scholarly journals Response by Overvad et al to Letter Regarding Article, “Female Sex Is a Risk Modifier Rather Than a Risk Factor for Stroke in Atrial Fibrillation: Should We Use a CHA 2 DS 2 -VA Score Rather Than CHA 2 DS 2 -VASc?”

Circulation ◽  
2018 ◽  
Vol 138 (4) ◽  
pp. 443-444
Author(s):  
Thure Filskov Overvad ◽  
Torben Bjerregaard Larsen ◽  
Peter Brønnum Nielsen
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Female Sex ◽  
Risk Modifier

scholarly journals Female Sex Is a Risk Modifier Rather Than a Risk Factor for Stroke in Atrial Fibrillation

Circulation ◽  
2018 ◽  
Vol 137 (8) ◽  
pp. 832-840 ◽  
Author(s):  
Peter Brønnum Nielsen ◽  
Flemming Skjøth ◽  
Thure Filskov Overvad ◽  
Torben Bjerregaard Larsen ◽  
Gregory Y. H. Lip
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Female Sex ◽  
Risk Modifier

scholarly journals Female Sex as a Thromboembolic Risk Factor in the Era of Nonvitamin K Antagonist Oral Anticoagulants

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Mariacarla Gallù ◽  
Giulia Marrone ◽  
Jacopo Maria Legramante ◽  
Antonino De Lorenzo ◽  
Nicola Di Daniele ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Stroke Risk ◽  
Current Knowledge ◽  
Oral Anticoagulants ◽  
Optimal Time ◽  
Complete Evaluation ◽  
Thromboembolic Risk ◽  
Female Patients ◽  
Female Sex

Sex-specific differences have been definitively demonstrated in cardiovascular (CV) diseases. These differences can also impact on the effects of CV therapies. Female sex is recognized as an independent predictor of thromboembolic risk, particularly in older patients. Most of strokes are due to atrial fibrillation (AF). Women affected by AF have higher stroke risk compared to men. The introduction of novel oral anticoagulants (NOACs) for long-term anticoagulation completely changed the anticoagulant therapeutic approach and follow-up of patients affected by nonvalvular atrial fibrillation (NVAF). CHA2DS2-VASc stroke risk scoring in use in the current international guidelines attributes 1 point to “female sex”. Besides, no anticoagulation is indicated for AF female patients without other risk factors. Interestingly, NOACs seem to normalize the differences between males and females both in terms of safety and efficacy, whereas residual higher stroke risk and systemic embolism persist in AF women treated with vitamin K antagonist anticoagulants VKA with optimal time in therapeutic range. Based on the CHA2DS2-VASc score, NOACs represent the preferred choice in NVAF patients. Moreover, complete evaluation of apparently lower risk factor along with concomitant clinical conditions in AF patients appears mandatory, particularly for female patients, in order to achieve the most appropriate anticoagulant treatment, either in male or in female patients. The present review was performed to review sex differences in AF-related thromboembolic risk reported in the literature and possibly highlight current knowledge gaps in prevention and management that need further research.

Female Sex as a Risk Modifier for Stroke Risk in Atrial Fibrillation: Using CHA2DS2-VASc versus CHA2DS2-VA for Stroke Risk Stratification in Atrial Fibrillation: A Note of Caution

2020 ◽  
Vol 120 (06) ◽  
pp. 894-898 ◽  
Author(s):  
Peter Brønnum Nielsen ◽  
Thure Filskov Overvad
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Stroke Risk ◽  
Scoring Systems ◽  
Recent Discussion ◽  
Anticoagulation Treatment ◽  
Female Sex ◽  
Risk Scoring ◽  
Methodological Approaches ◽  
Risk Modifier

AbstractStroke prevention is a key clinical concern in the management of patients with atrial fibrillation. Oral anticoagulation treatment reduces the risk of disabling stroke, but the treatment increases the risk of bleeding. For decades, the decision to initiate oral anticoagulation has been guided by clinical risk scoring systems such as the CHADS2 and CHA2DS2-VASc scores. In this narrative review, we focus on the recent discussion of the “Sc” (Sex Category) criterion in the CHA2DS2-VASc score. Epidemiological considerations when assessing stroke rates in cohorts are discussed, and the implications of different methodological approaches are outlined. Next, we review studies investigating the association of the “Sc” criterion on the stroke rates under various approaches. Lastly, we discuss potential consequences of implementing the recently suggested sex-less CHA2DS2-VA score, which leaves out female sex from stroke risk assessment in atrial fibrillation.

scholarly journals Assessment of female sex as a risk factor in atrial fibrillation in Sweden: nationwide retrospective cohort study

BMJ ◽  
2012 ◽  
Vol 344 (may30 3) ◽  
pp. e3522-e3522 ◽  
Author(s):  
L. Friberg ◽  
L. Benson ◽  
M. Rosenqvist ◽  
G. Y. H. Lip
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Female Sex

Female sex as a risk factor for ischaemic stroke varies with age in patients with atrial fibrillation

Heart ◽  
2019 ◽  
Vol 106 (7) ◽  
pp. 534-540 ◽  
Author(s):  
Victor Chien-Chia Wu ◽  
Michael Wu ◽  
Victor Aboyans ◽  
Shang-Hung Chang ◽  
Shao-Wei Chen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Heart Disease ◽  
Ischaemic Stroke ◽  
Stroke Risk ◽  
Research Database ◽  
Stroke Risk Factor ◽  
Female Sex ◽  
Included Patient ◽  
History Of

ObjectivesFemale sex is an inconsistent ischaemic stroke risk factor in patients with atrial fibrillation (AF). We hypothesised that the ischaemic stroke risk varies with age among women compared with men.MethodsWe retrieved the patients with newly diagnosed AF during 2001–2013 from Taiwan’s National Health Insurance Research Database. Patients with missing information, age <20 years, history of valvular heart disease and surgery, rheumatic heart disease, hyperthyroidism or anticoagulation and/or antiplatelet use were excluded. Propensity score matching (PSM) included patient comorbidities, medications and index date stratified by age and sex groups. Primary outcome was defined as ischaemic stroke at follow-up.ResultsAfter exclusion criteria, 87 369 men and 71 853 women remained for analysis (aged 73.1±14.4 years). After 1:1 PSM, we included 59 583 men (aged 73.5±13.7 years) and 59 583 women (aged 73.4±13.8 years) for analysis. We also stratified patients by age. The ischaemic stroke risk varied with age in women compared with men: lower in the ≤55 years (subdistribution HR (SHR)=0.75, 95% CI 0.62 to 0.90) and 56–65 years (SHR=0.87, 95% CI 0.78 to 0.98) groups, neutral in the 66–75 years group (SHR=1.01, 95% CI 0.94 to 1.08) and adverse in the >75 years group (SHR=1.14, 95% CI 1.09 to 1.19).ConclusionsThe female/male ischaemic stroke risk ratio varied with age. Only women aged >75 years had a higher risk, whereas women aged <65 years had a lower risk compared with men. These findings challenge the ‘sex category’ component of the CHA2DS2-VASc score, used to make decision regarding anticoagulation treatment in AF patients.

Female sex as an independent risk factor for stroke in atrial fibrillation: Possible mechanisms

2014 ◽  
Vol 111 (03) ◽  
pp. 385-391 ◽  
Author(s):  
Christine Albert ◽  
Felicita Andreotti ◽  
Lina Badimon ◽  
Isabelle Van Gelder ◽  
Elaine Hylek ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sex Differences ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Stroke Risk ◽  
Thrombus Formation ◽  
Blood Stasis ◽  
Stroke Risk Factor ◽  
Female Sex ◽  
Increased Risk

SummaryAtrial fibrillation (AF) is an independent risk factor for thromboembolism and stroke. Women with AF are at a higher overall risk for thromboembolic stroke when compared to men with AF. Recent evidence suggests that female sex, after adjusting for stroke risk profile and sex differences in utilisation of anticoagulation, is an independent stroke risk factor in AF. The inclusion of female sex has improved the accuracy of the CHADS2 stroke risk stratification schema (Congestive heart failure, Hypertension, Age 75 years or greater, Diabetes mellitus, and prior Stroke or TIA). The newly revised and validated schema, CHA2DS2-VASc, dichotomises age and incorporates female sex and vascular disease history. The pathophysiological mechanisms to explain this increased risk in women are not well understood. According to Virchow’s triad, thrombosis that leads to stroke in AF should arise from three co-existing phenomena: structural abnormalities, blood stasis, and a hypercoagulable state. Herein, we explore the sex differences in the biological processes that lead to thrombus formation as applied to Virchow’s Triad. The objective of this review is to describe the potential mechanisms behind the increased risk of stroke in AF associated with female sex.

scholarly journals Sex Difference in the Risk of Dementia in Patients with Atrial Fibrillation

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 760
Author(s):  
Yung-Lung Chen ◽  
Joseph Chen ◽  
Hui-Ting Wang ◽  
Ya-Ting Chang ◽  
Shaur-Zheng Chong ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Heart Surgery ◽  
Demographic Data ◽  
Research Database ◽  
Female Sex ◽  
Diagnosis Of Dementia ◽  
The Difference ◽  
New Diagnosis ◽  
The Impact

Atrial fibrillation (AF) is one of the risk factors for dementia. Female sex is an inconsistent risk factor for dementia after adjusting for age in the general population, and there lacks research on its impact in developing dementia in patients with AF. This paper aims to investigate whether female sex is a risk factor for dementia in AF patients. Data of patients with newly diagnosed AF between 2001–2013 were retrieved from Taiwan’s National Health Insurance Research Database. Exclusion criteria were: patients with incomplete demographic data, age < 20 years, rheumatic heart disease, hyperthyroidism, past valvular heart surgery, and a history of dementia. Propensity score matching (PSM) between sexes was performed, including comorbidities, medications and index date stratified by age. The primary outcome was a new diagnosis of dementia at follow-up. A total of 117,517 men and 156,705 women were eligible for analysis. After 1:1 PSM, both 100,065 men and women (aged 72.5 ± 12.5 years) were included for analysis. Dementia risk varied with age in women compared with men. The difference was negligible for ≤55 years (sub distribution HR (SHR) = 0.89, 95% CI 0.73–1.07), but increased between 56–65 years (SHR = 1.13, 95% CI 1.02–1.25), 66–75 years (SHR = 1.14, 95% CI 1.09–1.20), 75–85 years (SHR = 1.11, 95% CI 1.07–1.15) and >85 years (SHR 1.10, 95% CI 1.04–1.16) for females. This study establishes that female sex increases the risk of developing dementia compared to male sex in AF patients aged >56 years. However, the impact of female sex on dementia in AF patients differs between dementia types.

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