Related Experiment Video
Updated: Jul 25, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Sex Differences in Atrial Fibrillation and Associated Complications in Hypertensive Patients with Left Ventricular
Joshua B Feinberg1,2, Emil E Nielsen1,2, Sverre E Kjeldsen3
1Department of Internal Medicine, Cardiology Section, Holbaek Hospital, Holbaek, Denmark.
Insights
Females with new-onset atrial fibrillation (AF) have a higher stroke risk than males, particularly older women. However, stroke risk is similar for males and females with a history of AF.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Clinical Trials
Background:
- Atrial fibrillation (AF) poses a higher stroke risk in females than males, but the reasons remain unclear.
- Biological sex differences may contribute to this disparity, warranting further investigation.
Purpose of the Study:
- To investigate sex-specific differences in stroke risk among patients with hypertension and left ventricular hypertrophy (LVH) and atrial fibrillation (AF).
- To analyze stroke risk based on new-onset AF versus a history of AF in relation to sex and age.
Main Methods:
- Utilized data from The Losartan Intervention for Endpoint study, a multicenter randomized clinical trial.
- Analyzed stroke risk in 9,193 patients with hypertension and LVH, followed for at least four years.
- Stratified analysis by sex, age, and AF status (new-onset vs. history of AF).
Main Results:
- Females with new-onset AF showed a trend toward higher stroke risk (HR 1.52) compared to males.
- This increased risk in females with new-onset AF was more pronounced in older patients (above 64 years).
- No significant sex difference in stroke risk was observed for patients with a history of AF (HR 0.88).
Conclusions:
- In patients with hypertension and LVH, new-onset AF confers a higher stroke risk in females than males, particularly in older age groups.
- Stroke risk is comparable between sexes for patients with a history of AF, increasing with age in both.
- Sex-specific risk stratification may be important for managing stroke risk in AF patients.
Background:
There is no consensus on whether biological differences account for the higher risk of stroke seen in females compared to males with atrial fibrillation (AF).
Methods:
Capitalizing on The Losartan Intervention for Endpoint study, a multicenter randomized clinical trial randomizing 9,193 patients and followed for at least four years, we aimed to identify sex differences in the risk of stroke in the presence of AF in patients with hypertension and left ventricular hypertrophy (LVH).
Results:
342 Patients had a history of AF, and 669 developed new-onset AF. History of AF and new-onset AF were more prevalent among males (5.0% vs. 2.9% and 3.0% vs. 0.9%) in patients aged 55-63 years, but the relative difference decreased with age. Females with new-onset AF tended to have a higher risk of stroke than males (HR 1.52 [95% CI 0.95-2.43]). However, females with a history of AF did not have a higher risk than males (HR 0.88 [95% CI 0.5-1.6]). In patients with new-onset AF, the relative higher stroke risk in females increased with age. Among patients with a history of AF, stroke risk was comparable and increased with age in both sexes.
Conclusions:
Among patients with hypertension and LVH, females with new-onset AF had a higher risk of stroke than males, especially in patients above 64 years. However, the risk did not differ between the sexes among patients with a history of AF.
Related Concept Videos
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
01:20Mitral Regurgitation I: Introduction
01:29Heart Failure II: Pathophysiology
01:30Hypertension III: Clinical Manifestations and Diagnostic Studies
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias