Skip to main content
Top
Published in: Internal and Emergency Medicine 2/2020

01-03-2020 | Stroke | IM - COMMENTARY

Female sex and stroke in atrial fibrillation: an intriguing relationship

Authors: Giuseppe Boriani, Jacopo Colella, Jacopo Imberti, Elisa Fantecchi, Marco Vitolo

Published in: Internal and Emergency Medicine | Issue 2/2020

Login to get access

Excerpt

The growing epidemics of atrial fibrillation (AF) as well as the possibility to prevent stroke by use of anticoagulants in patients with a profile at risk of thromboembolism promoted in the last 20 years the elaboration and the refinement of scores for better characterising the risk of stroke, as a guide for anticoagulants prescription [1, 2]. …
Literature
1.
go back to reference Boriani G, Diemberger I, Martignani C, Biffi M, Branzi A (2006) The epidemiological burden of atrial fibrillation: a challenge for clinicians and health care systems. Eur Heart J 27:893–894CrossRef Boriani G, Diemberger I, Martignani C, Biffi M, Branzi A (2006) The epidemiological burden of atrial fibrillation: a challenge for clinicians and health care systems. Eur Heart J 27:893–894CrossRef
2.
go back to reference Lip GYH, Banerjee A, Boriani G, Chiang CE, Fargo R, Freedman B et al (2018) Antithrombotic therapy for atrial fibrillation: CHEST guideline and expert panel report. Chest 154:1121–1201CrossRef Lip GYH, Banerjee A, Boriani G, Chiang CE, Fargo R, Freedman B et al (2018) Antithrombotic therapy for atrial fibrillation: CHEST guideline and expert panel report. Chest 154:1121–1201CrossRef
3.
go back to reference Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ (2001) Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 285:2864–2870CrossRef Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ (2001) Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 285:2864–2870CrossRef
4.
go back to reference Eckman MH, Singer DE, Rosand J, Greenberg SM (2011) Moving the tipping point: the decision to anticoagulate patients with atrial fibrillation. Circ Cardiovasc Qual Outcomes 4:14–21CrossRef Eckman MH, Singer DE, Rosand J, Greenberg SM (2011) Moving the tipping point: the decision to anticoagulate patients with atrial fibrillation. Circ Cardiovasc Qual Outcomes 4:14–21CrossRef
5.
go back to reference Ko D, Rahman F, Schnabel RB, Yin X, Benjamin EJ, Christophersen IE (2016) Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis. Nat Rev Cardiol 13:321–332CrossRef Ko D, Rahman F, Schnabel RB, Yin X, Benjamin EJ, Christophersen IE (2016) Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis. Nat Rev Cardiol 13:321–332CrossRef
6.
go back to reference Boriani G, Laroche C, Diemberger I, Fantecchi E, Popescu MI, Rasmussen LH et al (2015) Asymptomatic atrial fibrillation: clinical correlates, management, and outcomes in the EORP-AF Pilot General Registry. Am J Med 128(509–518):e502 Boriani G, Laroche C, Diemberger I, Fantecchi E, Popescu MI, Rasmussen LH et al (2015) Asymptomatic atrial fibrillation: clinical correlates, management, and outcomes in the EORP-AF Pilot General Registry. Am J Med 128(509–518):e502
7.
go back to reference Lip GY, Laroche C, Boriani G, Cimaglia P, Dan GA, Santini M et al (2015) Sex-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Observational Research Programme Pilot survey on Atrial Fibrillation. Europace 17:24–31CrossRef Lip GY, Laroche C, Boriani G, Cimaglia P, Dan GA, Santini M et al (2015) Sex-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Observational Research Programme Pilot survey on Atrial Fibrillation. Europace 17:24–31CrossRef
8.
go back to reference Malavasi VL, Pettorelli D, Fantecchi E, Zoccali C, Laronga G, Trenti T et al (2018) Variations in clinical management of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation according to different equations for estimating renal function: post hoc analysis of a prospective cohort. Intern Emerg Med 13:1059–1067CrossRef Malavasi VL, Pettorelli D, Fantecchi E, Zoccali C, Laronga G, Trenti T et al (2018) Variations in clinical management of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation according to different equations for estimating renal function: post hoc analysis of a prospective cohort. Intern Emerg Med 13:1059–1067CrossRef
9.
go back to reference Boriani G, Laroche C, Diemberger I, Fantecchi E, Meeder J, Kurpesa M et al (2018) Overweight and obesity in patients with atrial fibrillation: sex differences in 1-year outcomes in the EORP-AF General Pilot Registry. J Cardiovasc Electrophysiol 29:566–572CrossRef Boriani G, Laroche C, Diemberger I, Fantecchi E, Meeder J, Kurpesa M et al (2018) Overweight and obesity in patients with atrial fibrillation: sex differences in 1-year outcomes in the EORP-AF General Pilot Registry. J Cardiovasc Electrophysiol 29:566–572CrossRef
10.
go back to reference Camm AJ, Savelieva I (2017) Female gender as a risk factor for stroke associated with atrial fibrillation. Eur Heart J 38(19):1480–1484CrossRef Camm AJ, Savelieva I (2017) Female gender as a risk factor for stroke associated with atrial fibrillation. Eur Heart J 38(19):1480–1484CrossRef
12.
go back to reference Fang MC, Singer DE, Chang Y, Hylek EM, Henault LE, Jensvold NG et al (2005) Gender differences in the risk of ischemic stroke and peripheral embolism in atrial fibrillation: the AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) study. Circulation 112:1687–1691CrossRef Fang MC, Singer DE, Chang Y, Hylek EM, Henault LE, Jensvold NG et al (2005) Gender differences in the risk of ischemic stroke and peripheral embolism in atrial fibrillation: the AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) study. Circulation 112:1687–1691CrossRef
13.
go back to reference Oza NM, Baveja S, Tedrow U (2015) Bridging the gender gap in atrial fibrillation. Expert Rev Cardiovasc Ther 13:317–323CrossRef Oza NM, Baveja S, Tedrow U (2015) Bridging the gender gap in atrial fibrillation. Expert Rev Cardiovasc Ther 13:317–323CrossRef
14.
go back to reference Boriani G, Lip GYH, Ricci RP, Proclemer A, Landolina M, Lunati M et al (2017) The increased risk of stroke/transient ischemic attack in women with a cardiac implantable electronic device is not associated with a higher atrial fibrillation burden. Europace 19:1767–1775CrossRef Boriani G, Lip GYH, Ricci RP, Proclemer A, Landolina M, Lunati M et al (2017) The increased risk of stroke/transient ischemic attack in women with a cardiac implantable electronic device is not associated with a higher atrial fibrillation burden. Europace 19:1767–1775CrossRef
15.
go back to reference Anselmino M, Battaglia A, Gallo C, Gili S, Matta M, Castagno D et al (2015) Atrial fibrillation and female sex. J Cardiovasc Med (Hagerstown) 16:795–801CrossRef Anselmino M, Battaglia A, Gallo C, Gili S, Matta M, Castagno D et al (2015) Atrial fibrillation and female sex. J Cardiovasc Med (Hagerstown) 16:795–801CrossRef
16.
go back to reference Penttilä T, Lehto M, Niiranen J, Mehtälä J, Khanfir H, Lassila R et al (2019) Differences in the risk of stroke, bleeding events, and mortality between female and male patients with atrial fibrillation during warfarin therapy. Eur Heart J Cardiovasc Pharmacother 5:29–36CrossRef Penttilä T, Lehto M, Niiranen J, Mehtälä J, Khanfir H, Lassila R et al (2019) Differences in the risk of stroke, bleeding events, and mortality between female and male patients with atrial fibrillation during warfarin therapy. Eur Heart J Cardiovasc Pharmacother 5:29–36CrossRef
17.
go back to reference Gomberg-Maitland M, Wenger NK, Feyzi J, Lengyel M, Volgman AS, Petersen P et al (2006) Anticoagulation in women with non-valvular atrial fibrillation in the stroke prevention using an oral thrombin inhibitor (SPORTIF) trials. Eur Heart J 27:1947–1953CrossRef Gomberg-Maitland M, Wenger NK, Feyzi J, Lengyel M, Volgman AS, Petersen P et al (2006) Anticoagulation in women with non-valvular atrial fibrillation in the stroke prevention using an oral thrombin inhibitor (SPORTIF) trials. Eur Heart J 27:1947–1953CrossRef
18.
go back to reference Humphries KH, Kerr CR, Connolly SJ, Klein G, Boone JA, Green M et al (2001) New-onset atrial fibrillation: sex differences in presentation, treatment, and outcome. Circulation 103:2365–2370CrossRef Humphries KH, Kerr CR, Connolly SJ, Klein G, Boone JA, Green M et al (2001) New-onset atrial fibrillation: sex differences in presentation, treatment, and outcome. Circulation 103:2365–2370CrossRef
19.
go back to reference Emdin CA, Wong CX, Hsiao AJ, Altman DG, Peters SA, Woodward M et al (2016) Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies. BMJ 532:h7013CrossRef Emdin CA, Wong CX, Hsiao AJ, Altman DG, Peters SA, Woodward M et al (2016) Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies. BMJ 532:h7013CrossRef
20.
go back to reference Marzona I, Proietti M, Farcomeni A, Romiti GF, Romanazzi I, Raparelli V et al (2018) Sex differences in stroke and major adverse clinical events in patients with atrial fibrillation: a systematic review and meta-analysis of 993,600 patients. Int J Cardiol 269:182–191CrossRef Marzona I, Proietti M, Farcomeni A, Romiti GF, Romanazzi I, Raparelli V et al (2018) Sex differences in stroke and major adverse clinical events in patients with atrial fibrillation: a systematic review and meta-analysis of 993,600 patients. Int J Cardiol 269:182–191CrossRef
21.
go back to reference Christenfeld NJ, Sloan RP, Carroll D, Greenland S (2004) Risk factors, confounding, and the illusion of statistical control. Psychosom Med 66:868–875CrossRef Christenfeld NJ, Sloan RP, Carroll D, Greenland S (2004) Risk factors, confounding, and the illusion of statistical control. Psychosom Med 66:868–875CrossRef
22.
go back to reference Renoux C, Coulombe J, Suissa S (2017) Revisiting sex differences in outcomes in non-valvular atrial fibrillation: a population-based cohort study. Eur Heart J 38:1473–1479PubMed Renoux C, Coulombe J, Suissa S (2017) Revisiting sex differences in outcomes in non-valvular atrial fibrillation: a population-based cohort study. Eur Heart J 38:1473–1479PubMed
23.
go back to reference Nielsen PB, Skjoth F, Overvad TF, Larsen TB, Lip GYH (2018) Female sex is a risk modifier rather than a risk factor for stroke in atrial fibrillation: should we use a CHA2DS2-VA score rather than CHA2DS2-VASc? Circulation 137:832–840CrossRef Nielsen PB, Skjoth F, Overvad TF, Larsen TB, Lip GYH (2018) Female sex is a risk modifier rather than a risk factor for stroke in atrial fibrillation: should we use a CHA2DS2-VA score rather than CHA2DS2-VASc? Circulation 137:832–840CrossRef
24.
go back to reference Gerstein HC (2002) Epidemiologic analyses of risk factors, risk indicators, risk markers, and causal factors. The example of albuminuria and the risk of cardiovascular disease in diabetes. Endocrinol Metab Clin N Am 31:537–551CrossRef Gerstein HC (2002) Epidemiologic analyses of risk factors, risk indicators, risk markers, and causal factors. The example of albuminuria and the risk of cardiovascular disease in diabetes. Endocrinol Metab Clin N Am 31:537–551CrossRef
25.
go back to reference Kraemer HC, Kazdin AE, Offord DR, Kessler RC, Jensen PS, Kupfer DJ (1997) Coming to terms with the terms of risk. Arch Gen Psychiatry 54:337–343CrossRef Kraemer HC, Kazdin AE, Offord DR, Kessler RC, Jensen PS, Kupfer DJ (1997) Coming to terms with the terms of risk. Arch Gen Psychiatry 54:337–343CrossRef
26.
go back to reference Baron RM, Kenny DA (1986) The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51:1173CrossRef Baron RM, Kenny DA (1986) The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51:1173CrossRef
27.
go back to reference Kraemer HC, Stice E, Kazdin A, Offord D, Kupfer D (2001) How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. Am J Psychiatry 158:848–856CrossRef Kraemer HC, Stice E, Kazdin A, Offord D, Kupfer D (2001) How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. Am J Psychiatry 158:848–856CrossRef
28.
go back to reference Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al (2006) ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114:e257–354CrossRef Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al (2006) ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114:e257–354CrossRef
29.
go back to reference Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S et al (2010) Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31:2369–2429CrossRef Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S et al (2010) Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31:2369–2429CrossRef
30.
go back to reference Members ATF, Camm AJ, Lip GYH, De Caterina R, Savelieva I, Atar D et al (2012) 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 33:2719–2747CrossRef Members ATF, Camm AJ, Lip GYH, De Caterina R, Savelieva I, Atar D et al (2012) 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 33:2719–2747CrossRef
31.
go back to reference Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al (2016) 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37:2893–2962CrossRef Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al (2016) 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37:2893–2962CrossRef
32.
go back to reference Skanes AC, Healey JS, Cairns JA, Dorian P, Gillis AM, McMurtry MS et al (2012) Focused 2012 update of the Canadian Cardiovascular Society atrial fibrillation guidelines: recommendations for stroke prevention and rate/rhythm control. Can J Cardiol 8:125–136CrossRef Skanes AC, Healey JS, Cairns JA, Dorian P, Gillis AM, McMurtry MS et al (2012) Focused 2012 update of the Canadian Cardiovascular Society atrial fibrillation guidelines: recommendations for stroke prevention and rate/rhythm control. Can J Cardiol 8:125–136CrossRef
33.
go back to reference Verma A, Cairns JA, Mitchell LB, Macle L, Stiell IG, Gladstone D et al (2014) 2014 focused update of the Canadian Cardiovascular Society Guidelines for the management of atrial fibrillation. Can J Cardiol 30:1114–1130CrossRef Verma A, Cairns JA, Mitchell LB, Macle L, Stiell IG, Gladstone D et al (2014) 2014 focused update of the Canadian Cardiovascular Society Guidelines for the management of atrial fibrillation. Can J Cardiol 30:1114–1130CrossRef
34.
go back to reference Macle L, Cairns J, Leblanc K, Tsang T, Skanes A, Cox JL et al (2016) 2016 focused update of the canadian cardiovascular society guidelines for the management of atrial fibrillation. Can J Cardiol 32:1170–1185CrossRef Macle L, Cairns J, Leblanc K, Tsang T, Skanes A, Cox JL et al (2016) 2016 focused update of the canadian cardiovascular society guidelines for the management of atrial fibrillation. Can J Cardiol 32:1170–1185CrossRef
35.
go back to reference Andrade JG, Verma A, Mitchell LB, Parkash R, Leblanc K, Atzema C et al (2018) 2018 focused update of the canadian cardiovascular society guidelines for the management of atrial fibrillation. Can J Cardiol 34:1371–1392CrossRef Andrade JG, Verma A, Mitchell LB, Parkash R, Leblanc K, Atzema C et al (2018) 2018 focused update of the canadian cardiovascular society guidelines for the management of atrial fibrillation. Can J Cardiol 34:1371–1392CrossRef
36.
go back to reference January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC et al (2014) 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 130:e199–267PubMedPubMedCentral January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC et al (2014) 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 130:e199–267PubMedPubMedCentral
37.
go back to reference January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC et al (2019) 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation 140:e125–e151CrossRef January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC et al (2019) 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation 140:e125–e151CrossRef
38.
go back to reference Chiang CE, Okumura K, Zhang S, Chao TF, Siu CW, Wei Lim T et al (2017) 2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation. J Arrhythm 33:345–367CrossRef Chiang CE, Okumura K, Zhang S, Chao TF, Siu CW, Wei Lim T et al (2017) 2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation. J Arrhythm 33:345–367CrossRef
39.
go back to reference Brieger D, Amerena J, Attia J, Bajorek B, Chan KH, Connell C et al (2018) National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the diagnosis and management of atrial fibrillation 2018. Heart Lung Circ 27:1209–1266CrossRef Brieger D, Amerena J, Attia J, Bajorek B, Chan KH, Connell C et al (2018) National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the diagnosis and management of atrial fibrillation 2018. Heart Lung Circ 27:1209–1266CrossRef
40.
go back to reference Joung B, Lee JM, Lee KH, Kim TH, Choi EK, Lim WH et al (2018) 2018 Korean guideline of atrial fibrillation management. Korean Circ J 48:1033–1080CrossRef Joung B, Lee JM, Lee KH, Kim TH, Choi EK, Lim WH et al (2018) 2018 Korean guideline of atrial fibrillation management. Korean Circ J 48:1033–1080CrossRef
Metadata
Title
Female sex and stroke in atrial fibrillation: an intriguing relationship
Authors
Giuseppe Boriani
Jacopo Colella
Jacopo Imberti
Elisa Fantecchi
Marco Vitolo
Publication date
01-03-2020
Publisher
Springer International Publishing
Published in
Internal and Emergency Medicine / Issue 2/2020
Print ISSN: 1828-0447
Electronic ISSN: 1970-9366
DOI
https://doi.org/10.1007/s11739-019-02169-2

Other articles of this Issue 2/2020

Internal and Emergency Medicine 2/2020 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine