scholarly journals Sex Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors, and Mortality in Community Cohorts

Circulation ◽  
2017 ◽  
pp. 1 ◽  
Author(s):  
Christina Magnussen ◽  
Teemu J. Niiranen ◽  
Francisco M. Ojeda ◽  
Francesco Gianfagna ◽  
Stefan Blankenberg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Sex Differences

Abstract W P121: Stroke Severity in Men and Women: What Proportion of the Disparity Can Be Explained by Differences in Cardiovascular Risk Factors?

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Karen C Albright ◽  
Amelia K Boehme ◽  
Bisakha Sen ◽  
Monica Aswani ◽  
Michael T Mullen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Cardiovascular Risk ◽  
Black Women ◽  
Cardiovascular Risk Factors ◽  
Stroke Severity ◽  
Stroke Subtype ◽  
Oaxaca Decomposition ◽  
Nihss Score

Background: Prior studies have shown that women present with more severe stroke. It has been suggested that sex differences in stroke severity are related to age, stroke subtype, or cardiovascular risk factors. We aimed to determine the proportion of sex disparity in stroke severity that can be explained by differences in these variables using Oaxaca decomposition, an econometric technique which quantifies the differences between groups. Methods: White and Black ischemic stroke patients who presented to two academic medical centers in the US (2004-2011) were identified using prospective stroke registries. In-hospital strokes were excluded. Patient demographics and medical history were collected. Stroke severity was measured by NIHSS. Linear regression was used to determine if female sex was associated with NIHSS score. This model was then adjusted for potential confounders including: age, race, stroke subtype, and cardiovascular risk factors. Oaxaca decomposition was then used to determine the proportion of the observed sex differences in stroke severity that can be explained by these variables. Results: 4925 patients met inclusion criteria. Nearly half (n=2346) were women and 39% (n=1942) were Black. Women presented with more severe strokes (median NIHSS 8 vs. 6). In addition, women were older on average (68 vs. 63 years) with more frequent atrial fibrillation (18% vs. 13%), diabetes (34% vs. 30%), and hypertension (78% vs. 72%). Oaxaca decomposition revealed that age, race, atrial fibrillation, large vessel etiology, diabetes, hypertension account for only 63% of the sex differences seen in NIHSS score on presentation. Conclusion: In our biracial sample, women presented with more severe strokes than men. This difference remained significant even after adjustment for age, stroke subtype, and cardiovascular risk factors. Further, over 1/3 of the observed gender difference in stroke severity was unexplained.. Additional study is warranted to investigate the etiology of the gender differences in stroke severity.

Atrial Fibrillation Manifestations Risk Factors and Sex Differences in a Population-Based Cohort (From the Gutenberg Health Study)

2018 ◽  
Vol 122 (1) ◽  
pp. 76-82 ◽  
Author(s):  
Christina Magnussen ◽  
Francisco M. Ojeda ◽  
Philipp S. Wild ◽  
Nils Sörensen ◽  
Thomas Rostock ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Population Based ◽  
Health Study ◽  
Gutenberg Health Study

scholarly journals Established and novel risk factors for atrial fibrillation in women compared with men

Heart ◽  
2018 ◽  
Vol 105 (3) ◽  
pp. 226-234 ◽  
Author(s):  
Sanne A E Peters ◽  
Mark Woodward
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Uric Acid ◽  
Risk Factor ◽  
Cystatin C ◽  
Cox Regression ◽  
Personal Characteristics ◽  
Physical Measurements ◽  
Novel Risk Factors

BackgroundAtrial fibrillation (AF) is a stronger risk factor for cardiovascular disease in women than men. We assessed whether there are sex differences in the effects of 43 established and novel risk factors and the risk of incident AF.MethodsData were used from the Scottish Heart Health Extended Cohort, a prospective cohort study with over 20 years of follow-up for AF incidence. Cox regression models were used to obtain the adjusted sex-specific HRs and 95% CIs, and the women-to-men ratio of HRs (RHRs), of incident AF associated with personal characteristics, smoking, physical measurements, diabetes mellitus, lipid, inflammatory, cardiac, and diet- and renal-related markers.ResultsOverall, 15 737 participants (52% women) were included. There were sex differences in the relationship between a 1 SD increase in body mass index (BMI), NT-pro-BNP, uric acid, and cystatin-C and the risk of AF. The HRs were 1.17 (95% CI 1.08 to 1.27) in women and 1.36 (95% CI 1.24 to 1.49) in men for BMI (RHR 0.86, 95% CI 0.77 to 0.97); 1.84 (95% CI 1.62 to 2.09) in women and 1.54 (95% CI 1.40 to 1.68) in men for NT-pro-BNP (RHR 1.22, 95% CI1.05 to 1.42); 1.27 (95% CI 1.14 to 1.41) in women and 1.10 (95% CI 1.00 to 1.20) in men for uric acid (RHR 1.17, 95% CI 1.01 to 1.35); and 1.22 (95% CI 1.13 to 1.32) in women and 1.07 (95% CI 0.96 to 1.18) in men for cystatin-C (RHR 1.16, 95% CI 1.05 to1.27).ConclusionHigher BMI is a stronger risk factor for AF in men whereas elevated NT-pro-BNP, uric acid and cystatin-C were more strongly associated with the risk of AF in women.

Sex Differences in Risk Factors for Incident Atrial Fibrillation (from the Reasons for Geographic and Racial Differences in Stroke [REGARDS] Study)

2019 ◽  
Vol 123 (9) ◽  
pp. 1453-1457 ◽  
Author(s):  
Abhishek Bose ◽  
Wesley T. O'Neal ◽  
Chengyi Wu ◽  
Leslie A. McClure ◽  
Suzanne E. Judd ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Racial Differences ◽  
Regards Study

scholarly journals Sex differences in the predictors of recurrent atrial fibrillation after catheter ablation: insights from the Kansai Plus Atrial Fibrillation (KPAF) registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Tanaka ◽  
K Inoue ◽  
A Kobori ◽  
K Kazutai ◽  
T Morimoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Catheter Ablation ◽  
Large Scale ◽  
Funding Source ◽  
Recurrent Atrial Fibrillation ◽  
History Of ◽  
The Impact ◽  
Af Recurrence

Abstract Background The impact of sex differences on the clinical outcomes of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) is controversial. We previously reported that females experienced more frequent AF recurrences than males after the index and last RFCA procedures. Purpose To identify the risk factors associated with recurrent AF in females and males after RFCA of AF. Methods We conducted a large-scale, prospective, multicenter, observational study (Kansai Plus Atrial Fibrillation Registry). We enrolled 5010 consecutive patients who underwent an initial RFCA of AF at 26 centers (64±10 years; 1369 [27.3%] females; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years. Results The incidence of AF recurrences after a single procedure was 43.3% in females and 39.0% in males. After a multivariate adjustment at baseline, the significant predictors of AF recurrence in females after the index RFCA were non-paroxysmal AF (hazard ration [HR],1.59; 95% confidence interval [CI],1.31–1.93, p<0.0001), a history of AF ≥2 years (HR,1.47; 95% CI,1.24–1.74, p<0.0001), coronary artery disease (HR,1.43; 95% CI,1.03–1.98, p=0.0035), and an estimated glomerular filtration rate (eGFR)<60 mL/min/1.73m2 (HR,1.46; 95% CI,1.10–1.95, p=0.0086). On the other hand, significant predictors of AF recurrence in males after the index RFCA were non-paroxysmal AF (HR,1.54; 95% CI,1.37–1.73, p<0.0001), a history of AF ≥2 years (HR,1.40; 95% CI,1.26–1.56, p<0.0001), the number of antiarrhythmic drugs (HR,1.06; 95% CI,1.003–1.13, p=0.040), a left atrial diameter≥40mm (HR,1.13; 95% CI,1.007–1.27, p=0.038), and dilated cardiomyopathy (HR,1.55; 95% CI,1.07–2.26, p=0.021), however, an eGFR<60 mL/min/1.73m2 was not associated with AF recurrence in males (HR, 1.00; 95% CI, 0.88–1.13, p=0.97). Conclusion The Kansai Plus Atrial Fibrillation Registry revealed a distinct sex difference in terms of the predictors of recurrent AF after RFCA. Non-Paroxysmal AF and a long history of AF were common risk factors both in females and males. However, renal dysfunction was a significant predictor of AF recurrence in females, while it was not a risk of recurrence in males. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Research Institute for Production Development in Kyoto, Japan.

scholarly journals P110: A prospective cohort study to evaluate sex differences in presentations and management for patients presenting to emergency departments with atrial fibrillation and flutter

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S95-S96
Author(s):  
B. H. Rowe ◽  
S. Patrick ◽  
P. Duke ◽  
K. Lobay ◽  
M. Haager ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Emergency Departments ◽  
Oral Anticoagulants ◽  
Chi Square ◽  
University Of Alberta ◽  
Before And After ◽  
History Of ◽  
Atrial Fibrillation And Flutter

Introduction: Atrial fibrillation and flutter (AFF) represent the most common arrhythmia presentations to emergency departments (EDs). Some research suggests that women with AFF experience different symptoms, receive different treatment and have worse outcomes than men. This study explored sex differences in risk factors, medication, and outcomes before and after ED visits for acute AFF. Methods: Adult patients presenting to the one of three hospitals affiliated with the University of Alberta with acute AFF were enrolled. Following informed consent, each patient completed a survey administered by a trained researcher, administrative ED information (e.g., ED times) was collected from the ED information system, a chart review on treatments was conducted and patients were contacted for follow-up at 7 days via telephone. Descriptive (median and interquartile range {IQR} and proportions) and simple (Wilcoxon-Mann-Whitney, chi-square, z-proportion) statistics are presented for continuous and dichotomous outcomes. Results: Overall, 217 patients were enrolled; the median age was 64 years (IQR: 55, 73) and 39% were female. Males presenting to the ED with AFF were 10 years younger than females (p<0.001); however, females weighed significantly less (median weight 69 vs. 95 kg; p<0.001), consumed less alcohol (12 vs 60 drinks/year; p<0.001) and were less likely to be ex-smokers (p=0.022) than men with AFF. Women arrived by Emergency Medical Services (EMS) (p=0.037), experienced palpitations (p=0.042), and reported a history of hypertension (p=0.022) more frequently than men. Females were more often prescribed oral anticoagulants before (p= 0.041) and after (p=0.011) the ED visit, and females with a history of AFF were less likely to present without anticoagulant/antiplatelet therapy (p=0.015). Overall, both sexes had similar attempts at cardioversion (59.4% vs. 61.3%) and hospitalizations (12.5% vs. 8.6%), respectively. If initial chemical cardioversion failed, females were more likely to receive subsequent electrical cardioversion (60.0% vs. 26.7%, p=0.036) than men. Conclusion: Overall, both women and men present frequently to the ED with AFF. Compared to men with AFF, women present with symptoms 10 years later, have different risk factors, experience more severe symptoms and use EMS more commonly; however, outcomes were similar. Unexplained sex-based variations in-ED and post-ED management are evident and these differences warrant further scrutiny.

scholarly journals Sex-related differences in risk factors, outcome, and quality of life in patients with permanent atrial fibrillation: results from the RACE II study

EP Europace ◽  
2019 ◽  
Vol 22 (11) ◽  
pp. 1619-1627 ◽  
Author(s):  
Mariëlle Kloosterman ◽  
Harry J G M Crijns ◽  
Bart A Mulder ◽  
Hessel F Groenveld ◽  
Dirk J Van Veldhuisen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Rate Control ◽  
Cardiovascular Events ◽  
Event Rate ◽  
Permanent Atrial Fibrillation

Abstract Aims Atrial fibrillation (AF) risk factors translate into disease progression. Whether this affects women and men differently is unclear. We aimed to investigate sex differences in risk factors, outcome, and quality of life (QoL) in permanent AF patients. Methods and results The Rate Control Efficacy in Permanent Atrial Fibrillation (RACE II) randomized 614 patients, 211 women and 403 men, to lenient or strict rate control. In this post hoc analysis risk factors, cardiovascular events during 3-year follow-up (cardiovascular death, heart failure hospitalization, stroke, systemic embolism, bleeding, and life-threatening arrhythmic events), outcome parameters, and QoL were compared between the sexes. Women were older (71 ± 7 vs. 66 ± 8 years, P &lt; 0.001), had more hypertension (70 vs. 57%, P = 0.002), and heart failure with preserved ejection fraction (36 vs. 17%, P &lt; 0.001), but less coronary artery disease (13 vs. 21%, P = 0.02). Women had more risk factors (3.7 ± 1.2 vs. 2.9 ± 1.4, P &lt; 0.001) Cardiovascular events occurred in 46 (22%) women and 59 (15%) men (P = 0.03). Women had a 1.52 times [95% confidence interval (CI) 1.03–2.24] higher yearly cardiovascular event-rate [8.2% (6.0–10.9) vs. 5.4% (4.1–6.9), P = 0.03], but this was no longer significant after adjusting for the number of underlying risk factors. Women had reduced QoL, irrespective of age and heart rate but negatively influenced by their risk factors. Conclusion In this permanent AF population, women had more accumulation of AF risk factors than men. The observed higher cardiovascular event rate in women was no longer significant after adjusting for the number of risk factors. Further, QoL was negatively influenced by the higher number of risk factors in women. This suggests that sex differences may be driven by the greater risk factor burden in women.

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