The cardiovascular risk advantage women with chronic kidney disease (CKD) have over men diminishes when their systolic blood pressure exceeds 140 mmHg, a new study finds.

Investigators compared the risk of cardiovascular events between 1192 White women and 1635 White men with nondialysis-dependent CKD from 40 Italian nephrology clinics who participated in 4 prospective cohort studies. Over 4 years, 517 cardiovascular deaths or non-fatal cardiovascular events requiring hospitalization (ie, myocardial infarction, congestive heart failure, stroke, revascularization, peripheral vascular disease, and non-traumatic amputation) occurred in 199 women and 318 men.

In an adjusted multivariable Cox regression analysis, women had a 27% lower risk of cardiovascular events compared with men, Roberto Minutolo, MD, PhD, of University of Campania Luigi Vanvitelli in Naples, Italy, and colleagues reported in Nephrology Dialysis Transplantation. However, they found a significant interaction between sex and systolic blood pressure. Women with systolic blood pressure levels less than 130 mmHg and 130-140 mmHg had significant 50% and 28% lower risks for cardiovascular events, respectively, compared with men. At systolic blood pressure levels above 140 mmHg, the cardiovascular risk advantage in women disappeared.

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In adjusted models, women with high vs normal systolic blood pressure exhibited significantly increased risks of cardiovascular events, but men did not. The investigators observed no difference between the sexes in use of antihypertensive or cardioprotective drugs or regular nephrology care.

“Higher BP levels abolish the cardiovascular protection seen in female vs male patients with overt CKD. This finding supports the need for higher awareness of hypertensive burden in women with CKD,” Dr Minutolo’s team wrote.

Among the study’s limitations, the investigators could not explore the potential role of non-traditional risk factors, such as hypertensive pregnancy disorders, gestational diabetes, and radiation or chemotherapy for breast cancer. Since the entire cohort was White, results may not pertain to other racial and ethnic groups.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Borrelli S, Garofalo C, Gabbai FB, et al.  Sex difference in cardiovascular risk in patients with chronic kidney disease: pooled analysis of four cohort studies. Nephrol Dial Transplant. Published online February 16, 2023. doi:10.1093/ndt/gfad036