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Published on: July 20, 2022
Sex-Specific Cardiometabolic Determinants of Postoperative Atrial Fibrillation After Cardiac Surgery
Amélie Paquin1, Pierre Voisine1, Paul Poirier2
1Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada.
Insights
Abdominal obesity is a key predictor of postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) in both men and women. However, women face a significantly higher risk from abdominal obesity, necessitating sex-specific prevention strategies.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Metabolic Health
Background:
- Cardiometabolic diseases elevate the risk of postoperative atrial fibrillation (POAF).
- POAF is linked to increased long-term risk of major cardiovascular events (MACE).
- Sex-specific differences in POAF risk factors after coronary artery bypass grafting (CABG) are not well understood.
Purpose of the Study:
- To evaluate sex-specific predictors of POAF following CABG.
- To investigate the differential impact of cardiometabolic risk factors on POAF between sexes.
Main Methods:
- Prospective registry analysis of patients undergoing isolated CABG.
- Logistic regression models used to compare POAF predictors between sexes.
- Abdominal obesity defined by waist circumference (WC) thresholds: men ≥ 102 cm, women ≥ 100 cm, with median WC used due to high prevalence in women.
Main Results:
- Analysis included 6177 patients (17% women); POAF occurred in 32% of men and 28% of women.
- Abdominal obesity and age were significant POAF predictors in both sexes.
- Women with POAF had higher prevalence of hypertension, diabetes, and elevated C-reactive protein, with a significantly greater impact of WC on POAF risk (P for interaction = 0.01).
Conclusions:
- Abdominal obesity is a major predictor of POAF in both sexes after CABG.
- Women experience a disproportionately higher risk of POAF associated with abdominal obesity.
- Enhanced strategies for managing abdominal obesity and sex-specific interventions are crucial for POAF prevention.
Background:
Cardiometabolic diseases increase the risk of postoperative atrial fibrillation (POAF), a complication leading to higher long-term risk of major cardiovascular events (MACE). It remains unknown whether the effect of these risk factors differs according to sex. We sought to evaluate the sex-specific predictors of POAF after coronary artery bypass grafting (CABG).
Methods:
In a prospective registry of patients undergoing isolated CABG, we compared predictors of POAF between sexes with logistic regression models. Because of high prevalence of abdominal obesity in women, > 80% having a waist circumference (WC) ≥ 88 cm, median WC values were used to define abdominal obesity (men ≥ 102 cm, women ≥ 100 cm).
Results:
This analysis included 6177 individuals (17% women). Mean age was 65.6 ± 8.9 years. POAF occurred in 32% of men and 28% of women (P < 0.05). Compared with men, women with POAF had similar WC; higher prevalence of hypertension and diabetes; lower high-density lipoprotein (HDL)-cholesterol; and higher glucose, triglyceride, low- density lipoprotein (LDL)-cholesterol, and C-reactive protein levels (all P < 0.05). After adjustment, age and abdominal obesity were associated with POAF in both sexes (P < 0.05). The interaction of WC with sex suggested a worse impact of WC on POAF risk among women (adjusted odds ratio [OR], 1.97; 95% confidence interval [CI], 1.48-2.62 vs in men 1.33; 95% CI, 1.17-1.50; P for interaction = 0.01).
Conclusions:
Abdominal obesity is a major predictor of POAF in both sexes, with higher risk in women. These results emphasize the need for enhanced strategies to manage abdominal obesity and its cardiometabolic consequences in the general population and the potential to develop sex-specific preventive interventions to reduce risk of POAF.
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