Stroke Risk in Women With AF
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND AND AIMS
Female sex is associated with higher rates of stroke in atrial fibrillation (AF) after adjustment for other CHA2DS2-VASc factors. This study aimed to describe sex differences in age and cardiovascular care to examine their relationship with stroke hazard in AF.
METHODS
Population-based cohort study using administrative datasets of people aged ≥66 years diagnosed with AF in Ontario between 2007 and 2019. Cause-specific hazard regression was used to estimate the adjusted hazard ratio (HR) for stroke associated with female sex over a 2-year follow-up. Model 1 included CHA2DS2-VASc factors, with age modelled as 66-74 vs. ≥ 75 years. Model 2 treated age as a continuous variable and included an age-sex interaction term. Model 3 further accounted for multimorbidity and markers of cardiovascular care.
RESULTS
The cohort consisted of 354 254 individuals with AF (median age 78 years, 49.2% female). Females were more likely to be diagnosed in emergency departments and less likely to receive cardiologist assessments, statins, or LDL-C testing, with higher LDL-C levels among females than males. In Model 1, the adjusted HR for stroke associated with female sex was 1.27 (95% confidence interval 1.21-1.32). Model 2 revealed a significant age-sex interaction, such that female sex was only associated with increased stroke hazard at age >70 years. Adjusting for markers of cardiovascular care and multimorbidity further decreased the HR, so that female sex was not associated with increased stroke hazard at age ≤80 years.
CONCLUSION
Older age and inequities in cardiovascular care may partly explain higher stroke rates in females with AF.
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Additional Info
Stroke risk in women with atrial fibrillation
Eur Heart J 2023 Aug 30;[EPub Ahead of Print], H Buhari, J Fang, L Han, PC Austin, P Dorian, CA Jackevicius, AYX Yu, MK Kapral, SM Singh, K Tu, DT Ko, CL Atzema, EJ Benjamin, DS Lee, H Abdel-QadirFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.