Sex differences in vascular dysfunction and cardiovascular outcomes: The cardiac, endothelial function, and arterial stiffness in ESRD (CERES) study
Abstract
INTRODUCTION: Recent studies suggest that women with end-stage renal disease (ESRD) may have higher rates of mortality than men, but it is unknown whether sex differences in vascular function explain this disparity. The cardiac, endothelial function, and arterial stiffness in ESRD (CERES) study is an ongoing, prospective observational study designed to investigate vascular function, myocardial injury, and cardiovascular outcomes in ESRD. METHODS: Among 200 CERES participants (34% women), we evaluated arterial wave reflections as augmentation index normalized to a heart rate of 75 (AIx75), arterial stiffness as pulse wave velocity, and macro- and microvascular endothelial dysfunction as flow-mediated dilation and velocity time integral (VTI). Over a median of 14 months, participants were followed for the composite outcome of cardiovascular hospitalization or all-cause death. FINDINGS: Women had higher arterial wave reflection (Mean, SD AIx75 30% ± 9% for women vs. 21% ± 10% for men; P < 0.001) and worse microvascular function (VTI 55 ± 30 cm for women vs. 70 ± 27 cm for men; P = 0.007). After multivariable adjustment, female sex remained associated with a 0.5-SD higher AIx75 (95% CI [0.01, 0.9]) and 0.3-SD lower VTI (95%CI [0.1, 0.7]). Women experienced higher adjusted rates of the composite outcome (HR 2.5; 95%CI [1.1, 5.6]; P = 0.03), and further adjustment for arterial wave reflection attenuated this risk. DISCUSSION: Vascular dysfunction may partly explain the association of female sex with higher cardiovascular risk and mortality in patients with ESRD. Further studies are needed to explore whether sex differences in vascular function predict long-term outcomes, and whether hormonal or inflammatory factors explain these associations.
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Pulse wave propagation delay between the genders indicates baseline differences in arterial stiffness with women displaying lower degrees of pulse arrival latency delay indicating higher vascular stiffness.
“Pulse wave propagation delay between the genders indicates baseline differences in arterial stiffness with women displaying lower degrees of pulse arrival latency delay indicating higher vascular stiffness [106,107].”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [107]
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Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring
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- Authors
- Guajardo, I., Ayer, A., Johnson, A. D., Ganz, P., Mills, C., Donovan, C., Scherzer, R., Shah, S. J., Peralta, C. A., & Dubin, R. F.
- Affiliations
- San Francisco VA Medical Center (US)
- San Francisco General Hospital (US)
- Division of Cardiology, Center for Vascular Excellence San Francisco General Hospital, University of California San Francisco California USA
- Northwestern University (US)
- Corresponding author
- Dubin, Ruth F.
- Venue
- Hemodialysis International
- Publisher
- Wiley
- Published
- 2017-03-08
- Volume
- 22
- Issue
- 1
- Pages
- 93-102
- ISSN
- 1492-7535 (ISSN-L)
- 1542-4758
- OpenAlex
- W2594185735
- Cited by
- 21
- References
- 25
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 5 · 2020: 1 · 2019: 1 · 2018: 1 · 2017: 1
- FWCI
- 0.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hemodialysis International (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (K23 DK092354, R03 DK104013)
- University of California, San Francisco
- National Center for Advancing Translational Sciences (UL1 TR000004)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal and Vascular Pathologies
- Keywords
- sex differences, end-stage renal disease, vascular dysfunction, arterial stiffness, arterial wave reflection, endothelial dysfunction, microvascular function, cardiovascular outcomes, cardiovascular mortality, cardiovascular hospitalization, women
- MeSH terms
- Cardiovascular Diseases, Endothelium, Vascular, Female, Humans, Kidney Failure, Chronic, Male, Middle Aged, Vascular Stiffness
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