Sex Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors, and Mortality in Community Cohorts

Abstract

BACKGROUND:Atrial fibrillation (AF) is a common cardiac disease in aging populations with high comorbidity and mortality. Sex differences in AF epidemiology are insufficiently understood. METHODS:In N=79 793 individuals without AF diagnosis at baseline (median age, 49.6 years; age range, 24.1-97.6 years; 51.7% women) from 4 community-based European studies (FINRISK, DanMONICA, Molisani Northern Sweden) of the BiomarCaRE consortium (Biomarker for Cardiovascular Risk Assessment in Europe), we examined AF incidence, its association with mortality, common risk factors, biomarkers, and prevalent cardiovascular disease, and their attributable risk by sex. Median follow-up time was 12.6 (to a maximum of 28.2) years. RESULTS:Fewer AF cases were observed in women (N=1796; 4.4%), than in men (N=2465; 6.4%). Cardiovascular risk factor distribution and lipid profile at baseline were less beneficial in men than in women, and cardiovascular disease was more prevalent in men. Cumulative incidence increased markedly after the age of 50 years in men and after 60 years in women. The lifetime risk was similar (>30%) for both sexes. Subjects with incident AF had a 3.5-fold risk of death in comparison with those without AF. Multivariable-adjusted models showed sex differences for the association of body mass index and AF (hazard ratio per standard deviation increase, 1.18; 95% confidence interval [CI], 1.12-1.23 in women versus 1.31; 95% CI 1.25-1.38 in men; interaction P value of 0.001). Total cholesterol was inversely associated with incident AF with a greater risk reduction in women (hazard ratio per SD, 0.86; 95% CI, 0.81-0.90 versus 0.92; 95% CI, 0.88-0.97 in men; interaction P value of 0.023). No sex differences were seen for C-reactive protein and N-terminal pro B-type natriuretic peptide. The population-attributable risk of all risk factors combined was 41.9% in women and 46.0% in men. About 20% of the risk was observed for body mass index. CONCLUSIONS:Lifetime risk of AF was high, and AF was strongly associated with increased mortality both in women and men. Body mass index explained the largest proportion of AF risk. Observed sex differences in the association of body mass index and total cholesterol with AF need to be evaluated for underlying pathophysiology and relevance to sexspecific prevention strategies. ORIGINAL RESEARCH ARTICLE A trial fibrillation (AF) is a common cardiac disease that increases the risk of morbidity and mortality in aging women and men. Sex Differences and Similarities in Atrial1-3 Considerable sex differences in prevalence, incidence, and mortality have been reported.2,4 AF prevalence in middle-aged and older community cohorts is almost twice as high in men as in women. [5][6][7] The increasing prevalence of AF and subsequent public health and economic burden require research efforts to understand sex differences in disease distribution and risk factor associations. 5 The onset of AF diminishes the survival advantage in women. 8 Risk of adverse outcomes in AF also appears to differ by sex, eg, st...

Sex Differences in the Impact of Body Mass Index on the Risk of Future Atrial Fibrillation: Insights From the Longitudinal Population‐Based Tromsø Study

“…Recent results from a substudy of the Biomarcare Consortium involving data from 4 community‐based European studies (FINRISK [Finnish National Risk Factor Survey], DanMONICA [Danish Monitoring of Trends and Determinants in Cardiovascular Disease], Moli‐sani, and Northern Sweden), including data from 79 793 individuals, found that among the classic risk factors, BMI explained the largest proportion of AF risk. Sex differences were seen for risk associations of BMI (HR per SD increase was 1.18 [95% CI, 1.12–1.23] in women versus 1.31 [95% CI, 1.25–1.38] in men; interaction P =0.001) . Therefore, the current study adds to the body of knowledge by comprehensively determining sex differences in the impact of BMI on future incident AF (including providing BMI‐specific HRs) and confirms that associations between BMI and future development of AF are significant in both sexes but differ in size.…”

Differences in Epidemiology and Risk Factors for Atrial Fibrillation Between Women and Men

“…Epidemiological studies show a high lifetime risk of AF in both women and men (4,9). At age 55 years, the lifetime risk to develop AF was 22.2% in women and 23.8% in men in the population-based Rotterdam Study (4).…”

“…Obesity has been shown to increase the risk of developing AF by 49% compared to non-obese individuals (10). In the large BiomarCaRE Consortium comprising almost 80,000 individuals among whom over 4,000 incident AF cases, BMI explained the largest proportion of AF risk (around 20% for overweight and obesity combined) (9). Elevated BMI was reported to account for up to 18% of risk for incident AF among women in the Women's Health Study (WHS) (11).…”

“…Elevated BMI was reported to account for up to 18% of risk for incident AF among women in the Women's Health Study (WHS) (11). A body of evidence suggests a stronger association between BMI and AF among men, compared with women (9,12). One standard deviation (SD) increase in BMI was associated with 11% and 14% greater excess risk for AF among men compared to women in the large BiomarCaRE Consortium (9) and in a recent analyses of the prospective Scottish Heart Health Extended Cohort, respectively (12).…”

Genetic risk and atrial fibrillation in patients with heart failure

“…Atrial fibrillation (AF) is the most common cardiac arrhythmia and is highly prevalent in patients with heart failure . The co‐existence of these conditions can be expected by virtue of their prevalence alone: the lifetime risk of developing AF is about one in three in individuals of European ancestry and one in five in individuals of African ancestry, and after age 45 the lifetime risk of heart failure ranges between 20–45%…”