JACC. Advances · 2025
Sex Differences in Clinical Characteristics, Treatment, and Outcomes of Cardiovascular Disease: Kenya Heart Registry Analysis.
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Mbau Lilian, Gulati Martha, Ngunga Mzee, Shah Jasmit, Gitura Bernard, Barasa Felix, Jeilan Mohamed, Barasa Anders, Otieno Harun, Amendezo Etienne
Аннотация
BACKGROUND: Cardiovascular disease is the leading cause of death globally, with approximately 80% of these deaths occurring in low- and middle-income countries. Sex differences in cardiovascular disease are well described in high-income countries but limited in low- and middle-income countries.
OBJECTIVES: This study sought to evaluate the sex differences in clinical presentation, cardiovascular risk profile, diagnosis, treatment, and outcomes among patients in the Kenya Heart Registry.
METHODS: Data were prospectively collected from 3 tertiary hospitals, including patients with heart failure, acute coronary syndrome, venous thromboembolism, and atrial fibrillation. Primary outcomes were in-hospital and 6-month mortality, as well as sex-specific differences in clinical presentation, cardiovascular risk factors, diagnosis, and treatment.
RESULTS: Among 1,687 participants, 51.3% were women. Of these, 1,241 were admitted, while 446 were managed as outpatients. Women were younger (50.9 vs 54.2 years; P < 0.001), had lower monthly income, higher left ventricular ejection fraction, higher rates of heart failure with preserved ejection fraction, venous thromboembolism, and atrial fibrillation, and lower rates of acute coronary syndrome than men. No sex difference was observed in diagnostics or treatment or adherence to guideline-directed therapies. In-hospital and 6-month all-cause mortality were 7.4% and 14.7%, respectively, and were similar by sex (women 8.0% and 14.8% vs men 6.9% and 14.5%; P = 0.449 and P = 0.881, respectively).
CONCLUSIONS: Significant sex differences exist in clinical profiles, but management and outcomes are similar. Scaling up evidence-based interventions is urgently needed to reduce the high mortality in this population.
OBJECTIVES: This study sought to evaluate the sex differences in clinical presentation, cardiovascular risk profile, diagnosis, treatment, and outcomes among patients in the Kenya Heart Registry.
METHODS: Data were prospectively collected from 3 tertiary hospitals, including patients with heart failure, acute coronary syndrome, venous thromboembolism, and atrial fibrillation. Primary outcomes were in-hospital and 6-month mortality, as well as sex-specific differences in clinical presentation, cardiovascular risk factors, diagnosis, and treatment.
RESULTS: Among 1,687 participants, 51.3% were women. Of these, 1,241 were admitted, while 446 were managed as outpatients. Women were younger (50.9 vs 54.2 years; P < 0.001), had lower monthly income, higher left ventricular ejection fraction, higher rates of heart failure with preserved ejection fraction, venous thromboembolism, and atrial fibrillation, and lower rates of acute coronary syndrome than men. No sex difference was observed in diagnostics or treatment or adherence to guideline-directed therapies. In-hospital and 6-month all-cause mortality were 7.4% and 14.7%, respectively, and were similar by sex (women 8.0% and 14.8% vs men 6.9% and 14.5%; P = 0.449 and P = 0.881, respectively).
CONCLUSIONS: Significant sex differences exist in clinical profiles, but management and outcomes are similar. Scaling up evidence-based interventions is urgently needed to reduce the high mortality in this population.