Atrial Fibrillation Is a Major Risk Factor for Stroke, Especially in Women: The Jichi Medical School Cohort Study Increased risk of first-ever stroke in younger patients with atrial fibrillation not recommended for antithrombotic therapy by current guidelines: a population-based study in an East Asian cohort of 22 million people. Gender Differences in the Risk of Ischemic Stroke and Peripheral Embolism in Atrial Fibrillation: The AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) Study Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Influence of Gender on Baseline Features and Clinical Outcomes among 17,370 Patients with Confirmed Ischaemic Stroke in the International Stroke Trial Gender differences in stroke risk of atrial fibrillation patients on oral anticoagulant treatment. Acute stroke with atrial fibrillation. The Copenhagen Stroke Study. A longitudinal population-based study of prothrombotic factors in elderly subjects with atrial fibrillation: the Rotterdam Study 1990-1999. Women hospitalized with atrial fibrillation: gender differences, trends and outcome from a 20-year registry in a Middle Eastern country (1991-2010). Impact of atrial fibrillation on mortality, stroke, and medical costs. Sex-specific increase in the prevalence of atrial fibrillation (The Copenhagen City Heart Study). Factors associated with ischemic stroke during aspirin therapy in atrial fibrillation: analysis of 2012 participants in the SPAF I-III clinical trials. The Stroke Prevention in Atrial Fibrillation (SPAF) Investigators. Risk factors for atrial fibrillation and their population burden in postmenopausal women: the Women's Health Initiative Observational Study Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Patients with nonvalvular atrial fibrillation at low risk of stroke during treatment with aspirin: Stroke Prevention in Atrial Fibrillation III Study. The SPAF III Writing Committee for the Stroke Prevention in Atrial Fibrillation Investigators. Prevalence of atrial fibrillation and association of atrial fibrillation with prior and new thromboembolic stroke in older patients. Impact of gender on the prognosis of patients with nonvalvular atrial fibrillation.
Background Only a few population -based cohort studies have investigated the impact of  atrial fibrillation ( AF ) on stroke in Japan . Methods A total of 10 929 participants ( 4147 men and 6782 women ) were included in this population -based prospect i ve cohort study . Baseline data , including  electrocardiograms ( ECGs )  to ascertain AF status , were obtained from April 1992 through July 1995 in 12 areas in Japan . Cox proportional hazards models were used to analyze the association of AF with stroke . Results A total of 54 participants had AF ( 0.49 % ) . The mean follow-up period was 10.7 years , during which 405 strokes were identified ; 12 of these occurred in participants with AF . The crude incidence of stroke in participants with and without AF was 14.9 and 4.5 per 1000 person-years in men , respectively , and 39.3 and 2.7 per 1000 person-years in women . After adjusting for geographical area , sex , age , smoking status , drinking status , obesity , hypertension , dyslipidemia , and diabetes mellitus , the hazard ratios ( 95 % confidence interval ) of AF in all participants and in male and female participants were 4.11 ( 2.28–7.41 ) , 2.12 ( 0.77–5.84 ) , and 10.6 ( 5.01–22.4 ) , respectively . The population attributable fraction ( PAF ) of stroke caused by AF was 2.2 % ; the PAFs were 1.0 % and 3.6 % in men and women , respectively . Conclusions The present Japanese population -based prospect i ve cohort study showed that AF is a major risk factor for stroke , especially in women OBJECTIVE To assess the risk of first-ever ischemic stroke in younger patients with atrial fibrillation ( AF ) who have none of the CHA2DS2-VASc ( congestive heart failure , hypertension , age ≥75 years , diabetes mellitus , previous stroke/transient ischemic attack , vascular disease , age 65 - 74 years , sex category [ female sex ] ) risk factors ( excluding female sex ) by using the National Health Insurance research data base in Taiwan . PATIENTS AND METHODS From 22,842,778 insured people , we identified 24,612 hospitalized patients with newly diagnosed AF between January 1 , 2002 , and December 31 , 2004 , as the AF group and r and omly selected 98,448 age- and sex-matched persons without AF as the non-AF group . Both groups were followed up until December 31 , 2010 , to estimate ischemic stroke incidences in relation to other stroke risk factors . RESULTS During a follow-up period of 89,468 person-years , the stroke rate was higher in patients with AF than in those without AF ( 5.79 per 100 person-years vs 2.25 per 100 person-years ) . The higher prevalence of CHA2DS2-VASc comorbidities ( heart failure , hypertension , diabetes , coronary artery disease , and peripheral artery disease ) in patients with AF further increased the stroke risk . In 790 patients with AF aged 30 to 55 years who had none of the CHA2DS2-VASc comorbidities at baseline and retained a " low risk , " that is , those with a CHA2DS2-VASc score of 0 in men and 1 in women during follow-up , the stroke rate remained considerably higher than that in their non-AF counterparts ( 1.00 per 100 person-years vs 0.25 per 100 person-years ) , with a sex-adjusted hazard ratio of 4.09 ( 95 % CI , 2.97 - 5.62 ) . CONCLUSION This study finds an increased risk of stroke in younger patients with AF who are not recommended for prevention of thromboembolism by current guidelines . Better stroke risk stratification tools are needed to prioritize younger patients with AF for thromboprophylactic therapy in this population Background —Previous studies provide conflicting results about whether women are at higher risk than men for thromboembolism in the setting of atrial fibrillation ( AF ) . We examined data from a large contemporary cohort of AF patients to address this question . Methods and Results —We prospect ively studied 13 559 adults with AF and recorded data on patients ’ clinical characteristics and the occurrence of incident hospitalizations for ischemic stroke , peripheral embolism , and major hemorrhagic events through search ing vali date d computerized data bases and medical record review . We compared event rates by patient sex using multivariable log-linear regression , adjusting for clinical risk factors for stroke , and stratifying by warfarin use . We identified 394  ischemic stroke and peripheral embolic events during 15 494 person-years of follow-up off warfarin . After multivariable analysis , women had higher annual rates of thromboembolism off warfarin than did men ( 3.5 % versus 1.8 % ; adjusted rate ratio [ RR ] , 1.6 ; 95 % CI , 1.3 to 1.9 ) . There was no significant difference by sex in 30-day mortality after thromboembolism ( 23 % for both ) . Warfarin use was associated with significantly lower adjusted thromboembolism rates for both women and men ( RR , 0.4 ; 95 % CI , 0.3 to 0.5 ; and RR , 0.6 ; 95 % CI , 0.5 to 0.8 , respectively ) , with similar annual rates of major hemorrhage ( 1.0 % and 1.1 % , respectively ) . Conclusions —Women are at higher risk than men for AF-related thromboembolism off warfarin . Warfarin therapy appears be as effective in women , if not more so , than in men , with similar rates of major hemorrhage . Female sex is an independent risk factor for thromboembolism and should influence the decision to use anticoagulant therapy in persons with AF AIMS The impact of some risk factors for stroke and bleeding , and the value of stroke and bleeding risk scores , in atrial fibrillation ( AF ) , has been debated , as clinical trial cohorts have not adequately tested these . Our objective was to investigate risk factors for stroke and bleeding in AF , and application of the new CHA(2)DS(2)-VASc and HAS-BLED schemes for stroke and bleeding risk assessment s , respectively . METHODS AND RESULTS We used the Swedish Atrial Fibrillation cohort study , a nationwide cohort study of 182 678 subjects with a diagnosis of AF at any Swedish hospital between 1 July 2005 and 31 December 2008 , who were prospect ively followed for an average of 1.5 years ( 260 000 years at risk ) . With the use of the National Swedish Drug Registry , all patients who used an oral anticoagulant  anytime during follow-up were identified . Most of the analyses were made on a subset of 90 490 patients who never used anticoagulants .  Risk factors for stroke , the composite thromboembolism endpoint ( stroke , TIA , or systemic embolism ) , and bleeding , and the performance of published stroke and bleeding risk stratification schemes were investigated . On multivariable analysis , significant associations were found between the following ' new ' risk factors and thromboembolic events ; peripheral artery disease [ hazard ratio ( HR ) 1.22 ( 95 % CI 1.12 - 1.32 ) ] , ' vascular disease ' [ HR 1.14 ( 1.06 - 1.23 ) ] , prior myocardial infa rct ion [ HR 1.09 ( 1.03 - 1.15 ) ] , and female gender [ HR 1.17 ( 1.11 - 1.22 ) ] . Previous embolic events , intracranial haemorrhage ( ICH ) , hypertension , diabetes , and renal failure were other independent predictors of the composite thromboembolism endpoint , while thyroid disease ( or hyperthyroidism ) was not an independent stroke risk factor . C-statistics for the composite thromboembolic endpoint with the CHADS(2 ) and CHA(2)DS(2)-VASc schemes were 0.66 ( 0.65 - 0.66 ) and 0.67 ( 0.67 - 0.68 ) , respectively . On multivariable analysis , age , prior ischaemic stroke or thromboembolism , prior major bleeding events , and hypertension were significant predictors of ICH and major bleeding . Heart failure , diabetes , renal failure , liver disease , anaemia or platelet/coagulation defect , alcohol abuse , and cancer were other significant predictors for major bleeding , but not ICH . The ability for predicting ICH and major bleeding with both bleeding risk schemes ( HEMORR(2)HAGES , HAS-BLED ) were similar , with c-statistics of ~0.6 . CONCLUSION Several independent risk factors ( prior ICH , myocardial infa rct ion , vascular disease , and renal failure ) predict ischaemic stroke and /or the composite thromboembolism endpoint in AF , but thyroid disease ( or hyperthyroidism ) was not an independent risk factor for stroke . There is a better performance for CHA(2)DS(2)-VASc over CHADS(2 ) schemes for the composite thromboembolism endpoint . While both tested bleeding risk schemes have similar predictive value , the HAS-BLED score has the advantage of simplicity Aim : We sought to determine whether there were differences between men and women with acute stroke in their baseline characteristics and outcome in a large cohort of patients r and omized in the International Stroke Trial ( IST ) . Methods : Of the 19,435 patients r and omized in the IST , 17,370 had an ischemic stroke confirmed by CT scan or autopsy ( 8,003 female and 9,367 male ) . In males and females , we compared baseline characteristics ( age , frequency of atrial fibrillation , pre-stroke administration of aspirin and systolic blood pressure , conscious level , stroke syndrome ) and outcome at 14 days and 6 months ( death , complications , dependency , recovery , place of residence ) . We developed a specific logistic regression model to adjust for case-mix in order to evaluate the separate influence of gender on outcome . Results : Female patients were older , suffered more frequently from atrial fibrillation , had higher systolic blood pressure at r and omization and generally had more severe strokes ( a higher proportion were unconscious or drowsy or had a total anterior circulation syndrome ) . Females had higher 14-day and 6-month case fatality and were more likely to be dead or dependent at six months ( and consequently more likely to require institutional or residential care ) . Gender was an independent predictor of death or dependency at 6 months . Conclusions : The adverse effect of female gender on outcome indicates that further research to explore the underlying biological mechanism is justified , and that more intensive acute and long-term treatment may be needed to improve outcome among female patients with stroke The efficacy of adjusted-dose oral anticoagulant treatment ( OAT ) in the prevention of stroke in atrial fibrillation ( AF ) is well documented . Available data show that AF patients are widely heterogeneous in terms of ischaemic stroke risk . The role of female gender as a predictor of stroke risk is inconsistent , in particular it is unclear if warfarin treatment is able to prevent stroke equally in both sexes . We performed a prospect i ve study on 780 AF patients on OAT , followed by an Anticoagulation Clinic , to evaluate if female gender is a risk factor for stroke among patients on OAT  and if the quality of anticoagulation is different between genders . No difference was found in relation to the quality of anticoagulation between genders ( p=0.5 ) . During follow-up 33 patients had major bleedings ( rate 1.37 x 100 pt/yrs ) but no difference was found between genders in bleeding risk . Forty patients had ischaemic events [ rate 1.66 x 100 pt/yrs ; males rate 1.2 x 100 pt/yrs ; females rate 2.43 x 100 pt/yrs ; p=0.042 ; relative risk ( RR ) of females vs. males 2.0 ( 95 % confidence interval [ CI ] 1.3 - 3.1 ) ; p= 0.004 ] . The higher rate of ischaemic events in females with respect to males was confirmed at Cox regression analysis after correction for age ( p=0.009 ) . In addition , strokes occurring in females were more disabling , and RR for severe and fatal stroke , defined according to Modified Rankin scale , of females vs. males was 3.1 ( 95 % CI 1.3 - 6.5 ; p=0.001 ) . In conclusion , our data show a higher risk of stroke in anticoagulated AF females with respect to males , despite a similar quality of anticoagulation BACKGROUND Atrial fibrillation ( AF ) is a common arrhythmia and a major risk factor for stroke . Many physicians remain reluctant to provide stroke prevention by anticoagulant therapy especially for elderly individuals with AF . Using multivariate regression analyses , we studied the characteristics and the prognosis of stroke in patients with AF . METHODS The study is part of the Copenhagen Stroke Study , a prospect i ve , community-based study of 1197 patients with acute stroke treated on a stroke unit from the time of acute admission to the end of rehabilitation .  Initial stroke severity was measured by the Sc and inavian Neurological Stroke Scale ( SSS ) . Neurological and functional outcomes were evaluated by the SSS and the Barthel Index . RESULTS AF was diagnosed in 18 % of the patients . AF increased steeply with age in the stroke population , from 2 % in patients < 50 years old , 15 % in patients in their 70s , and 28 % in patients in their 80s , to 40 % in patients > or = 90 years of age . In a multivariate analysis AF was associated with age ( odds ratio [ OR ] , 2.0 per 10-year increase ; 95 % confidence ratio [ CI ] , 1.6 to 2.6 ) , ischemic heart disease ( OR , 3.4 ; 95 % CI , 2.4 to 4.8 ) , previous stroke ( OR , 1.8 ; 95 % CI , 1.2 to 2.6 ) , and systolic blood pressure ( OR , 0.93 per 10-mm Hg increases ; 95 % CI , 0.88 to 0.99 ) , but not with sex , diabetes , hypertension , previous transient ischemic attack , or silent infa rct ion on computed tomography . Patients with AF had a higher mortality rate ( OR , 1.7 ; 95 % CI , 1.2 to 2.5 ) , longer hospital stays ( 50 days versus 40 days , P < .001 ) , and a lower discharge rate to their own homes ( OR , 0.60 ; 95 % CI , 0.44 to 0.85 ) . Neurological and functional outcomes were markedly poorer in patients with AF . Poorer outcome was exclusively explained by initially more-severe strokes . CONCLUSIONS Stroke in patients with AF is generally more severe and outcome markedly poorer than in patients with sinus rhythm . This accentuates the importance of anticoagulant treatment of individuals with AF . A lower blood pressure in the acute stage of stroke may contribute to the increased stroke severity in patients with AF BACKGROUND A prothrombotic or hypercoagulable state in atrial fibrillation may contribute to stroke and thromboembolism . Results of longitudinal population -based studies in elderly people with atrial fibrillation are not yet available . METHODS In the Rotterdam Study , a population -based prospect i ve cohort study , 162 participants with atrial fibrillation at baseline , aged 55 years and over , were matched for age and gender with 324 people in sinus rhythm . Associations were examined between three coagulation factors and the risk of total and cardiac mortality and stroke . Hazard rate ratios were calculated with 95 % confidence intervals using Cox 's proportional hazards model , adjusted for potential confounders . RESULTS Plasma von Willebr and factor was , age- and gender-adjusted , associated with cardiac mortality in the total population ( relative risk 1.16 ; 1.06 - 1.27 , per 10 IU dL(-1 ) increase ) , but statistical significance was lost after additional adjustments . A strong association ( 1.27 ; 1.08 - 1.50 , per 5-unit increase ) was found between soluble P-selectin ( sP-sel ) and cardiac mortality in atrial fibrillation patients but not in participants in sinus rhythm . Furthermore , the expected association between fibrinogen and cardiac mortality was observed only in those in sinus rhythm ( 2.60 ; 1.69 - 4.01 , per unit increase ) , and not in atrial fibrillation . No associations were found between coagulation factors and stroke . CONCLUSIONS In this population -based study , plasma levels of sP-sel predicted clinical adverse outcomes in atrial fibrillation , suggesting a role of platelets in the prothrombotic state associated with atrial fibrillation . Fibrinogen was a risk factor of cardiac and all-cause mortality in sinus rhythm , but not in atrial fibrillation BACKGROUND Most of the published research on atrial fibrillation ( AF ) is limited to studies in the developed world and included mainly Caucasian patients . Data about women with AF among other ethnicities is very limited . OBJECTIVES The aim of this study was to compare the clinical characteristics , treatment and outcome of women to men hospitalized with AF in a middle-eastern country . METHODS Retrospective analysis of prospect i ve registry of all patients hospitalized with AF in Qatar from 1991 through 2010 was made . Clinical characteristics , management , and outcomes of AF patients were compared according to gender . RESULTS During the 20-years period ; 1417 women and 2432 men were hospitalized for AF . Women were 5 years older and more likely to have diabetes mellitus , hypertension , and chronic renal impairment and were also less likely to be current smokers and to have ischemic heart disease and impaired left ventricular function when compared to men . There was no gender preference in the use of anticoagulation . The prevalence of concomitant ischemic heart disease and hypertension increased , while the prevalence of valvular heart disease and heart failure decreased among patients hospitalized with AF over the study period . In-hospital mortality and stroke rates were comparable between the two groups . CONCLUSIONS Women hospitalized with atrial fibrillation were older in age and had higher prevalence of co-morbid cardiovascular risk factors compared to men whereas , mortality and stroke rates were comparable BACKGROUND The impact of  atrial fibrillation ( AF ) on mortality , stroke , and medical costs is unknown . METHODS We conducted a prospect i ve cohort study of hospitalized Medicare patients with AF and 1 other cardiovascular diagnosis ( CVD ) compared with a matched group without AF ( n = 26,753 ) , r and omly selected in 6 age-sex strata from 1989 MedPAR files of more than 1 million patients diagnosed as having AF .  Stroke rates were also determined in another cohort free of CVD ( n = 14,267 ) .  Total medical costs after hospitalization were available from a 1991 cohort . Cumulative mortality , stroke rates , and costs following index admission were adjusted by multivariate and proportional hazard regression analyses . RESULTS Mortality rates were high in individuals with CVD , ranging from 19.0 % to 52.1 % in 1 year . Adjusted relative mortality risk was approximately 20 % higher in patients with AF in all age-sex strata during each of the 3 years studied ( P < .05 ) . Incidence of stroke was high in individuals with CVD , 6.2 % to 15.4 % in 1 year , with and without AF , and was at least 5-fold higher than in individuals without CVD . In those with CVD , stroke rates were approximately 25 % higher in women with AF ( P < .05 ) but only 10 % higher in men . Adjusted total Medicare spending in 1 year was 8.6- to 22.6-fold greater in men , and 9.8- to 11.2-fold greater in women with AF ( P < .05 ) . Second- and third-year costs were increased as well . CONCLUSION Prevention of AF and treatment of patients with AF and associated CVD may yield benefits in reduced mortality and stroke as well as reducing health care costs Atrial fibrillation ( AF ) is the most frequently encountered cardiac arrhythmia . It is a risk factor for stroke and premature death . We studied the temporal changes in the prevalence of  AF  from 1976 to 1994 in a r and om population aged 50 to 89 years . The prevalence of AF , diagnosed from electrocardiograms ( ECGs ) , was determined in 8,606 patients examined in 1976 to 1978 , in 8,943 patients examined in 1981 to 1983 , and in 6,733 subjects examined in 1991 to 1994 . Changes in prevalence of AF were estimated by logistic regression analysis . In men , the age-st and ardized prevalence of AF increased from 1.4 % in 1976 to 1978 ( odds ratio [ OR ] 1.0 , reference ) to 1.9 % in 1981 to 1983 ( OR 1.6 , 95 % confidence interval [ CI ] 1.1 to 2.1 ) , and to 3.3 % in 1991 to 1994 ( OR 2.3 , 95 % CI 1.6 to 3.4 , p<0.001 , adjusted for age ) . In women , the prevalence of AF decreased from 1.5 % in 1976 to 1978 ( OR 1.0 , reference ) to 1.0 % in 1981 to 1983 ( OR 0.7 , 95 % CI 0.5 to 1.0 ) , and to 1.1 % in 1991 to 1994 ( OR 0.7 , 95 % CI 0.5 to 1.0 ) , although the overall decrease was not significant ( p=0.11 , adjusted for age ) . After adjusting for changes in comorbidity , body weight , and height , the increase in the prevalence of AF in men from 1976 to 1978 and from 1991 to 1994 remained significant ( OR 1.9 , 95 % CI 1.3 to 2.8 , p=0.002 ) . Although unchanged in women , the prevalence of AF in men more than doubled from the 1970s to the 1990s . The factors responsible for this gender-specific increase in the prevalence of this common arrhythmia have yet to be identified BACKGROUND AND PURPOSE Nonvalvular atrial fibrillation ( AF ) is a strong , independent risk factor for stroke , but the absolute rate of stroke varies widely among AF patients , importantly influencing the potential benefit of antithrombotic prophylaxis . We explore factors associated with ischemic stroke in AF patients taking aspirin .  METHODS We performed multivariate logistic regression analysis of 2012 participants given aspirin alone or in combination with low , inefficacious doses of warfarin in the Stroke Prevention in Atrial Fibrillation I-III trials followed for a mean of 2.0 years , during which 130 ischemic strokes were observed . RESULTS Age ( relative risk [RR]=1.8 per decade , P<0.001 ) , female sex ( RR=1.6 , P=0.01 ) , history of hypertension ( RR=2.0 , P<0.001 ) , systolic blood pressure > 160 mm Hg ( RR=2.3 , P<0.001 ) , and prior stroke or transient ischemic attack ( RR=2.9 , P<0.001 ) were independently associated with increased stroke risk . Regular consumption of > /=14 alcohol-containing drinks per week was associated with reduced stroke risk ( adjusted RR=0.4 , P=0.04 ) . Among SPAF III participants , estrogen hormone replacement therapy was associated with a higher risk of ischemic stroke ( adjusted RR=3.2 , P=0.007 ) . With the use of these variables , a risk stratification scheme for primary prevention separated participants into those with high ( 7.1%/y , 22 % of the cohort ) , moderate ( 2.6%/y , 37 % of the cohort ) , and low ( 0.9%/y , 41 % of the cohort ) rates of stroke . Ischemic strokes in low-risk participants were less often disabling ( P<0.001 ) . CONCLUSIONS Patients with AF who have high and low rates of stroke during treatment with  aspirin can be identified . However , validation of our risk stratification scheme is necessary before it can be applied with confidence to clinical management . Postmenopausal estrogen replacement therapy and moderate alcohol consumption may additionally modify the risk of stroke in AF , but these findings require confirmation Objective Atrial fibrillation ( AF ) is the most common arrhythmia in women . Large studies evaluating key AF risk factors in older women are lacking . We aim ed to identify risk factors for AF  in postmenopausal women and measure population burden of modifiable risk factors . Design Prospect i ve observational study . Setting The Women 's Health Initiative ( WHI ) Observational Study . Patients 93 676 postmenopausal women were followed for an average of 9.8 years for cardiovascular outcomes . After exclusion of women with prevalent AF or incomplete data , 8252 of the remaining 81 892 women developed incident AF . Main outcome measures Incident AF was identified by WHI-ascertained hospitalisation records and diagnosis codes from Medicare cl aims . Multivariate Cox hazard regression analysis identified independent risk factors for incident AF . Results Age , hypertension , obesity , diabetes , myocardial infa rct ion and heart failure were independently associated with incident AF . Hypertension and overweight status accounted for 28.3 % and 12.1 % , respectively , of the population attributable risk . Hispanic and African – American participants had lower rates of incident AF ( HR 0.58 , 95 % CI 0.47 to 0.70 and HR 0.59 , 95 % CI 0.53 to 0.65 , respectively ) than Caucasians . Conclusions Caucasian ethnicity , traditional cardiovascular risk factors and peripheral arterial disease were independently associated with higher rates of incident AF  in postmenopausal women . Hypertension and overweight status accounted for a large proportion of population attributable risk . Measuring burden of modifiable AF risk factors in older women may help target interventions Atrial  fibrillation ( AF ) is a common arrhythmia in elderly persons and a common cause of embolic stroke . Most studies of the prevalence and correlates of AF have used selected , hospital-based population s. The Cardiovascular Health Study is a population -based , longitudinal study of risk factors for coronary artery disease and stroke in 5,201 men and women aged > or = 65 years .  AF  was diagnosed in 4.8 % of women and in 6.2 % of men at the baseline examination , and prevalence was strongly associated with advanced age in women . Prevalence of AF  was 9.1 % in men and women with clinical cardiovascular disease , 4.6 % in patients with evidence of sub clinical but no clinical cardiovascular disease , and only 1.6 % in subjects with neither clinical nor sub clinical cardiovascular disease . A history of congestive heart failure , valvular heart disease and stroke , echocardiographic evidence of enlarged left atrial dimension , abnormal mitral or aortic valve function , treated systemic hypertension , and advanced age were independently associated with the prevalence of AF .  The low prevalence of AF in the absence of clinical and sub clinical cardiovascular disease calls into question the existence and clinical usefulness of the concept of so-called " lone atrial fibrillation " in the elderly CONTEXT Nonvalvular atrial fibrillation ( AF ) carries an increased risk for stroke , but absolute rates of stroke vary widely within the broad spectrum of AF patients . OBJECTIVE To prospect ively vali date a risk stratification scheme identifying patients with AF with low rates of stroke when given aspirin .  DESIGN Prospect i ve cohort study with mean duration of follow-up of 2.0 years , conducted between 1993 and 1997 . SETTING Outpatient clinics affiliated with academic medical centers . PATIENTS Patients with AF categorized as " low risk " based on the absence of 4 prespecified thromboembolic risk factors : recent congestive heart failure or left ventricular fractional shortening of 25 % or less , previous thromboembolism , systolic blood pressure greater than 160 mm Hg , or female sex at age older than 75 years . INTERVENTION All participants given aspirin , 325 mg/d . MAIN OUTCOME MEASURES Ischemic stroke ( considered disabling when Rankin score was II or worse 1 - 3 months later ) and systemic embolism ( primary events ) . RESULTS Among 892 participants , the mean ( SD ) age was 67 ( 10 ) years , 78 % were men , and histories of hypertension , diabetes , and ischemic heart disease were present in 46 % , 13 % , and 16 % , respectively . The rate of primary events was 2.2 % per year ( 95 % confidence interval [ CI ] , 1.6%-3.0 % ) , of ischemic stroke was 2.0 % per year ( 95 % CI , 1.5%-2.8 % ) , and of disabling ischemic strokes was 0.8 % per year ( 95 % CI , 0.5%-1.3 % ) . Those with a history of hypertension had a higher rate of primary events ( 3.6 % per year ) than those with no history of hypertension ( 1.1 % per year ) ( P<.001 ) . The rate of disabling ischemic stroke was low in those with and without a history of hypertension ( 1.4 % per year and 0.5 % per year , respectively ) . The rate of major bleeding during aspirin therapy was 0.5 % per year . CONCLUSION Patients with AF who have relatively low rates of ischemic stroke , particularly disabling stroke , during treatment with aspirin can be reliably identified OBJECTIVE To correlate atrial fibrillation with the incidence of new thromboembolic ( TE ) stroke  in older patients with and without prior TE stroke . DESIGN In a prospect i ve study of 2101 older patients ,  electrocardiograms  showed that atrial fibrillation was present in 283 patients ( 13 % ) . At 42-month mean follow-up , atrial fibrillation was associated with the incidence of new TE stroke in patients with and without prior TE stroke . SETTING A large long-term health care facility where 2101 older patients were studied . PATIENTS The 2101 patients included 1451 women and 650 men , mean age 81 + /- 8 years ( range 60 to 103 ) . MEASUREMENTS AND MAIN RESULTS Atrial fibrillation was present in 283 of 2101 patients ( 13 % ) . The mean age was 84 + /- 7 years in patients with atrial fibrillation and 81 + /- 8 years in patients with sinus rhythm ( P = .0001 ) . The prevalence of atrial fibrillation was 5 % in patients aged 60 to 70 years , 14 % in patients aged 71 to 80 years , 13 % in patients aged 81 to 90 years , and 22 % in patients aged 91 to 103 years ( P < .0001 ) . Mean follow-up was 31 + /- 18 months in patients with atrial fibrillation and 44 + /- 27 months in patients with sinus rhythm ( P = .0001 ) . Previous TE stroke occurred in 123 of 283 patients ( 43 % ) with atrial fibrillation and in 431 of 1818 patients ( 24 % ) with sinus rhythm ( P < .0001 ) . New TE stroke occurred in 131 of 283 patients ( 46 % ) with atrial fibrillation and in 303 of 1818 patients ( 17 % ) with sinus rhythm ( P < .0001 ) . The log-rank test showed that patients with atrial fibrillation had a significantly higher probability of developing new TE stroke than those with sinus rhythm ( P < .0001 ) . The multivariate Cox regression model showed that independent risk factors for new TE stroke were male sex ( relative risk = 1.3 ) , prior TE stroke ( relative risk = 3.1 ) , and atrial fibrillation ( relative risk = 3.3 ) . CONCLUSIONS Atrial fibrillation , prior TE stroke , and male sex are independent risk factors for the development of new TE stroke in older patients Treatment guidelines for atrial fibrillation ( AF ) used in Western countries describe female gender as a risk factor for thromboembolic events in patients with nonvalvular AF ( NVAF ) . The present study aim ed to determine the impact of gender on prognosis of Japanese patients with NVAF . A sub analysis of 7,406 patients with NVAF ( mean age 70 years ) who were followed-up prospect ively for 2 years was performed using data from the J-RHYTHM registry . The primary end points were thromboembolic events , major hemorrhaging , total mortality , and cardiovascular mortality . Compared with male subjects ( n = 5,241 ) , female subjects ( n = 2,165 ) were older and displayed greater prevalences of paroxysmal AF , heart failure , and hypertension but less prevalences of diabetes , previous cerebral infa rct ion , and coronary artery disease . Male and female patients had mean CHADS2 ( Congestive heart failure , Hypertension , Age of 75 years or more , Diabetes mellitus and prior Stroke or transient ischemic attack ) scores of 1.6 and 1.8 , respectively ( p < 0.001 ) . Warfarin was given to 87 % of male patients and 86 % of female patients ( p = 0.760 ) , and the 2 genders displayed similar mean international normalized ratio of prothrombin time values at baseline ( 1.91 vs 1.90 , respectively , p = 0.756 ) . Multivariate logistic regression analysis indicated that male gender was an independent risk factor for major hemorrhaging ( odds ratio 1.59 , 95 % confidence interval 1.05 to 2.40 , p = 0.027 ) and all-cause mortality ( odds ratio 1.78 , 95 % confidence interval 1.25 to 2.55 , p < 0.002 ) but not for thromboembolic events ( odds ratio 1.24 , 95 % confidence interval 0.83 to 1.86 , p = 0.297 ) or cardiovascular mortality ( odds ratio 0.96 , 95 % confidence interval 0.56 to 1.66 , p = 0.893 ) . In conclusion , female gender is not a risk factor for thromboembolic events among Japanese patients with NVAF who were treated mostly with warfarin . However , male gender is a risk factor for major hemorrhaging and all-cause mortality
Women with AF are at increased risk of stroke , particularly elderly women .
BACKGROUND Atrial fibrillation ( AF ) increases the risk of stroke , but this risk is not homogenous .
Many risk factors contribute to stroke risk however , the evidence for female sex as a risk factor is less well-established .
AIM To perform a systematic review and meta- analysis of the available evidence to establish if female sex is a risk factor for stroke/thromboembolism among patients with AF .