Comparison of the impact of atrial fibrillation on the risk of stroke and cardiovascular death in women versus men (The Copenhagen City Heart Study)

Friberg, Jens; Scharling, Henrik; Gadsbøll, Niels; Truelsen, Thomas; Jensen, Gorm

doi:10.1016/j.amjcard.2004.06.023

Cited by 234 publications

(157 citation statements)

References 24 publications

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“…12 The Copenhagen City Heart Study, which followed 29310 patients for 4.7 years, found AF to be independently associated with a higher cardiovascular mortality rate in women (hazard ratio [HR]: 4.4) as compared to men (HR: 2.2). 13 Female sex has been associated with an additional risk of stroke, especially for those older than 75 years. The SPAF I-III (Stroke Prevention in Atrial Fibrillation) trials described a particularly high risk of disabling embolic stroke in elderly women with AF.…”

Section: Atrial Fibrillationmentioning

confidence: 99%

Arrhythmias in Women

Curtis

Narasimha

2012

Clinical Cardiology

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There are important gender differences in cardiac electrophysiology that affect the epidemiology, presentation, and prognosis of various arrhythmias. Women have been noted to have higher resting heart rates compared to men. They also have a longer QT interval, which puts them at an increased risk for drug-induced torsades de pointes. Women with atrial fibrillation are at a higher risk of stroke, and they are less likely to receive anticoagulation and ablation procedures compared to men. Women have a lower risk of sudden cardiac death and are less likely to have known coronary artery disease at the time of an event compared to men. Both men and women have been shown to derive an equal survival benefit from implantable cardioverter defibrillators and cardiac resynchronization therapy, although these devices are significantly underutilized in women. Women also appear to have a better response to cardiac resynchronization therapy in terms of reduced numbers of hospitalizations and more robust reverse ventricular remodeling. Further studies are required to elucidate the underlying pathophysiology of these sex differences in cardiac arrhythmias. IntroductionSex differences in cardiac electrophysiology affect the epidemiology, presentation, and prognosis of various arrhythmias. These sex differences can have important clinical and therapeutic implications. Although the exact reason for these differences is not known, the potential mechanisms include differences in cardiac size, structure, and the different ways in which hormones, drugs, and electrolytes affect cardiac ion channels in men and women. The purpose of this review is to provide a synopsis of the important gender differences with respect to arrhythmias and to summarize updates from recent studies.

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Section: Atrial Fibrillationmentioning

confidence: 99%

Arrhythmias in Women

Curtis

Narasimha

2012

Clinical Cardiology

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“…Although absolute incidence rates for AF are lower in women compared with men, the risk of stroke and other thromboembolic events associated with AF is higher in women than in men worldwide 3, 23. In the Copenhagen City Heart Study, the cardiovascular mortality for AF in women was found to be 2.5 times higher than in men 24. AF in women, therefore, deserves heightened attention.…”

Section: Discussionmentioning

confidence: 99%

Impact of a History of Hypertension in Pregnancy on Later Diagnosis of Atrial Fibrillation

Scantlebury

Kattah

Weissgerber

et al. 2018

JAHA

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BackgroundAtrial fibrillation/flutter (AF) produces significant morbidity in women and is typically attributed to cardiac remodeling from multiple causes, particularly hypertension. Hypertensive pregnancy disorders (HPDs) are associated with future hypertension and adverse cardiac remodeling. We evaluated whether women with AF were more likely to have experienced a HPD compared with those without.Methods and ResultsA nested case–control study was conducted within a cohort of 7566 women who had a live or stillbirth delivery in Olmsted County, Minnesota between 1976 and 1982. AF cases were matched (1:1) to controls based on date of birth, age at first pregnancy, and parity. AF and pregnancy history were confirmed by chart review. We identified 105 AF cases: mean age 57±8 (mean±SD) years, (controls 56±8 years), 32±8 years (controls 31±8 years) after the first pregnancy. Cases were more likely to have obesity during childbearing years, and hypertension, diabetes mellitus, dyslipidemia, coronary disease, valvular disease, and heart failure at the time of AF diagnosis. Cases were more likely to have a history of HPDs, compared with controls: 28/105 (26.7%) cases versus 12/105 (11.4%) controls, odds ratio: 2.60 (95% confidence interval, 1.21–6.04). After adjustment for hypertension and obesity, the association was attenuated and no longer statistically significant; odds ratio (95% confidence interval, 2.12 (0.92–5.23).ConclusionsWomen with AF are more likely to have had a HPD, a relationship at least partially mediated by associated obesity and hypertension. Given the high morbidity of AF, studies evaluating the benefit of screening for and management of cardiovascular risk factors in women with a history of HPD should be performed.

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“…33 In the Copenhagen City Heart Study, the effect of AF on the risk of cardiovascular death was significantly increased 4.4 times in women and 2.2 times in men. 34 In the Euro Heart Survey on Atrial Fibrillation, women with AF had a 1.83 times significantly increased risk of stroke than men with AF. 35 AF after isolated coronary artery surgery significantly increased mortality at 51-month median follow-up (adjusted hazard ratio = 2.13).…”

Section: Associated Risksmentioning

confidence: 99%

“…40 In the Copenhagen City Heart Study, the effect of AF on the risk of stroke was significantly increased 7.6 times in women and 1.7 times in men. 34 AF is also a risk factor for impaired cognitive function. 41 In 2,384 older persons, mean age 81 years, AF was present in 17% of older persons with LV hypertrophy and in 8% of persons without LV hypertrophy 31 Both AF (risk ratio = 3.2) and LV hypertrophy (risk ratio = 2.8) were independent risk factors for new TE stroke at 44-month follow-up.…”

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confidence: 99%

Atrial Fibrillation: The New Epidemic of the Ageing World

Aronow¹,

Banach²

2009

J.A.F.I.B

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The prevalence of atrial fibrillation (AF) increases with age. As the population ages, the burden of AF increases.AF is associated with an increased incidence of mortality, stroke, and coronary events compared to sinus rhythm. AF with a rapid ventricular rate may cause a tachycardia-related cardiomyopathy. Immediate direct-current (DC) cardioversion should be performed in patients with AF and acute myocardial infarction, chest pain due to myocardial ischemia, hypotension, severe heart failure, or syncope. Intravenous beta blockers, diltiazem, or verapamil may be administered to reduce immediately a very rapid ventricular rate in AF. An oral beta blocker, verapamil, or diltiazem should be used in persons with AF if a fast ventricular rate occurs at rest or during exercise despite digoxin. Amiodarone may be used in selected patients with symptomatic life-threatening AF refractory to other drugs. Digoxin should not be used to treat patients with paroxysmal AF. Nondrug therapies should be performed in patients with symptomatic AF in whom a rapid ventricular rate cannot be slowed by drugs. Paroxysmal AF associated with the tachycardia-bradycardia syndrome should be treated with a permanent pacemaker in combination with drugs. A permanent pacemaker should be implanted in patients with AF and symptoms such as dizziness or syncope associated with ventricular pauses greater than 3 seconds which are not drug-induced. Elective DC cardioversion has a higher success rate and a lower incidence of cardiac adverse effects than does medical cardioversion in converting AF to sinus rhythm. Unless transesophageal echocardiography has shown no thrombus in the left atrial appendage before cardioversion, oral warfarin should be given for 3 weeks before elective DC or drug cardioversion of AF and continued for at least 4 weeks after maintenance of sinus rhythm. Many cardiologists prefer, especially in elderly patients , ventricular rate control plus warfarin rather than maintaining sinus rhythm with antiarrhythmic drugs. Patients with chronic or paroxysmal AF at high risk for stroke should be treated with long-term warfarin to achieve an International Normalized Ratio of 2.0 to 3.0. Patients with AF at low risk for stroke or with contraindications to warfarin should be treated with aspirin 325 mg daily

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Comparison of the impact of atrial fibrillation on the risk of stroke and cardiovascular death in women versus men (The Copenhagen City Heart Study)

Cited by 234 publications

References 24 publications

Arrhythmias in Women

Arrhythmias in Women

Impact of a History of Hypertension in Pregnancy on Later Diagnosis of Atrial Fibrillation

Atrial Fibrillation: The New Epidemic of the Ageing World

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