BACKGROUND: Female sex has been suggested as a risk factor for stroke/thromboembolism in patients with non-valvular atrial fibrillation (AF) and has therefore been included within risk scores, e.g., the CHA2 DS2 -VASc score, and guidelines. OBJECTIVES: To investigate the risk of stroke/thromboembolism associated with female sex in non-valvular AF patients. PATIENTS/ METHODS: Using the national Danish registers, we identified non-anticoagulated patients discharged with non-valvular AF (1997-2008), and subdivided the population into three age intervals: < 65, 65-74 and ≥ 75 years. We calculated stroke rates according to sex, and assessed the stroke risk associated with female sex by using Cox regression analysis. RESULTS: We included 87,202 AF patients, and 44,744 (51.3%) were female. The rate of stroke/thromboembolism for females aged < 65 and 65-74 years was not increased as compared with men, whereas the rate for females aged ≥ 75 years was increased. At both 1-year and 12-year follow-up, female sex did not increase the risk of stroke for patients aged < 75 years. At 1-year follow-up, the hazard ratios associated with female sex were 0.89 (95% confidence interval [CI] 0.70-1.13) and 0.91 (95 CI 0.79-1.05) for patients aged < 65 and 65-74 years, respectively, and being female and aged ≥ 75 years was associated with an increased risk of stroke of 1.20 (95 CI 1.12-1.28). CONCLUSION: Female sex was only associated with an increased risk of stroke for AF patients aged ≥ 75 years. Our study suggests that female sex should not be automatically included as an independent stroke/thromboembolic risk factor in guidelines or in the CHA2 DS2 -VASc score, without careful prior consideration of the 'age < 65 and lone AF' criterion.
BACKGROUND: Female sex has been suggested as a risk factor for stroke/thromboembolism in patients with non-valvular atrial fibrillation (AF) and has therefore been included within risk scores, e.g., the CHA2 DS2 -VASc score, and guidelines. OBJECTIVES: To investigate the risk of stroke/thromboembolism associated with female sex in non-valvular AFpatients. PATIENTS/ METHODS: Using the national Danish registers, we identified non-anticoagulated patients discharged with non-valvular AF (1997-2008), and subdivided the population into three age intervals: < 65, 65-74 and ≥ 75 years. We calculated stroke rates according to sex, and assessed the stroke risk associated with female sex by using Cox regression analysis. RESULTS: We included 87,202 AFpatients, and 44,744 (51.3%) were female. The rate of stroke/thromboembolism for females aged < 65 and 65-74 years was not increased as compared with men, whereas the rate for females aged ≥ 75 years was increased. At both 1-year and 12-year follow-up, female sex did not increase the risk of stroke for patients aged < 75 years. At 1-year follow-up, the hazard ratios associated with female sex were 0.89 (95% confidence interval [CI] 0.70-1.13) and 0.91 (95 CI 0.79-1.05) for patients aged < 65 and 65-74 years, respectively, and being female and aged ≥ 75 years was associated with an increased risk of stroke of 1.20 (95 CI 1.12-1.28). CONCLUSION: Female sex was only associated with an increased risk of stroke for AFpatients aged ≥ 75 years. Our study suggests that female sex should not be automatically included as an independent stroke/thromboembolic risk factor in guidelines or in the CHA2 DS2 -VASc score, without careful prior consideration of the 'age < 65 and lone AF' criterion.
Authors: Ralph F Bosch; David Pittrow; Anne Beltzer; Irmtraut Kruck; Wilhelm Kirch; Annette Kohlhaussen; Hendrik Bonnemeier Journal: Herzschrittmacherther Elektrophysiol Date: 2013-08-27
Authors: George Ntaios; Gregory Y H Lip; Konstantinos Vemmos; Eleni Koroboki; Efstathios Manios; Anastasia Vemmou; Ana Rodríguez-Campello; Elisa Cuadrado-Godia; Jaume Roquer; Valentina Arnao; Valeria Caso; Maurizio Paciaroni; Exuperio Diez-Tejedor; Blanca Fuentes; Josefa Pérez Lucas; Antonio Arauz; Sebastian F Ameriso; Lucía Pertierra; Maia Gómez-Schneider; Maximiliano A Hawkes; Fabio Bandini; Beatriz Chavarria Cano; Ana Maria Iglesias Mohedano; Andrés García Pastor; Antonio Gil-Núñez; Jukka Putaala; Turgut Tatlisumak; Miguel A Barboza; George Athanasakis; Fotios Gioulekas; Konstantinos Makaritsis; Vasileios Papavasileiou Journal: Neurology Date: 2017-07-07 Impact factor: 9.910