Abstract
INTRODUCTION: The risk of cardiovascular disease increases in patients with acute pancreatitis (AP). However, it remains unknown whether this increase varies between sexes.
OBJECTIVES: Our aim was to assess sex differences in cardiovascular outcomes in AP patients during long-term follow-up.
PATIENTS AND METHODS: The participants were recruited from the United Kingdom Biobank, which is a population-based cohort study consisting of 502 368 individuals aged 40-69 years old. Cardiovascular outcomes were defined as major cardiovascular and cerebrovascular adverse events (MACCEs), encompassing all-cause death, myocardial infarction, and stroke. We compared sex difference in MACCE incidence using incidence rate per 1000 person-years. The association between sex and MACCE risk was assessed using the Cox proportional hazards models and win ratio method, adjusted for demographic, lifestyle, metabolic factors, and medication use.
RESULTS: A total of 1371 participants with AP were included, 42.5% were men. Over the median (interquartile range) follow-up of 13.9 (13-14.7) years, 226 MACCEs occurred. The incidence rate of MACCE was 16.44 for men and 9.8 for women. The multivariate Cox regression analysis indicated a higher risk of MACCEs in men than in women (hazard ratio [HR], 1.8; 95% CI, 1.36-2.38). Adjusted HR for all-cause mortality, myocardial infarction, and stroke were 1.49, 2.75, and 1.67, respectively. The adjusted win ratio by inverse probability of treatment weighting was 0.55 (P <0.001), suggesting a worse outcome in men.
CONCLUSIONS: Men experienced more adverse cardiovascular outcomes than women in long follow-up after AP, suggesting a need for sex-specific management strategies in AP patients.