The Impact of Gender on Atrial Fibrillation Incidence and Progression to Dementia

Golive, Anjani; May, Heidi T; Bair, Tami L; Jacobs, Victoria; Crandall, Brian G.; Cutler, Michael J.; Day, John D.; Mallender, Charles; Osborn, Jeffrey S.; Weiss, J. Peter; Bunch, T. Jared

doi:10.1016/j.amjcard.2018.07.031

Cited by 12 publications

(8 citation statements)

References 27 publications

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“…Among the patients who developed AF, the 5-year rate of dementia in women was 2.9% versus 2.3% in men (p=0.180), and the long-term rate was 3.7% in women and 3.0% in men (p=0.110). [18]…”

Section: Af and Dementia Risk With And Without Overt Cerebral Ischaemmentioning

confidence: 99%

Atrial Fibrillation and Dementia: Exploring the Association, Defining Risks and Improving Outcomes

Bunch

Galenko

Graves

et al. 2019

Arrhythm Electrophysiol Rev

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AF is strongly associated with a spectrum of cranial injuries including stroke and dementia. Dementia risk is seen in patients with and without a prior stroke and includes idiopathic forms of dementia, such as Alzheimer’s disease. The initiation, use and efficacy of anticoagulation have been shown in multiple observational trials to have an impact on dementia risk. Cerebral hypoperfusion during AF can result in cognitive decline and patients with cranial atherosclerosis may have unique susceptibility. Therapies to carefully control the ventricular rate and catheter ablation have been shown in observational trials to lower dementia risk. There is a need for further research in multiple areas and the observational trials will require prospective trials confirmation. Recent guidelines for AF have advocated the initiation of effective anticoagulation, the treatment of associated disease conditions that may influence the progression of AF and catheter ablation, with long-term management of risk factors to lower risk of dementia.

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“…Among the patients who developed AF, the 5-year rate of dementia in women was 2.9% versus 2.3% in men (p=0.180), and the long-term rate was 3.7% in women and 3.0% in men (p=0.110). [18]…”

Section: Af and Dementia Risk With And Without Overt Cerebral Ischaemmentioning

confidence: 99%

Atrial Fibrillation and Dementia: Exploring the Association, Defining Risks and Improving Outcomes

Bunch

Galenko

Graves

et al. 2019

Arrhythm Electrophysiol Rev

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“…These researchers reported pathophysiological disease links between AF and vascular cognitive impairment identifying therapeutic targets for new interventions, but conclude that evidence on sex differences in rates of cognitive disease progression remains unclear. Golive and associates reported women with or without AF have higher rates of dementia over time versus men which they attributed to higher stroke rates and nontraditional cardiovascular risk factors in women 54 . Higher rates of dementia were reported in patients with AF compared to no AF; yet they found no sex‐based differences in AF‐related dementia (0.4% vs. 0.4%, p = 0.88) 54 …”

Section: Discussionmentioning

confidence: 98%

Is the association between cognitive disease progression and atrial fibrillation modified by sex?

Wood

Han

et al. 2023

Alzheimer's & Dementia

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INTRODUCTIONIt is unclear if sex differences exist in cognitive disease progression in mild cognitive impairment (MCI) and dementia associated with atrial fibrillation (AF).METHODSUsing a variety of statistical methods, we examined sex differences between AF and neuropsychological tests and cognitive disease progression, using the National Alzheimer's Coordinating Center data (N = 43,630).RESULTSAF is associated with higher odds of dementia (odds ratio [OR] 3.00, 95% confidence interval [CI] [1.22, 7.37] in women and MCI in women (OR 3.43, 95% CI [1.55, 7.55]) versus men. Women with AF and normal baseline cognition had a higher risk of disease progression (hazard ratio [HR] 1.26, 95% CI [1.06, 1.50]) from normal to MCI and from MCI to vascular dementia (HR3.27, 95% CI [1.89, 5.65]) than men with AF or men and women without AF.DISCUSSIONAF was associated with more rapid progression to MCI and dementia in women, but more research is needed to confirm these findings.

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“…Further studies focusing on the mechanism of sex dependent development of AD dementia in AF patients should be conducted. Golive et al reported that in patients who developed AF during follow-up, dementia rates increased and did not show sex-based differences in risk [ 33 ]. Prior stroke history was an independent risk factor for the development of dementia in both sexes.…”

Section: Discussionmentioning

confidence: 99%

Sex Difference in the Risk of Dementia in Patients with Atrial Fibrillation

Chen

Wang

et al. 2021

Diagnostics

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Atrial fibrillation (AF) is one of the risk factors for dementia. Female sex is an inconsistent risk factor for dementia after adjusting for age in the general population, and there lacks research on its impact in developing dementia in patients with AF. This paper aims to investigate whether female sex is a risk factor for dementia in AF patients. Data of patients with newly diagnosed AF between 2001–2013 were retrieved from Taiwan’s National Health Insurance Research Database. Exclusion criteria were: patients with incomplete demographic data, age < 20 years, rheumatic heart disease, hyperthyroidism, past valvular heart surgery, and a history of dementia. Propensity score matching (PSM) between sexes was performed, including comorbidities, medications and index date stratified by age. The primary outcome was a new diagnosis of dementia at follow-up. A total of 117,517 men and 156,705 women were eligible for analysis. After 1:1 PSM, both 100,065 men and women (aged 72.5 ± 12.5 years) were included for analysis. Dementia risk varied with age in women compared with men. The difference was negligible for ≤55 years (sub distribution HR (SHR) = 0.89, 95% CI 0.73–1.07), but increased between 56–65 years (SHR = 1.13, 95% CI 1.02–1.25), 66–75 years (SHR = 1.14, 95% CI 1.09–1.20), 75–85 years (SHR = 1.11, 95% CI 1.07–1.15) and >85 years (SHR 1.10, 95% CI 1.04–1.16) for females. This study establishes that female sex increases the risk of developing dementia compared to male sex in AF patients aged >56 years. However, the impact of female sex on dementia in AF patients differs between dementia types.

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The Impact of Gender on Atrial Fibrillation Incidence and Progression to Dementia

Cited by 12 publications

References 27 publications

Atrial Fibrillation and Dementia: Exploring the Association, Defining Risks and Improving Outcomes

Atrial Fibrillation and Dementia: Exploring the Association, Defining Risks and Improving Outcomes

Is the association between cognitive disease progression and atrial fibrillation modified by sex?

Sex Difference in the Risk of Dementia in Patients with Atrial Fibrillation

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