Sex differences in cardiovascular-kidney-metabolic syndrome: the FINE-HEART pooled analysis.

In 30 seconds

This prespecified pooled analysis combined participant-level data from three trials involving people with chronic kidney disease and type 2 diabetes or heart failure with mildly reduced or preserved ejection fraction. Among 18 991 participants, 6664 (35%) were women. Over a median follow-up of 2.9 years, women and men had similar adjusted risk of heart failure hospitalization or cardiovascular death (adjusted HR 0.97, 95% CI 0.89-1.06), while women had lower all-cause mortality (adjusted HR 0.83, 95% CI 0.76-0.91). Finerenone’s effects on cardiovascular, kidney, and mortality outcomes did not differ by sex.

Key findings

• Women were more likely than men to have Stage 4 CKM syndrome but less likely to receive several commonly indicated CKM therapies at baseline.
• Heart failure hospitalization or cardiovascular death rates were 4.8 vs 3.9 per 100 patient-years in women and men, respectively; adjusted HR 0.97, 95% CI 0.89-1.06.
• Women had lower adjusted all-cause mortality than men (adjusted HR 0.83, 95% CI 0.76-0.91; P < .001).
• There was no evidence that finerenone’s effects on cardiovascular, kidney, or mortality outcomes differed by sex (all Pinteraction >.05).

Why it matters

The findings highlight a mismatch between women’s greater likelihood of advanced CKM syndrome and their lower baseline use of commonly indicated therapies. Similar cardiovascular event risk and consistent finerenone effects across sexes support attention to equitable assessment and treatment, while the lower observed all-cause mortality in women provides important context for sex-specific risk comparisons.

What to keep in mind

The analysis pooled participants from trials of selected CKM-related populations, so findings may not generalize to all people with CKM syndrome.