The effect of the gender on the risk of long-covid and cardiovascular complications in healthy patients without comorbidities- data from the polish long-COVID cardiovascular (PoLoCOV-CVD) study
Authors: Bielecka-Dabrowa A , Sakowicz A , Kapusta J , Banach M , Jankowski P , Chudzik M 
Published: November 2023

Abstract

Background
The long-Covid (LC) is now a great challenge for the healthcare systems worldwide. There are still inconsistent data on gender as an independent risk factor of LC complications.

PURPOSE
We aimed to assess the age-independent differences between males and females without comorbidities on the risk of long Covid (LC) and LC cardiovascular complications.

Methods
Patient’s information, course of the disease, post-COVID-19 symptoms were collected in men and women at least 12 weeks and one year after the COVID-19 recovery. ECG, 24-hour ECG monitoring; 24-hour ambulatory blood pressure monitoring (ABPM), echocardiography, and selected biochemical tests were performed. LC was diagnosed based on the World Health Organization (WHO) definition. To reduce the impact of confounders i.e. body mass index (BMI) and age on the results of study, the Nearest Neighbour (NN) propensity score matching (PSM) method was used.

Results
Out of 2192 women and 1237 men after COVID-19 we identified 783 women (mean age 45) and 455 men (mean age 44). After elimination of patients with comorbidities and matching the PSM analyses reduced the total number of cases into 733 cases (i.e. 395 women and 378 men). The further analyses showed that males required more often the hospitalisation due to of pneumonia (12.5 vs 5.5%; p=0.0003) during the acute phase of COVID-19 compared to females, however there was no difference regarding the Intensive Care Unit (ICU) stay. Both after 3 months and after a one year women reported more long-COVID symptoms than men (4 vs 3, p&lt;0.0001 and 2 vs 0, p=0.004; respectively). After one year follow-up women suffered from long-COVID more often than men (63 vs 59% p=0.0001). The symptoms that significantly differed women and were fatigue (32 in women vs 24 % in men; p=0.007) and hair lost (6,5 vs 0,26%; p&lt;0.0001). Females during LC had lower mean arterial pressure (MAP) [ 88 (82-94) mmHg versus (vs) 94 (89-99); p&lt;0.0001] and lower pulse pressure (PP) [46 (41-520 mmHg vs 51(47-56); p&lt;0.0001] in 24 -hours ABPM compared to males one year after COVID-19 (Figure 1). Men had more often one of the ECG abnormalities: HR &gt;100/min, QRS &gt;=120ms, ST-T changes, T inversion, arrhythmia, QRS fragmentation [29 vs 22%; p=0.02] (Figure 1). There were no significant differences in myocardial damage assessed in late gadolinium enhancement cardiac magnetic resonance (CMR) between sex. There were no differences regarding sport activity, the level of stress and fatigue as well as alcohol drinking and smoking between men and women at the same age and BMI. One year after COVID-19, 82% of women and 78% of men reported having completed a course of vaccination against COVID-19 (p&gt;0.05).

Conclusion
One-year after Covid-19 recovery women without comorbidities more often suffered from long-COVID than men regardless of the age. Females after COVID-19 had lower mean arterial pressure and pulse pressure in 24 -hours ABPM and less ECG abnormalities than males.