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Female sex as a risk factor for stroke in atrial fibrillation: a nationwide cohort study
Author(s) -
MIKKELSEN A. P.,
LINDHARDSEN J.,
LIP G. Y. H.,
GISLASON G. H.,
TORPPEDERSEN C.,
OLESEN J. B.
Publication year - 2012
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/j.1538-7836.2012.04853.x
Subject(s) - medicine , atrial fibrillation , stroke (engine) , hazard ratio , risk factor , confidence interval , cohort , population , proportional hazards model , cohort study , female sex , mechanical engineering , environmental health , engineering
Summary. Background: Female sex has been suggested as a risk factor for stroke/thromboembolism in patients with non‐valvular atrial fibrillation (AF) and has therefore been included within risk scores, e.g. the CHA 2 DS 2 ‐VASc score, and guidelines. Objectives: To investigate the risk of stroke/thromboembolism associated with female sex in non‐valvular AF patients. Patients/Methods: Using the national Danish registers, we identified non‐anticoagulated patients discharged with non‐valvular AF (1997–2008), and subdivided the population into three age intervals: < 65, 65–74 and ≥ 75 years. We calculated stroke rates according to sex, and assessed the stroke risk associated with female sex by using Cox regression analysis. Results: We included 87 202 AF patients, and 44 744 (51.3%) were female. The rate of stroke/thromboembolism for females aged < 65 and 65–74 years was not increased as compared with men, whereas the rate for females aged ≥ 75 years was increased. At both 1‐year and 12‐year follow‐up, female sex did not increase the risk of stroke for patients aged < 75 years. At 1‐year follow‐up, the hazard ratios associated with female sex were 0.89 (95% confidence interval [CI] 0.70–1.13) and 0.91 (95 CI 0.79–1.05) for patients aged < 65 and 65–74 years, respectively, and being female and aged ≥ 75 years was associated with an increased risk of stroke of 1.20 (95 CI 1.12–1.28). Conclusion: Female sex was only associated with an increased risk of stroke for AF patients aged ≥ 75 years. Our study suggests that female sex should not be automatically included as an independent stroke/thromboembolic risk factor in guidelines or in the CHA 2 DS 2 ‐VASc score, without careful prior consideration of the ‘age < 65 and lone AF’ criterion.