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Circulation. 2017 Oct 24;136(17):1588-1597. doi: 10.1161/CIRCULATIONAHA.117.028981. Epub 2017 Oct 16.

Sex Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors, and Mortality in Community Cohorts: Results From the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe).

Author information

1
From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.).
2
From Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (C.M., F.M.O., S.B., T.Z., R.B.S.); DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany (C.M., S.B., T.Z., R.B.S.); National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, MA (T.J.N.); Department of Community Medicine, University of Tromso The Arctic University of Norway, Tromsø (I.N.); Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy (F.G., S.C., M.B.D., G.d.G., L.I.); EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy (F.G.); National Institute for Health and Welfare, Helsinki, Finland (T.J.N., E.V., P.J., T.P., K.K., V.S.); Catalan Department of Health, Barcelona, Spain (S. Sans); Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Netherlands (G.P.); Center of Excellence for Public Health, Institute of Clinical Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland (M.H.); Research Center for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L., T.J.); Department of Epidemiology and Public Health, University College London, UK (M.B.); Laboratory of Experimental Cardiology, University Medical Center Utrecht, Netherlands (H.M.d.R.); Department of Clinical Medicine, Brain and Circulation Research Group, UiT The Arctic University of Norway, Tromsø (E.M.); Research Center for Prevention and Health, Glostrup University Hospital, Denmark (T.J.); Faculty of Medicine, Aalborg University, Denmark (T.J.); Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden (S. Söderberg); and Department of Medicine and Surgery, University of Insubria, Varese, Italy (L.I.). r.schnabel@uke.de.

Abstract

BACKGROUND:

Atrial fibrillation (AF) is a common cardiac disease in aging populations with high comorbidity and mortality. Sex differences in AF epidemiology are insufficiently understood.

METHODS:

In N=79 793 individuals without AF diagnosis at baseline (median age, 49.6 years; age range, 24.1-97.6 years; 51.7% women) from 4 community-based European studies (FINRISK, DanMONICA, Moli-sani Northern Sweden) of the BiomarCaRE consortium (Biomarker for Cardiovascular Risk Assessment in Europe), we examined AF incidence, its association with mortality, common risk factors, biomarkers, and prevalent cardiovascular disease, and their attributable risk by sex. Median follow-up time was 12.6 (to a maximum of 28.2) years.

RESULTS:

Fewer AF cases were observed in women (N=1796; 4.4%), than in men (N=2465; 6.4%). Cardiovascular risk factor distribution and lipid profile at baseline were less beneficial in men than in women, and cardiovascular disease was more prevalent in men. Cumulative incidence increased markedly after the age of 50 years in men and after 60 years in women. The lifetime risk was similar (>30%) for both sexes. Subjects with incident AF had a 3.5-fold risk of death in comparison with those without AF. Multivariable-adjusted models showed sex differences for the association of body mass index and AF (hazard ratio per standard deviation increase, 1.18; 95% confidence interval [CI], 1.12-1.23 in women versus 1.31; 95% CI 1.25-1.38 in men; interaction P value of 0.001). Total cholesterol was inversely associated with incident AF with a greater risk reduction in women (hazard ratio per SD, 0.86; 95% CI, 0.81-0.90 versus 0.92; 95% CI, 0.88-0.97 in men; interaction P value of 0.023). No sex differences were seen for C-reactive protein and N-terminal pro B-type natriuretic peptide. The population-attributable risk of all risk factors combined was 41.9% in women and 46.0% in men. About 20% of the risk was observed for body mass index.

CONCLUSIONS:

Lifetime risk of AF was high, and AF was strongly associated with increased mortality both in women and men. Body mass index explained the largest proportion of AF risk. Observed sex differences in the association of body mass index and total cholesterol with AF need to be evaluated for underlying pathophysiology and relevance to sex-specific prevention strategies.

KEYWORDS:

atrial fibrillation; biomarkers; cohort studies; epidemiology; mortality; risk assessment; sex

PMID:
29038167
PMCID:
PMC5657474
[Available on 2018-10-24]
DOI:
10.1161/CIRCULATIONAHA.117.028981
[Indexed for MEDLINE]

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