Even among patients with chronic kidney disease (CKD), the risk for cardiovascular events is considerably lower in women compared with men, according to investigators.

Ana C. Ricardo, MD, MPH, MS, of the University of Illinois at Chicago, and colleagues compared the risk for cardiovascular events between 1778 women and 2161 men with a baseline estimated glomerular filtration rate of 20 to 70 mL/min/1.73 m2 from the multiethnic Chronic Renal Insufficiency Cohort (CRIC). Women had a significant 29% lower risk for atherosclerotic events, a composite of myocardial infarction, stroke, and peripheral artery disease, the investigators reported in the American Journal of Kidney Diseases. Women also had a significant 24% lower risk for heart failure, and 45% and 42% lower risks for death from cardiovascular and all causes, respectively. Similar trends were observed in subgroup analyses by baseline age, cardiovascular disease status, and estimated glomerular filtration rate (eGFR), and in analyses excluding patients who reached kidney failure.

With respect to other risk factors, women had less physical activity and use of cardioprotective medications and higher body mass index, waist circumference, low-density lipoprotein (LDL) cholesterol, and family history of coronary heart disease at baseline compared with men. Women were less likely to be smokers, and they had higher high-density lipoprotein (HDL) cholesterol and lower prevalence of cardiovascular disease.

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Estrogen may have a protective effect against atherosclerosis, but it was not assessed in this study. The investigators found no differences in results when they stratified data by the average age of menopause (51 years).

After adjusting for traditional risk factors, and for cardiac markers of myocardial distention, injury, and inflammation (eg, C-reactive protein, N-terminal prohormone of brain natriuretic peptide, troponin), the risk for cardiovascular events in women for the most part remained lower than in men.

“From the clinician’s perspective, it is concerning that most baseline risk factor control and cardioprotective medication use were suboptimal in both women and men,” Dr Ricardo’s team wrote. “Importantly, women with CKD should still be considered to be at very high cardiovascular risk. Future work is needed to evaluate the differential impact of risk factor management to improve outcomes in women and men with CKD.”


Toth-Manikowski SM, Yang W, Appel L, et al; for the Chronic Renal Insufficiency Cohort (CRIC) investigators. Sex differences in cardiovascular outcomes in CKD: findings from the CRIC study. Am J Kidney Dis. 2021 Aug;78(2):200-209. doi:10.1053/j.ajkd.2021.01.020