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Thromb Haemost 2014; 112(04): 789-795
DOI: 10.1160/TH14-06-0545
Cardiovascular Biology and Cell Signalling
Schattauer GmbH

Female sex as a risk factor for thromboembolism and death in patients with incident atrial fibrillation

The prospective Danish Diet, Cancer and Health study
Thure Filskov Overvad
1   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
2   University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
,
Lars Hvilsted Rasmussen
1   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
,
Flemming Skjøth
1   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
3   Department of Cardiology, AF Study group, Aalborg University Hospital, Denmark
,
Kim Overvad
3   Department of Cardiology, AF Study group, Aalborg University Hospital, Denmark
4   Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
,
Ida Ehlers Albertsen
2   University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
3   Department of Cardiology, AF Study group, Aalborg University Hospital, Denmark
,
Deirdre A. Lane
2   University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
,
Gregory Y. H. Lip   *
1   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
2   University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
,
Torben Bjerregaard Larsen   *
1   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
3   Department of Cardiology, AF Study group, Aalborg University Hospital, Denmark
› Author Affiliations
Further Information

Publication History

Received: 23 June 2014

Accepted after minor revision: 17 July 2014

Publication Date:
04 December 2017 (online)

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Summary

Several studies have demonstrated sex differences in risk of thromboembolism and death among patients with atrial fibrillation, but it is unclear to what extent these associations relate to actual physiological differences. To date, no study has investigated sex differences with concomitant control for lifestyle related factors known to influence stroke risk. We used data from the Danish Diet, Cancer and Health study, including 57,053 participants (52% female) aged 50–64 years. The study population for this study included the 2,895 patients (36% female) with incident atrial fibrillation after inclusion. Data were linked to outcomes identified using nationwide registries. Risk of thromboembolism and death according to female sex were analysed using Cox proportional hazards models. After a median follow-up of 5.0 years, 137 men and 62 women suffered a thromboembolic event, and 349 men and 151 women died. In a crude analysis, female sex was associated with a non-significant lower risk of thromboembolism (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.61–1.11). Adjustment for differences in antithrombotic therapy, relevant comorbidities and lifestyle did not change this association (HR 0.77, 95% CI 0.55–1.13). In the final model, female sex was associated with a lower risk of death (HR 0.65, 95% CI 0.51–0.84). The associations were similar in a sensitivity analysis of women not taking hormone replacement therapy, and the effect of hormone replacement therapy use within females was non-significant for both endpoints of thromboembolism and death. In conclusion, in a relatively young population of patients with atrial fibrillation, female sex was associated with a lower risk of thromboembolism and death.

Keywords

Atrial fibrillation - sex differences - thromboembolism - stroke - death - epidemiology

* Joint senior authors.


 

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