The impact of gender on the risk of cardiovascular events in older adults with advanced chronic kidney disease
Megan E Astley, Fergus Caskey, Marie Evans, Claudia Torino, Maciej Szymczak, Christiane Drechsler, Maria Pippias, Esther de Rooij, Gaetana Porto, Vianda S Stel, Friedo W. Dekker, Christoph Wanner, Kitty J. Jager, Nicholas C Chesnaye, the EQUAL study investigators, Andreas Schneider, Anke Torp, Beate Iwig, Boris Perras, Christian Marx, Christiane Drechsler, Christof Blaser, Christoph Wanner, Claudia Emde, Detlef H. Krieter, Dunja Fuchs, Ellen Irmler, Eva Platen, Hans Schmidt-Gürtler, Hendrik Schlee, Holger Naujoks, Ines Schlee, Sabine Cäsar, Joachim Beige, Jochen Röthele, Justyna Mazur, Kai Hahn, Katja Blouin, Katrin Neumeier, Kirsten Anding‐Rost, Lothar Schramm, Monika Hopf, Nadja Wuttke, Nikolaus Frischmuth, Pawlos Ichtiaris, Petra Kirste, Petra Schulz, Sabine Aign, Sandra Biribauer, Sherin Manan, Silke Röser, Stefan Heidenreich, Stephanie Palm, Susanne Schwedler, Sylke Delrieux, Sylvia Renker, Sylvia Schättel, Theresa Stephan, Thomas Schmiedeke, Thomas Weinreich, Til Leimbach, Torsten Stövesand, Udo Bahner, Wolfgang Seeger, Adamasco Cupisti, Adelia Sagliocca, Alberto Ferraro, Alessandra Mele, Alessandro Naticchia, Alex Còsaro, Andrea Ranghino, Andrea Stucchi, Angelo Pignataro, Antonella De Blasio, Antonello Pani, Aris Tsalouichos, Antonio Bellasi, Biagio Di Iorio, Butti Alessandra, Cataldo Abaterusso, Chiara Somma, Claudia D’Alessandro, Claudia Torino, Claudia Zullo, Claudio Pozzi, Daniela Bergamo, Daniele Ciurlino, Daria Motta, Domenico Russo, Enrico Favaro, Federica Neve Vigotti, Ferruccio Ansali, Ferruccio Conte, Francesca Cianciotta, Francesca Giacchino, Francesco Cappellaio, Francesco Pizzarelli, Gaetano Greco, Gaetana Porto, Giada Bigatti
Abstract
Background: Patients with chronic kidney disease (CKD) are at a higher risk of major adverse cardiovascular events (MACE) compared with the general population, but gender differences in this risk, especially in older adults, are not fully known. We aim to identify gender differences in the risk of MACE in older European CKD patients, and explore factors that may explain these differences. Methods: The European Quality study (EQUAL) is a prospective study on stage 4-5 CKD patients, ≥65 years old, not on dialysis, from Germany, Italy, the Netherlands, Poland, Sweden and the UK. Cox regression and cumulative incidence competing risk curves were used to identify gender differences in MACE risks. Mediation analysis was used to identify variables which may explain risk differences between men and women. Results: = .02), which was attenuated after adjusting for pre-existing cardiometabolic comorbidities and cardiovascular risk factors. There were no significant gender differences in the risk of recurrent MACE or fatal MACE. The risk difference in MACE by gender was larger in patients aged 65-75 years, compared with patients over 75 years. Conclusions: In a cohort of older adults with advanced CKD, women had lower risks of MACE. These risk differences were partially explained by pre-existing cardiometabolic comorbidities and cardiovascular risk factors.