Female Patients Hospitalized With COVID-19 Are Less Likely to Have Cardiovascular Complications

Patients of the female sex who are hospitalized with COVID-19 are less likely to have cardiovascular (CV) complications than male patients, according to a recent study published in the journal BMJ Medicine. Females were also found to be 35% less likely than males to die in the hospital.

“Sex differences exist in the risk of admission to hospital and death from COVID-19, with female individuals reportedly having better outcomes, on average, than male individuals,” the study authors wrote in the article. “We [also] found clear sex differences in the risk of cardiovascular disease (CVD) associated with COVID-19.”

The most prevalent COVID-19 complications include arrhythmia, heart failure, and thromboembolic events, despite the illness being respiratory. Previous studies suggest that patients with CVD have a greater risk of severe COVID-19 or death after contracting the virus, and other reports suggest that female patients have a lower risk of hospitalization or death from COVID-19.

However, few studies have evaluated the link between the interaction between sex and CVD on the risk of severe COVID-19. Further, few studies have examined the risk of CV complications from COVID-19 because of sex, according to the current study. The investigators conducted the current study to evaluate the risk of CV complications from COVID-19 between the sexes, and whether risks based on sex were associated with pre-existing CVD.

Data were collected on 11,167 adults who were hospitalized due to COVID-19 illness between March 2020 and May 2021. Patients were taken from the Cardiac complicAtions in Patients With SARS Corona vIrus 2 regisTrY (CAPACITY-COVID). Among the patients evaluated, 3423 had pre-existing CVD.

The primary outcome was any CV complication during hospitalization, and secondary outcomes were defined as in-hospital mortality or CV complication subtypes.

After investigators performed a subgroup analysis of age, ethnicity, pre-existing CVD, and CVD risk factors, they found that females were less likely to have a CV complication or die from COVID-19. Additionally, female patients admitted to the hospital with COVID-19 were independently associated with a reduced risk of complications including arrhythmia, cardiac ischemia, pulmonary embolism, or death.

Females had a 29% lower risk of developing a CV complication, although they shared a similar complication profile to males. And despite a female’s reduced CV risk, it cannot be attributed to a lower prevalence of pre-existing CVD.

“The persistence of the female advantage in those with pre-existing cardiovascular disease suggests that the pathophysiological mechanisms of COVID-19 itself might differentially affect the sexes,” the study authors wrote.

The study includes limitations, the first of which being that the population was limited to patients hospitalized with COVID-19. The findings are also generalized to older patients. Additionally, the COVID-19 landscape is constantly changing—at 1 part of the study period, a vaccine was not available.

“Further research is needed to better understand the male disadvantage in COVID-19, specifically whether the pathophysiological mechanisms of COVID-19 itself affect female and male individuals differentially,” the study authors wrote in the report.

Reference

Hockham C, Linschoten M, Asselbergs F, et al. Sex differences in cardiovascular complications and mortality in hospital patients with covid-19: registry based observational study. BMJ Medicine. 2023. doi: 10.1136/bmjmed-2022-000245