Sex Differences in Atrial Fibrillation Risk

Siddiqi, Hasan K.; Vinayagamoorthy, Manickavasagar; Gencer, Baris; Ng, C. M.; Pester, Julie; Cook, Nancy R.; Lee, I-Min; Buring, Julie E.; Manson, JoAnn E.; Albert, Christine M.

doi:10.1001/jamacardio.2022.2825

Cited by 29 publications

(19 citation statements)

References 47 publications

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“…The next, another possible explanation is that 80% of the patients in the population were male atrial fibrillation. There were gender differences in AF patients [24,25] . Cheng [26] conducted a meta-analysis of 151370 patients, 34% of whom were women, and discovered that women who underwent catheter ablation of AF may have a higher risk of stroke/TIA and major complications than men, and that genetic, vascular biology, hormonal, or thromboembolic factors that differ between men and women may lead to a higher risk of complications [27,28] .…”

Section: Discussionmentioning

confidence: 92%

Catheter ablation of atrial fibrillation in the young: a systematic review and meta-analysis

Zhan

Zheng

Huang

et al. 2023

Preprint

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Aims The differences in the clinical outcomes of rhythm and safety after catheter ablation in young and old atrial fibrillation(AF) patients remain unclear. The purpose of this study was to compare the clinical outcomes of catheter ablation for in young and old AF patients. Methods and results The Medline and EMBASE databases were searched for published articles up to Octomber 2022. Studies that met our predefined inclusion criteria were included. The primary endpoints were freedom from AF/atrial tachycardia (AT) recurrence, safety ouctcomes including the stroke/transient ischaemic attack (TIA), cardiac tamponade and pericardial effusion. After literature search and detailed assessment, 6 studies (9982 patients) were identified. Our analyses showed that the rate of freedom from AF/AT recurrence was higher in young than old AF patients after ablation [odds ratio (OR): 0.58, 95% confidence interval (CI) 0.36–0.92; P -0.02]. Compared to older patients, there were similar rate of adverse outcomes including pericardial effusion /tamponade (OR=0.61, 95%CI 0.29-1.27,P=0.18), hematoma(OR=1.87, 95%CI 0.62,5.63, P=0.27) and stroke/ TIA rate(OR=0.25, 95%CI 0.05,1.41, P=0.12) . Conclusions In younger atrial fibrillation patients, there is a lower major complication rate and a comparable efficacy rate, with a greater chance of being AF free without antiarrhythmic drugs. These findings suggest that it may be appropriate to consider ablative therapy as first-line therapy in this age group.

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Section: Discussionmentioning

confidence: 92%

Catheter ablation of atrial fibrillation in the young: a systematic review and meta-analysis

Zhan

Zheng

Huang

et al. 2023

Preprint

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“…However, we observed high correlations between self-reported and directly measured variables, such as weight and BMI, in a subset of VITAL participants enrolled in the Clinical Translational Science Center. 47 Fifth, participants with morbid obesity were underrepresented in the study population; thus, the proportion presenting with paroxysmal AF may, to some degree, be an overestimate of the general population. Sixth, standardized echocardiograms were not systematically collected in this cohort, and, therefore, we were unable to perform a formal mediation analysis.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for the Development of New-Onset Persistent Atrial Fibrillation: Subanalysis of the VITAL Study

Middeldorp,

Sandhu,

Mao

et al. 2023

Circ: Arrhythmia and Electrophysiology

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BACKGROUND: Sustained forms of atrial fibrillation (AF) are associated with lower treatment success rates and poorer prognosis compared with paroxysmal AF. Yet, little is known about risk factors that predispose to persistent AF on initial presentation. Our objective was to define risk factors associated with new-onset persistent AF. METHODS: We prospectively examined the differential associations between lifestyle, clinical, and socioeconomic risk factors and AF pattern (persistent versus paroxysmal) at the time of diagnosis among 25 119 participants without a history of cardiovascular disease, AF, or cancer in the VITAL rhythm study (Vitamin D and Omega-3). RESULTS: During a median follow-up of 5.3 years, 900 participants developed AF and 346 (38.4%) were classified as persistent at the time of diagnosis. In multivariable competing risk models, increasing age, male sex, White race, height, weight, body mass index ≥30 kg/m 2 , hypertension, current or past smoking, alcohol intake ≥2 drinks/day, postcollege education, and randomized treatment with vitamin D were significantly associated with incident persistent AF. Compared with paroxysmal AF, increasing age, male sex, weight, body mass index ≥30 kg/m 2 , and postcollege education were more strongly associated with persistent AF in multivariable models regardless of whether interim cardiovascular disease and heart failure events were censored. CONCLUSIONS: In a prospective cohort without baseline AF or cardiovascular disease, over one-third of AF at the time of diagnosis is persistent. Older age, male sex, postcollege education, and obesity were preferentially associated with persistent AF and represent a high-risk AF subset for population-based intervention.

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“…The pathophysiologic mechanisms involved in the differential risk for men and women per decade are unclear and may include increased pregnancies due to repeated hormonal exposure and other metabolic factors ( 32 ); including earlier age at menopause associated with the anti-inflammatory effects of estrogens ( 33 ), DM has been associated with incident AF in women but not in men ( 34 ), and OSA is more frequent in women older than 55 years ( 35 ). Siddiqi et al reported that women are at higher risk for incident AF than men when BMI is analyzed in stratified models ( 36 ). Although the accumulation of comorbidities increases the chance of developing risk factors, some factors such as family history of AF, ethnicity and genetic risk profile should be considered to explain the increased AF risk in older women ( 37 ).…”

Section: Discussionmentioning

confidence: 99%

Machine learning for atrial fibrillation risk prediction in patients with sleep apnea and coronary artery disease

Silva

Morillo²,

Leite-Castro³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundPatients with sleep apnea (SA) and coronary artery disease (CAD) are at higher risk of atrial fibrillation (AF) than the general population. Our objectives were: to evaluate the role of CAD and SA in determining AF risk through cluster and survival analysis, and to develop a risk model for predicting AF.MethodsElectronic medical record (EMR) database from 22,302 individuals including 10,202 individuals with AF, CAD, and SA, and 12,100 individuals without these diseases were analyzed using K-means clustering technique; k-nearest neighbor (kNN) algorithm and survival analysis. Age, sex, and diseases developed for each individual during 9 years were used for cluster and survival analysis.ResultsThe risk models for AF, CAD, and SA were identified with high accuracy and sensitivity (0.98). Cluster analysis showed that CAD and high blood pressure (HBP) are the most prevalent diseases in the AF group, HBP is the most prevalent disease in CAD; and HBP and CAD are the most prevalent diseases in the SA group. Survival analysis demonstrated that individuals with HBP, CAD, and SA had a 1.5-fold increased risk of developing AF [hazard ratio (HR): 1.49, 95% CI: 1.18–1.87, p = 0.0041; HR: 1.46, 95% CI: 1.09–1.96, p = 0.01; HR: 1.54, 95% CI: 1.22–1.94, p = 0.0039, respectively] and individuals with chronic kidney disease (CKD) developed AF approximately 50% earlier than patients without these comorbidities in a period of 7 years (HR: 3.36, 95% CI: 1.46–7.73, p = 0.0023). Comorbidities that contributed to develop AF earlier in females compared to males in the group of 50–64 years were HBP (HR: 3.75 95% CI: 1.08–13, p = 0.04) CAD and SA in the group of 60–75 years were (HR: 2.4 95% CI: 1.18–4.86, p = 0.02; HR: 2.51, 95% CI: 1.14–5.52, p = 0.02, respectively).ConclusionMachine learning based algorithms demonstrated that CAD, SA, HBP, and CKD are significant risk factors for developing AF in a Latin–American population.

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Sex Differences in Atrial Fibrillation Risk

Cited by 29 publications

References 47 publications

Catheter ablation of atrial fibrillation in the young: a systematic review and meta-analysis

Catheter ablation of atrial fibrillation in the young: a systematic review and meta-analysis

Risk Factors for the Development of New-Onset Persistent Atrial Fibrillation: Subanalysis of the VITAL Study

Machine learning for atrial fibrillation risk prediction in patients with sleep apnea and coronary artery disease

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