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28:13
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Sex, stroke, and atrial fibrillation
Archives of Neurology
|September 26, 2012
Summary
Women with atrial fibrillation (AF) face a higher stroke risk than men, even with comparable warfarin use. This increased risk in women persists regardless of anticoagulation therapy, highlighting a critical disparity in stroke prevention.
Area of Science:
- Cardiology
- Geriatrics
- Public Health
Background:
- Atrial fibrillation (AF) is a significant risk factor for stroke, with women experiencing higher rates than men.
- The underlying reasons for elevated stroke risk in women with AF are not fully understood, with potential links to undertreatment of anticoagulation.
- Warfarin is a key anticoagulant medication used to mitigate stroke risk in patients with AF.
Purpose of the Study:
- To compare warfarin utilization patterns between older men and women diagnosed with AF.
- To assess and compare the risk of subsequent stroke in older men and women with AF at a population level.
- To investigate potential sex-based differences in stroke risk among elderly AF patients.
Main Methods:
- A population-based cohort study was conducted using administrative data from Quebec, Canada (1998-2007).
- The study included patients aged 65 years or older admitted with a new diagnosis of AF.
- Data linkage included hospital discharge, physician claims, and prescription drug claims to track warfarin use and stroke events.
Main Results:
- The cohort consisted of 39,398 men and 44,115 women; women were older and had higher CHADS2 scores at admission.
- Warfarin prescription filling rates were similar between sexes (men: 58.2%, women: 60.6%), with women showing slightly higher adjusted utilization.
- Crude stroke incidence was higher in women (2.02 per 100 person-years) than in men (1.61 per 100 person-years), a difference most pronounced in those aged 75+.
- Multivariable analysis confirmed women had a significantly higher risk of stroke (adjusted hazard ratio: 1.14) independent of comorbidities and warfarin treatment.
Conclusions:
- Older women with recently diagnosed AF exhibit a greater risk of stroke compared to older men.
- This elevated stroke risk in women persists irrespective of warfarin use, suggesting other factors contribute to the disparity.
- The findings underscore the need for further research into sex-specific mechanisms and management strategies for stroke prevention in AF.
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