difference existed, this difference was smaller among those with preexisting cardiovascular disease than those without, but our confidence intervals were wide (despite our large sample size of over 11,000). This could suggest that the female advantage is attenuated in those with preexisting disease, but we need more large-scale studies to confirm this. Only by incorporating a sex lens across all stages of research will we be able to derive a holistic understanding of how the sexes are differentially impacted by COVID-19 and, importantly, why.”
For more information:
Carinna Hockham, DPhil, MSc, BA, can be reached at chockham@georgeinstitute.org.uk.
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