Sex and the Risk of Atheromatous and Non-Atheromatous Cardiovascular Disease in CKD: Findings From the CKD-REIN Cohort Study
Rationale & ObjectiveSex differences in cardiovascular disease (CVD) are well-established, but whether chronic kidney disease (CKD) modifies these risk differences, and whether they differ between atheromatous (ACVD) and non-atheromatous (N-ACVD) CVD is unknown. Assessing this interaction was th...
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| Veröffentlicht in: | American journal of kidney diseases 2024-06, Vol.84 (5), p.546-556 |
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| creator | Faucon, Anne-Laure Lambert, Oriane Massy, Ziad Drüeke, Tilman Combe, Christian Fouque, Denis Frimat, Luc Jacquelinet, Christian Laville, Maurice Liabeuf, Sophie Pecoits-Filho, Roberto Hauguel-Moreau, Marie Mansencal, Nicolas de Pinho, Natalia Alencar Stengel, Bénédicte Azar, Raymond Belenfant, Xavier Besnier, Dominique Bourdenx, Jean Philippe Burtey, Stéphane Chauveau, Dominique Chazot, Charles Choukroun, Gabriel Combe, Christian Delahousse, Michel Deroure, Benjamin Essig, Marie Glowacki, François Hannedouche, Thierry Hoffmann, Maxime Hourmant, Maryvonne Jamali, Mohamed Juillard, Laurent Kamar, Nassim Keller, Adrien Klein, Alexandre Kuentz, François Lacraz, Adeline Lambrey, Guy Landru, Isabelle Lang, Philippe Lebrun, Gaetan Lobbedez, Thierry Magnant, Eric Mailliez, Sébastien Maisonneuve, Nathalie Martin, Séverine Moulin, Bruno Noel, Christian Panescu, Viktor Sekhri, Hacène Smati, Mustafa Testa, Angelo Thervet, Eric Urena, Pablo Vela, Carlos Zaoui, Philippe |
| description | Rationale & ObjectiveSex differences in cardiovascular disease (CVD) are well-established, but whether chronic kidney disease (CKD) modifies these risk differences, and whether they differ between atheromatous (ACVD) and non-atheromatous (N-ACVD) CVD is unknown. Assessing this interaction was the principal goal of this study.Study DesignProspective cohort study.Setting & ParticipantsAdults enrolled in the CKD-Renal Epidemiology and Information Network (CKD-REIN) cohort from from 2013 to 2020, a nationally representative sample of 40 nephrology clinics in France.ExposureSex.OutcomesFatal and non-fatal composite ACVD events (ischaemic coronary, cerebral, and peripheral artery disease) and composite N-ACVD events (heart failure, haemorrhagic stroke, and arrhythmias).Analytical ApproachMultivariable cause-specific Cox proportional hazards models.Results1,044 women and 1,976 men with moderate to severe CKD (median age, 67 vs. 69; mean estimated glomerular filtration rate [eGFR], 32±12 vs. 33±12 mL/min/1.73m2) were studied. Over a median follow-up of 5.0 (interquartile range, 4.8;5.2) years, the ACVD rate (per 100 patient-years) was significantly lower in women than men: 2.1 (95% confidence interval: 1.6-2.5) vs 3.6 (3.2-4.0) (P |
| doi_str_mv | 10.1053/j.ajkd.2024.04.013 |
| format | Article |
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Assessing this interaction was the principal goal of this study.Study DesignProspective cohort study.Setting & ParticipantsAdults enrolled in the CKD-Renal Epidemiology and Information Network (CKD-REIN) cohort from from 2013 to 2020, a nationally representative sample of 40 nephrology clinics in France.ExposureSex.OutcomesFatal and non-fatal composite ACVD events (ischaemic coronary, cerebral, and peripheral artery disease) and composite N-ACVD events (heart failure, haemorrhagic stroke, and arrhythmias).Analytical ApproachMultivariable cause-specific Cox proportional hazards models.Results1,044 women and 1,976 men with moderate to severe CKD (median age, 67 vs. 69; mean estimated glomerular filtration rate [eGFR], 32±12 vs. 33±12 mL/min/1.73m2) were studied. Over a median follow-up of 5.0 (interquartile range, 4.8;5.2) years, the ACVD rate (per 100 patient-years) was significantly lower in women than men: 2.1 (95% confidence interval: 1.6-2.5) vs 3.6 (3.2-4.0) (P<0.01), while the N-ACVD rate was not: 5.7 (5.0-6.5) vs 6.4 (5.8-7.0) (P=0.55). N-ACVD had a steeper relationship with eGFR than did ACVD. There was an interaction (P<0.01) between sex and baseline eGFR and the ACVD hazard: the adjusted hazard ratio for women compared to men was 0.42 (0.25;0.71) at 45 mL/min/1.73m2 and gradually attenuated at lower levels of eGFR, reaching 1.00 (0.62;1.63) at 16 mL/min/1.73m2. In contrast, the N-ACVD hazard did not differ between the sexes across the eGFR range studied.LimitationsCardiovascular biomarkers and sex hormones were not assessed.ConclusionThis study shows how the lower risk of ACVD among women compared to men attenuates fully with kidney disease progression. The equal risk of N-ACVD between sexes across CKD stages and its steeper association with eGFR suggest an important contribution of CKD to the development of this CVD type.</description><identifier>ISSN: 0272-6386</identifier><identifier>EISSN: 1523-6838</identifier><identifier>DOI: 10.1053/j.ajkd.2024.04.013</identifier><language>eng</language><publisher>Elsevier</publisher><subject>Cardiology and cardiovascular system ; Human health and pathology ; Life Sciences ; Urology and Nephrology</subject><ispartof>American journal of kidney diseases, 2024-06, Vol.84 (5), p.546-556</ispartof><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><orcidid>0000-0003-0772-5656 ; 0000-0002-9707-7199 ; 0000-0001-5384-9006 ; 0000-0002-0438-6487 ; 0000-0003-0772-5656 ; 0000-0001-5384-9006 ; 0000-0002-0438-6487 ; 0000-0002-9707-7199</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://u-picardie.hal.science/hal-04627418$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Faucon, Anne-Laure</creatorcontrib><creatorcontrib>Lambert, Oriane</creatorcontrib><creatorcontrib>Massy, Ziad</creatorcontrib><creatorcontrib>Drüeke, Tilman</creatorcontrib><creatorcontrib>Combe, Christian</creatorcontrib><creatorcontrib>Fouque, Denis</creatorcontrib><creatorcontrib>Frimat, Luc</creatorcontrib><creatorcontrib>Jacquelinet, Christian</creatorcontrib><creatorcontrib>Laville, Maurice</creatorcontrib><creatorcontrib>Liabeuf, Sophie</creatorcontrib><creatorcontrib>Pecoits-Filho, Roberto</creatorcontrib><creatorcontrib>Hauguel-Moreau, Marie</creatorcontrib><creatorcontrib>Mansencal, Nicolas</creatorcontrib><creatorcontrib>de Pinho, Natalia Alencar</creatorcontrib><creatorcontrib>Stengel, Bénédicte</creatorcontrib><creatorcontrib>Azar, Raymond</creatorcontrib><creatorcontrib>Belenfant, Xavier</creatorcontrib><creatorcontrib>Besnier, Dominique</creatorcontrib><creatorcontrib>Bourdenx, Jean Philippe</creatorcontrib><creatorcontrib>Burtey, Stéphane</creatorcontrib><creatorcontrib>Chauveau, Dominique</creatorcontrib><creatorcontrib>Chazot, Charles</creatorcontrib><creatorcontrib>Choukroun, Gabriel</creatorcontrib><creatorcontrib>Combe, Christian</creatorcontrib><creatorcontrib>Delahousse, Michel</creatorcontrib><creatorcontrib>Deroure, Benjamin</creatorcontrib><creatorcontrib>Essig, Marie</creatorcontrib><creatorcontrib>Glowacki, François</creatorcontrib><creatorcontrib>Hannedouche, Thierry</creatorcontrib><creatorcontrib>Hoffmann, Maxime</creatorcontrib><creatorcontrib>Hourmant, Maryvonne</creatorcontrib><creatorcontrib>Jamali, Mohamed</creatorcontrib><creatorcontrib>Juillard, Laurent</creatorcontrib><creatorcontrib>Kamar, Nassim</creatorcontrib><creatorcontrib>Keller, Adrien</creatorcontrib><creatorcontrib>Klein, Alexandre</creatorcontrib><creatorcontrib>Kuentz, François</creatorcontrib><creatorcontrib>Lacraz, Adeline</creatorcontrib><creatorcontrib>Lambrey, Guy</creatorcontrib><creatorcontrib>Landru, Isabelle</creatorcontrib><creatorcontrib>Lang, Philippe</creatorcontrib><creatorcontrib>Lebrun, Gaetan</creatorcontrib><creatorcontrib>Lobbedez, Thierry</creatorcontrib><creatorcontrib>Magnant, Eric</creatorcontrib><creatorcontrib>Mailliez, Sébastien</creatorcontrib><creatorcontrib>Maisonneuve, Nathalie</creatorcontrib><creatorcontrib>Martin, Séverine</creatorcontrib><creatorcontrib>Moulin, Bruno</creatorcontrib><creatorcontrib>Noel, Christian</creatorcontrib><creatorcontrib>Panescu, Viktor</creatorcontrib><creatorcontrib>Sekhri, Hacène</creatorcontrib><creatorcontrib>Smati, Mustafa</creatorcontrib><creatorcontrib>Testa, Angelo</creatorcontrib><creatorcontrib>Thervet, Eric</creatorcontrib><creatorcontrib>Urena, Pablo</creatorcontrib><creatorcontrib>Vela, Carlos</creatorcontrib><creatorcontrib>Zaoui, Philippe</creatorcontrib><title>Sex and the Risk of Atheromatous and Non-Atheromatous Cardiovascular Disease in CKD: Findings From the CKD-REIN Cohort Study</title><title>American journal of kidney diseases</title><description>Rationale & ObjectiveSex differences in cardiovascular disease (CVD) are well-established, but whether chronic kidney disease (CKD) modifies these risk differences, and whether they differ between atheromatous (ACVD) and non-atheromatous (N-ACVD) CVD is unknown. Assessing this interaction was the principal goal of this study.Study DesignProspective cohort study.Setting & ParticipantsAdults enrolled in the CKD-Renal Epidemiology and Information Network (CKD-REIN) cohort from from 2013 to 2020, a nationally representative sample of 40 nephrology clinics in France.ExposureSex.OutcomesFatal and non-fatal composite ACVD events (ischaemic coronary, cerebral, and peripheral artery disease) and composite N-ACVD events (heart failure, haemorrhagic stroke, and arrhythmias).Analytical ApproachMultivariable cause-specific Cox proportional hazards models.Results1,044 women and 1,976 men with moderate to severe CKD (median age, 67 vs. 69; mean estimated glomerular filtration rate [eGFR], 32±12 vs. 33±12 mL/min/1.73m2) were studied. Over a median follow-up of 5.0 (interquartile range, 4.8;5.2) years, the ACVD rate (per 100 patient-years) was significantly lower in women than men: 2.1 (95% confidence interval: 1.6-2.5) vs 3.6 (3.2-4.0) (P<0.01), while the N-ACVD rate was not: 5.7 (5.0-6.5) vs 6.4 (5.8-7.0) (P=0.55). N-ACVD had a steeper relationship with eGFR than did ACVD. There was an interaction (P<0.01) between sex and baseline eGFR and the ACVD hazard: the adjusted hazard ratio for women compared to men was 0.42 (0.25;0.71) at 45 mL/min/1.73m2 and gradually attenuated at lower levels of eGFR, reaching 1.00 (0.62;1.63) at 16 mL/min/1.73m2. In contrast, the N-ACVD hazard did not differ between the sexes across the eGFR range studied.LimitationsCardiovascular biomarkers and sex hormones were not assessed.ConclusionThis study shows how the lower risk of ACVD among women compared to men attenuates fully with kidney disease progression. The equal risk of N-ACVD between sexes across CKD stages and its steeper association with eGFR suggest an important contribution of CKD to the development of this CVD type.</description><subject>Cardiology and cardiovascular system</subject><subject>Human health and pathology</subject><subject>Life Sciences</subject><subject>Urology and Nephrology</subject><issn>0272-6386</issn><issn>1523-6838</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNqVjE9Lw0AUxBdRMFa_gKd39bBx_6Tb6K2kDZVKD6338HC3ZtN0V3aTYsEP31i8eBQGhvnNe0PIPWcpZ2P52KTY7HQqmMhSNojLC5LwsZBU5TK_JAkTE0GVzNU1uYmxYYw9SaUS8r0xX4BOQ1cbWNu4A7-F6RCC32Pn-3guV97RP7DAoK0_YHzvWwwws9FgNGAdFMvZM5TWaes-IpTDx3l6wHQ9f1lB4WsfOth0vT7ekqstttHc_fqIPJTzt2JBa2yrz2D3GI6VR1stpq_VD2OZEpOM5wcu_3N7Am5aWFs</recordid><startdate>202406</startdate><enddate>202406</enddate><creator>Faucon, Anne-Laure</creator><creator>Lambert, Oriane</creator><creator>Massy, 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Viktor</creatorcontrib><creatorcontrib>Sekhri, Hacène</creatorcontrib><creatorcontrib>Smati, Mustafa</creatorcontrib><creatorcontrib>Testa, Angelo</creatorcontrib><creatorcontrib>Thervet, Eric</creatorcontrib><creatorcontrib>Urena, Pablo</creatorcontrib><creatorcontrib>Vela, Carlos</creatorcontrib><creatorcontrib>Zaoui, Philippe</creatorcontrib><collection>Hyper Article en Ligne (HAL)</collection><jtitle>American journal of kidney diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Faucon, Anne-Laure</au><au>Lambert, Oriane</au><au>Massy, Ziad</au><au>Drüeke, Tilman</au><au>Combe, Christian</au><au>Fouque, Denis</au><au>Frimat, Luc</au><au>Jacquelinet, Christian</au><au>Laville, Maurice</au><au>Liabeuf, Sophie</au><au>Pecoits-Filho, Roberto</au><au>Hauguel-Moreau, Marie</au><au>Mansencal, Nicolas</au><au>de Pinho, Natalia Alencar</au><au>Stengel, Bénédicte</au><au>Azar, Raymond</au><au>Belenfant, Xavier</au><au>Besnier, Dominique</au><au>Bourdenx, Jean Philippe</au><au>Burtey, Stéphane</au><au>Chauveau, Dominique</au><au>Chazot, Charles</au><au>Choukroun, Gabriel</au><au>Combe, Christian</au><au>Delahousse, Michel</au><au>Deroure, Benjamin</au><au>Essig, Marie</au><au>Glowacki, François</au><au>Hannedouche, Thierry</au><au>Hoffmann, Maxime</au><au>Hourmant, Maryvonne</au><au>Jamali, Mohamed</au><au>Juillard, Laurent</au><au>Kamar, Nassim</au><au>Keller, Adrien</au><au>Klein, Alexandre</au><au>Kuentz, François</au><au>Lacraz, Adeline</au><au>Lambrey, Guy</au><au>Landru, Isabelle</au><au>Lang, Philippe</au><au>Lebrun, Gaetan</au><au>Lobbedez, Thierry</au><au>Magnant, Eric</au><au>Mailliez, Sébastien</au><au>Maisonneuve, Nathalie</au><au>Martin, Séverine</au><au>Moulin, Bruno</au><au>Noel, Christian</au><au>Panescu, Viktor</au><au>Sekhri, Hacène</au><au>Smati, Mustafa</au><au>Testa, Angelo</au><au>Thervet, Eric</au><au>Urena, Pablo</au><au>Vela, Carlos</au><au>Zaoui, Philippe</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sex and the Risk of Atheromatous and Non-Atheromatous Cardiovascular Disease in CKD: Findings From the CKD-REIN Cohort Study</atitle><jtitle>American journal of kidney diseases</jtitle><date>2024-06</date><risdate>2024</risdate><volume>84</volume><issue>5</issue><spage>546</spage><epage>556</epage><pages>546-556</pages><issn>0272-6386</issn><eissn>1523-6838</eissn><abstract>Rationale & ObjectiveSex differences in cardiovascular disease (CVD) are well-established, but whether chronic kidney disease (CKD) modifies these risk differences, and whether they differ between atheromatous (ACVD) and non-atheromatous (N-ACVD) CVD is unknown. Assessing this interaction was the principal goal of this study.Study DesignProspective cohort study.Setting & ParticipantsAdults enrolled in the CKD-Renal Epidemiology and Information Network (CKD-REIN) cohort from from 2013 to 2020, a nationally representative sample of 40 nephrology clinics in France.ExposureSex.OutcomesFatal and non-fatal composite ACVD events (ischaemic coronary, cerebral, and peripheral artery disease) and composite N-ACVD events (heart failure, haemorrhagic stroke, and arrhythmias).Analytical ApproachMultivariable cause-specific Cox proportional hazards models.Results1,044 women and 1,976 men with moderate to severe CKD (median age, 67 vs. 69; mean estimated glomerular filtration rate [eGFR], 32±12 vs. 33±12 mL/min/1.73m2) were studied. Over a median follow-up of 5.0 (interquartile range, 4.8;5.2) years, the ACVD rate (per 100 patient-years) was significantly lower in women than men: 2.1 (95% confidence interval: 1.6-2.5) vs 3.6 (3.2-4.0) (P<0.01), while the N-ACVD rate was not: 5.7 (5.0-6.5) vs 6.4 (5.8-7.0) (P=0.55). N-ACVD had a steeper relationship with eGFR than did ACVD. There was an interaction (P<0.01) between sex and baseline eGFR and the ACVD hazard: the adjusted hazard ratio for women compared to men was 0.42 (0.25;0.71) at 45 mL/min/1.73m2 and gradually attenuated at lower levels of eGFR, reaching 1.00 (0.62;1.63) at 16 mL/min/1.73m2. In contrast, the N-ACVD hazard did not differ between the sexes across the eGFR range studied.LimitationsCardiovascular biomarkers and sex hormones were not assessed.ConclusionThis study shows how the lower risk of ACVD among women compared to men attenuates fully with kidney disease progression. The equal risk of N-ACVD between sexes across CKD stages and its steeper association with eGFR suggest an important contribution of CKD to the development of this CVD type.</abstract><pub>Elsevier</pub><doi>10.1053/j.ajkd.2024.04.013</doi><orcidid>https://orcid.org/0000-0003-0772-5656</orcidid><orcidid>https://orcid.org/0000-0002-9707-7199</orcidid><orcidid>https://orcid.org/0000-0001-5384-9006</orcidid><orcidid>https://orcid.org/0000-0002-0438-6487</orcidid><orcidid>https://orcid.org/0000-0003-0772-5656</orcidid><orcidid>https://orcid.org/0000-0001-5384-9006</orcidid><orcidid>https://orcid.org/0000-0002-0438-6487</orcidid><orcidid>https://orcid.org/0000-0002-9707-7199</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0272-6386 |
| ispartof | American journal of kidney diseases, 2024-06, Vol.84 (5), p.546-556 |
| issn | 0272-6386 1523-6838 |
| language | eng |
| recordid | cdi_hal_primary_oai_HAL_hal_04627418v1 |
| source | Elsevier ScienceDirect Journals Complete |
| subjects | Cardiology and cardiovascular system Human health and pathology Life Sciences Urology and Nephrology |
| title | Sex and the Risk of Atheromatous and Non-Atheromatous Cardiovascular Disease in CKD: Findings From the CKD-REIN Cohort Study |
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