Sex‐Based Differences in Cardiovascular Outcomes Associated With COVID‐19: A Systematic Review and Meta‐Analysis

ABSTRACT COVID‐19 has emerged as a global health crisis with significant consequences, not only for respiratory health but also for the cardiovascular system. This study aimed to investigate potential sex‐based disparities in cardiovascular outcomes among individuals diagnosed with COVID‐19 A systematic search was performed in PUBMED/MEDLINE, SCOPUS, and EMBASE, up until January 2024 to identify studies measuring the sex‐based differences in cardiovascular outcomes associated with COVID‐19. The outcomes of interest included (myocardial infarction, venous thromboembolism, ischemic stroke, major bleeding, mortality, heart failure and hospitalization length). The meta‐analysis was performed using the ‘Stata’ software, version 18. We identified 11 studies involving 31,044 males and 25,917 females in our review. A slightly lower risk of myocardial infarction in females (RR: 1.24; 95% CI [1.03, 1.49]; p = 0.02) contrasted with a substantially increased risk of venous thromboembolic events (RR: 1.43; 95% CI [1.19, 1.71]; p = 0.00) in males. Additionally, males displayed a slightly higher risk of major bleeding (RR: 1.22; 95% CI [1.06, 1.40]; p = 0.00). This trend continued with significantly higher rates of extracorporeal membrane oxygenation (ECMO) utilization (RR: 2.14; 95% CI [1.11, 4.13]; p = 0.02) in males. Moreover, stroke outcomes and overall mortality were demonstrably worse for males (RR: 1.46; p = 0.05 and RR: 1.21; p = 0.00, respectively). Males with COVID‐19 face higher risks of myocardial infarction, venous thromboembolism, ischemic stroke, major bleeding, and mortality. Heart failure and hospitalization length show no gender disparity. These findings highlight the crucial role of gender in COVID‐19's cardiovascular complications.