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Abstract: TH-PO609

Sex Hormone and Risk of Cardiovascular Disease and Mortality in Men and Women With CKD: A Systematic Review and Meta-Analysis

Session Information

Category: Hypertension and CVD

  • 1501 Hypertension and CVD: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Oh, Ester, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, United States
  • Steele, Cortney, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, United States
  • You, Zhiying, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, United States
  • Nowak, Kristen L., University of Colorado - Anschutz Medical Campus, Aurora, Colorado, United States
  • Jovanovich, Anna, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, United States
Background

Patients with chronic kidney disease (CKD) commonly experience sex hormone disturbances, which may be associated with risk of cardiovascular disease (CVD) and mortality. A few studies examined the association of sex hormone levels with the risk of cardiovascular outcomes and mortality in a CKD population; however, no studies to date have systematically evaluated current evidence on the association of sex hormone levels with the risk of CVD events and CVD and all-cause death in male and female patients.

Methods

Articles were systematically searched in CINAHL, Cochrane, and PubMed from February 1955 through October 2021. A total of 1,698 articles were independently screened by two reviewers, and 17 prospective cohort studies were included. The sex hormones studied were testosterone, estradiol, prolactin, dehydroepiandrosterone sulfate, and relaxin. A random-effects model was used to generate a pooled hazard ratio (HR) to evaluate the association of testosterone levels with the risk of CVD and all-cause death.

Results

The sample size ranged from 111-2,419 and the mean age of subjects ranged from 52-72 years. The clinical conditions of the patients included those with non-dialysis CKD (mean/median eGFR between 15–51 mL/min/1.73 m2) and dialysis CKD (mean/median vintage between 6–125 months). The majority of the studies examined testosterone levels (11 out of 17 studies) and studied only male patients (12 out of 17 studies). A lower testosterone level was associated with a higher risk of CVD death [HR 4.37 (1.40-13.65), P=0.01] (Fig. 1A) and all-cause death [HR 1.96 (1.35-2.83), P=0.0004] (Fig. 1B) in men with CKD.

Conclusion

A lower testosterone level was associated with a higher risk of CVD and all-cause death. There is a strong need for additional studies examining the association of female sex hormones with the cardiovascular and mortality risk.

HR for CVD death (A) and all-cause death (B) comparing highest vs. lowest tertile of testosterone level in men with CKD

Funding

  • NIDDK Support