Irene Marzona1, Marco Proietti2, Alessio Farcomeni3, Giulio Francesco Romiti4, Imma Romanazzi5, Valeria Raparelli6, Stefania Basili4, Gregory Y H Lip7, Alessandro Nobili8, Maria Carla Roncaglioni9. 1. Department of Cardiovascular Diseases, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy. Electronic address: irene.marzona@marionegri.it. 2. Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Neuroscience, IRCCS- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy. 3. Department of Public Health and Infectious Disease, Sapienza-University of Rome, Rome, Italy. 4. Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Rome, Italy. 5. Department of Internal Medicine, IRCCS Ca' Granda Foundation, Maggiore Policlinico Hospital, Milan, Italy. 6. Department of Experimental Medicine, Sapienza-University of Rome, Rome, Italy; Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada. 7. Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark. 8. Department of Neuroscience, IRCCS- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy. 9. Department of Cardiovascular Diseases, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
Abstract
BACKGROUND: Atrial fibrillation (AF) is the most commonly diagnosed arrhythmia, which is associated with an increased risk of stroke. Several studies have suggested that female AF patients could have a greater risk for stroke and thromboembolic events (TE). METHODS: A systematic literature review update and meta-analysis was conducted using Pubmed. The search used the terms "atrial fibrillation", "gender", "sex", "female", "women", "stroke", "thromboembolism". Main aim of the study was to compare and male AF patients for occurrence of stroke and TE. Secondary outcomes were: major bleeding, cardiovascular (CV) death and all-cause death. RESULTS: Forty-four studies were included in the analysis including 993,603 patients (48.9% women). After pooling the data, there was a higher risk of stroke for women vs. male AF patients (hazard ratio [HR]: 1.24; 95% confidence intervals [CIs]: 1.14-1.36). Overall, TE risk was not different between female and male patients, despite sensitivity analysis left some uncertainties. No sex differences were found for major bleeding, CV death and all-cause death. A significant relationship between increasing age and the difference in stroke risk between female and male AF patients was found (Delta HR: 1.01; 95% CI: 1.00-1.03 for each year of age increase). CONCLUSIONS: Female patients with AF are at increased risk of stroke compared to men. A significant relationship between increasing age and stroke risk in women compared to men was found, most evident at age > 65 years. Female sex may act as a stroke risk modifier, particularly in elderly and very elderly AF subjects, conferring a significant increase in stroke risk.
BACKGROUND:Atrial fibrillation (AF) is the most commonly diagnosed arrhythmia, which is associated with an increased risk of stroke. Several studies have suggested that female AFpatients could have a greater risk for stroke and thromboembolic events (TE). METHODS: A systematic literature review update and meta-analysis was conducted using Pubmed. The search used the terms "atrial fibrillation", "gender", "sex", "female", "women", "stroke", "thromboembolism". Main aim of the study was to compare and male AFpatients for occurrence of stroke and TE. Secondary outcomes were: major bleeding, cardiovascular (CV) death and all-cause death. RESULTS: Forty-four studies were included in the analysis including 993,603 patients (48.9% women). After pooling the data, there was a higher risk of stroke for women vs. male AFpatients (hazard ratio [HR]: 1.24; 95% confidence intervals [CIs]: 1.14-1.36). Overall, TE risk was not different between female and male patients, despite sensitivity analysis left some uncertainties. No sex differences were found for major bleeding, CV death and all-cause death. A significant relationship between increasing age and the difference in stroke risk between female and male AFpatients was found (Delta HR: 1.01; 95% CI: 1.00-1.03 for each year of age increase). CONCLUSIONS: Female patients with AF are at increased risk of stroke compared to men. A significant relationship between increasing age and stroke risk in women compared to men was found, most evident at age > 65 years. Female sex may act as a stroke risk modifier, particularly in elderly and very elderly AF subjects, conferring a significant increase in stroke risk.
Authors: Annabelle Santos Volgman; Emelia J Benjamin; Anne B Curtis; Margaret C Fang; Kathryn J Lindley; Gerald V Naccarelli; Carl J Pepine; Odayme Quesada; Marmar Vaseghi; Albert L Waldo; Nanette K Wenger; Andrea M Russo Journal: J Cardiovasc Electrophysiol Date: 2020-12-29 Impact factor: 2.942
Authors: David S Eccleston; Joseph M Kim; Jurien M Ten Berg; P Gabriel Steg; Deepak L Bhatt; Stefan H Hohnloser; Anne de Veer; Matias Nordaby; Corinna Miede; Takeshi Kimura; Gregory Y H Lip; Jonas Oldgren; Christopher P Cannon Journal: Clin Cardiol Date: 2021-05-27 Impact factor: 2.882