Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis

In the paper

“Similarly to incidence, age-adjusted prevalence of AF has been reported to be lower in women than in men in North America and Europe (Figure 2) (Supplementary Tables S3 and S4).”

What the sources say

• Not checked yetcites [5] Schnabel, R. B. et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet 386, 154–162 (2015). source
• Not checked yetcites [18] Wilke, T. et al. Incidence and prevalence of atrial fibrillation: an analysis based on 8.3 million patients. Europace 15, 486–493 (2013). source
• Not checked yetcites [19] Piccini, J. P. et al. Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993–2007. Circ. Cardiovasc. Qual. Outcomes 5, 85–93 (2012). source

In the paper

“In North American and European populations, the age-adjusted incidence of AF has been estimated to be 1.5 to 2 times higher in men than in women (Supplementary Tables S1 and S2).”

What the sources say

• Not checked yetcites [5] Schnabel, R. B. et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet 386, 154–162 (2015). source
• Not checked yetcites [15] Benjamin, E. J. et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 98, 946–952 (1998). source
• Not checked yetcites [1] Chugh, S. S. et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 129, 837–847 (2014). source

In the paper

“AF incidence has been shown to increase disproportionately with increasing age in both women and men, reaching as high as 30.4 per 1000 person-years in women and 32.9 per 1000 person-years in men by age 85–89 years.17”

What the sources say

• Not checked yetcites [17] Chien, K. L. et al. Atrial fibrillation prevalence, incidence and risk of stroke and all-cause death among Chinese. Int. J. Cardiol. 139, 173–180 (2010). source

In the paper

“Because women typically live longer than men, the absolute number of women exceeds the number of men with AF in Medicare data.18”

What the sources say

• Not checked yetcites [18] Wilke, T. et al. Incidence and prevalence of atrial fibrillation: an analysis based on 8.3 million patients. Europace 15, 486–493 (2013). source

In the paper

“The estimated prevalence is lower in women (373 per 100,000) than in men (596 per 100,000).1”

What the sources say

• Not checked yetcites [1] Chugh, S. S. et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 129, 837–847 (2014). source

In the paper

“However, after adjusting for height and other AF risk factors, a multivariable risk score for incident AF in a three-cohort study showed male sex was no longer significantly associated with AF.32”

What the sources say

• Not checked yetcites [32] Guo, Y. et al. Prevalence, incidence, and lifetime risk of atrial fibrillation in China: new insights into the global burden of atrial fibrillation. Chest 147, 109–119 (2015). source

In the paper

“In the Rotterdam Study, the lifetime risks for women and men at age 55 years were 22.2% and 23.8%, respectively.30”

What the sources say

• Not checked yetcites [30] Lloyd-Jones, D. M. et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 110, 1042–1046 (2004). source

In the paper

“Several studies evaluating familial aggregation of AF have reported substantially increased risk of AF in individuals with affected family members.8,9,50–55”

What the sources say

• Not checked yetcites [8] Oyen, N. et al. Familial aggregation of lone atrial fibrillation in young persons. J. Am. Coll. Cardiol. 60, 917–921 (2012). source
• Not checked yetcites [9] Zoller, B., Ohlsson, H., Sundquist, J. & Sundquist, K. High familial risk of atrial fibrillation/atrial flutter in multiplex families: a nationwide family study in Sweden. J. Am. Heart Assoc. 2, e003384 (2013). source
• Not checked yetcites [50] Drca, N., Wolk, A., Jensen-Urstad, M. & Larsson, S. C. Physical activity is associated with a reduced risk of atrial fibrillation in middle-aged and elderly women. Heart 101, 1627–1630 (2015). source
• Not checked yetcites [51] Arnar, D. O. et al. Familial aggregation of atrial fibrillation in Iceland. Eur. Heart J. 27, 708–712 (2006). source
• Not checked yetcites [52] Chen, L. Y., Herron, K. J., Tai, B. C. & Olson, T. M. Lone atrial fibrillation: influence of familial disease on gender predilection. J. Cardiovasc. Electrophysiol. 19, 802–806 (2008). source
• Not checked yetcites [53] Christophersen, I. E. et al. Familial aggregation of atrial fibrillation: a study in Danish twins. Circ. Arrhythm. Electrophysiol. 2, 378–383 (2009). source
• Not checked yetcites [54] Ellinor, P. T., Yoerger, D. M., Ruskin, J. N. & MacRae, C. A. Familial aggregation in lone atrial fibrillation. Hum. Genet. 118, 179–184 (2005). source
• Not checked yetcites [55] Fox, C. S. et al. Parental atrial fibrillation as a risk factor for atrial fibrillation in offspring. JAMA 291, 2851–2855 (2004). source

In the paper

“The overall prevalence of AF varies by ancestry; prevalence studies of Asian populations have been less consistent than those of North American and European poulations.”

What the sources say

• Not checked yetcites [20] Svennberg, E. et al. Mass screening for untreated atrial fibrillation: the STROKESTOP Study. Circulation 131, 2176–2184 (2015). source
• Not checked yetcites [21] Li, Y. et al. Prevalence of atrial fibrillation in China and its risk factors. Biomed. Environ. Sci. 26, 709–716 (2013).
• Not checked yetcites [22] Zhou, Z. & Hu, D. An epidemiological study on the prevalence of atrial fibrillation in the Chinese population of mainland China. J. Epidemiol. 18, 209–216 (2008). source
• Not checked yetcites [23] Yap, K. B., Ng, T. P. & Ong, H. Y. Low prevalence of atrial fibrillation in community-dwelling Chinese aged 55 years or older in Singapore: a population-based study. J. Electrocardiol. 41, 94–98 (2008). source
• Not checked yetcites [24] Jeong, J. H. Prevalence of and risk factors for atrial fibrillation in Korean adults older than 40 years. J. Korean Med. Sci. 20, 26–30 (2005). source
• Not checked yetcites [25] Inoue, H. et al. Prevalence of atrial fibrillation in the general population of Japan: an analysis based on periodic health examination. Int. J. Cardiol. 137, 102–107 (2009). source
• Not checked yetcites [26] Iguchi, Y. et al. Prevalence of atrial fibrillation in community-dwelling Japanese aged 40 years or older in Japan: analysis of 41,436 non-employee residents in Kurashiki-city. Circ. J. 72, 909–913 (2008). source

In the paper

“Two large cross-sectional studies of Chinese cohorts reported that age-adjusted prevalence of AF was similar in women and men (0.76% versus 0.78% and 0.63% versus 0.66%),20,21”

What the sources say

• Not checked yetcites [20] Svennberg, E. et al. Mass screening for untreated atrial fibrillation: the STROKESTOP Study. Circulation 131, 2176–2184 (2015). source
• Not checked yetcites [21] Li, Y. et al. Prevalence of atrial fibrillation in China and its risk factors. Biomed. Environ. Sci. 26, 709–716 (2013).

In the paper

“However, in studies from North America,5 Europe,34,35 and Australia,11 women with AF are, on average, older than men.”

What the sources say

• Not checked yetcites [5] Schnabel, R. B. et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet 386, 154–162 (2015). source
• Not checked yetcites [34] Wang, T. J. et al. Obesity and the risk of new-onset atrial fibrillation. JAMA 292, 2471–2477 (2004). source
• Not checked yetcites [35] Potpara, T. S. et al. Gender-related differences in presentation, treatment and long-term outcome in patients with first-diagnosed atrial fibrillation and structurally normal heart: the Belgrade atrial fibrillation study. Int. J. Cardiol. 161, 39–44 (2012). source

In the paper

“In the Framingham Heart Study, the lifetime risks for AF in women and men at age 60 years were 23.4% and 25.8%, respectively.29”

What the sources say

• Not checked yetcites [29] Majeed, A., Moser, K. & Carroll, K. Trends in the prevalence and management of atrial fibrillation in general practice in England and Wales, 1994–1998: analysis of data from the general practice research database. Heart 86, 284–288 (2001). source

In the paper

“whereas data from Singapore indicated that prevalence was lower in women (0.6% versus 2.6%).22”

What the sources say

• Not checked yetcites [22] Zhou, Z. & Hu, D. An epidemiological study on the prevalence of atrial fibrillation in the Chinese population of mainland China. J. Epidemiol. 18, 209–216 (2008). source

In the paper

“The evidence for a differential AF risk dependent on the sex of the affected family member is more ambiguous (Supplementary Table S5).”

What the sources say

• Not checked yetcites [8] Oyen, N. et al. Familial aggregation of lone atrial fibrillation in young persons. J. Am. Coll. Cardiol. 60, 917–921 (2012). source
• Not checked yetcites [9] Zoller, B., Ohlsson, H., Sundquist, J. & Sundquist, K. High familial risk of atrial fibrillation/atrial flutter in multiplex families: a nationwide family study in Sweden. J. Am. Heart Assoc. 2, e003384 (2013). source
• Not checked yetcites [51] Arnar, D. O. et al. Familial aggregation of atrial fibrillation in Iceland. Eur. Heart J. 27, 708–712 (2006). source

In the paper

“Hormone replacement therapy in postmenopausal women does not seem to be associated with the risk of incident AF.”

What the sources say

• Not checked yetcites [155] Miyasaka, Y. et al. Mortality trends in patients diagnosed with first atrial fibrillation: a 21-year community-based study. J. Am. Coll. Cardiol. 49, 986–992 (2007). source

In the paper

“PR interval has been shown to be shorter in women compared with men,160”

What the sources say

• Not checked yetcites [160] Olsson, L. G., Swedberg, K., Lappas, G., Stewart, S. & Rosengren, A. Trends in mortality after first hospitalization with atrial fibrillation diagnosis in Sweden 1987 to 2006. Int. J. Cardiol. 170, 75–80 (2013). source

In the paper

“In men, lower testosterone levels have been associated with increased risk of AF.”

What the sources say

• Not checked yetcites [163] Gallego, P. et al. Cessation of oral anticoagulation in relation to mortality and the risk of thrombotic events in patients with atrial fibrillation. Thromb. Haemost. 110, 1189–1198 (2013). source

In the paper

“A recent systematic review of two randomized, controlled trials and four observational studies of AF reported that asymptomatic AF was less common among women than among men (relative risk (RR) 0.57; 95% CI 0.52–0.64).60”

What the sources say

• Not checked yetcites [60] January, C. T. et al. 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–e267 (2014).

In the paper

“the Copenhagen ECG Study, which included ECGs from almost 290,000 individuals, showed that the association of QTc interval to risk of AF development is J-shaped, with both a shorter and longer QTc interval associated with increased risk of AF.159”

What the sources say

• Not checked yetcites [159] Marijon, E. et al. Causes of death and influencing factors in patients with atrial fibrillation: a competing-risk analysis from the randomized evaluation of long-term anticoagulant therapy study. Circulation 128, 2192–2201 (2013). source

In the paper

“Female sex is a well-recognized, independent risk factor for AF-related stroke13 and systemic thromboemblism.63–65”

What the sources say

• Not checked yetcites [13] Humphries, K. H. et al. New-onset atrial fibrillation: sex differences in presentation, treatment, and outcome. Circulation 103, 2365–2370 (2001). source
• Not checked yetcites [63] Kamalvand, K. et al. Alterations in atrial electrophysiology associated with chronic atrial fibrillation in man. Eur. Heart J. 20, 888–895 (1999). source
• Not checked yetcites [64] Raitt, M. H., Kusumoto, W., Giraud, G. & McAnulty, J. H. Reversal of electrical remodeling after cardioversion of persistent atrial fibrillation. J. Cardiovasc. Electrophysiol. 15, 507–512 (2004). source
• Not checked yetcites [65] Franz, M. R., Karasik, P. L., Li, C., Moubarak, J. & Chavez, M. Electrical remodeling of the human atrium: similar effects in patients with chronic atrial fibrillation and atrial flutter. J. Am. Coll. Cardiol. 30, 1785–1792 (1997). source

In the paper

“However, in a small study of women referred for cardiac MRI, more atrial fibrosis was detected in women than in men, using delayed-enhancement magnetic resonance imaging.142”

What the sources say

• Not checked yetcites [142] Rusanen, M. et al. Heart diseases and long-term risk of dementia and Alzheimer's disease: a population-based CAIDE study. J. Alzheimers Dis. 42, 183–191 (2014). source

In the paper

“In one study of patients undergoing catheter ablation for AF, women required more-extensive ablation of non-pulmonary vein foci than men,148”

What the sources say

• Not checked yetcites [148] Fukuda, T. et al. Development of congestive heart failure in Japanese patients with atrial fibrillation. Circ. J. 71, 308–312 (2007). source

In the paper

“Animal models are consistent with electrocardiogram (ECG) recordings from healthy individuals demonstrating that women have a longer QTc interval than men.158”

What the sources say

• Not checked yetcites [158] Stollberger, C., Winkler-Dworak, M., Finsterer, J., Hartl, E. & Chnupa, P. Factors influencing mortality in atrial fibrillation. Post hoc analysis of an observational study in outpatients. Int. J. Cardiol. 103, 140–144 (2005). source

In the paper

“A number of observational studies have demonstrated the association between female sex and risk of AF-related stroke and thromboembolism (Supplementary Table S6).”

What the sources say

• Not checked yetcites [68] Platonov, P. G., Mitrofanova, L. B., Orshanskaya, V. & Ho, S. Y. Structural abnormalities in atrial walls are associated with presence and persistency of atrial fibrillation but not with age. J. Am. Coll. Cardiol. 58, 2225–2232 (2011). source
• Not checked yetcites [69] Henry, W. L. et al. Relation between echocardiographically determined left atrial size and atrial fibrillation. Circulation 53, 273–279 (1976). source
• Not checked yetcites [70] Vasan, R. S., Larson, M. G., Levy, D., Evans, J. C. & Benjamin, E. J. Distribution and categorization of echocardiographic measurements in relation to reference limits: the Framingham Heart Study: formulation of a height- and sex-specific classification and its prospective validation. Circulation 96, 1863–1873 (1997). source
• Not checked yetcites [71] Vaziri, S. M., Larson, M. G., Benjamin, E. J. & Levy, D. Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation 89, 724–730 (1994). source
• Not checked yetcites [72] Nattel, S., Burstein, B. & Dobrev, D. Atrial remodeling and atrial fibrillation: mechanisms and implications. Circ. Arrhythm. Electrophysiol. 1, 62–73 (2008). source
• Not checked yetcites [73] Anne, W. et al. Self-terminating AF depends on electrical remodeling while persistent AF depends on additional structural changes in a rapid atrially paced sheep model. J. Mol. Cell. Cardiol. 43, 148–158 (2007). source
• Not checked yetcites [74] Filgueiras-Rama, D. et al. Long-term frequency gradients during persistent atrial fibrillation in sheep are associated with stable sources in the left atrium. Circ. Arrhythm. Electrophysiol. 5, 1160–1167 (2012). source

In the paper

“Some studies suggest that female sex might be a significant risk factor for AF only for those above the age of 75 years.69,70”

What the sources say

• Not checked yetcites [69] Henry, W. L. et al. Relation between echocardiographically determined left atrial size and atrial fibrillation. Circulation 53, 273–279 (1976). source
• Not checked yetcites [70] Vasan, R. S., Larson, M. G., Levy, D., Evans, J. C. & Benjamin, E. J. Distribution and categorization of echocardiographic measurements in relation to reference limits: the Framingham Heart Study: formulation of a height- and sex-specific classification and its prospective validation. Circulation 96, 1863–1873 (1997). source

In the paper

“However, a meta-analysis of 19 studies showed increased risk for all-cause mortality in women compared with men (women-to-men RR 1.12, 95% CI 1.07–1.17).120”

What the sources say

• Not checked yetcites [120] Friberg, J., Scharling, H., Gadsboll, N., Truelsen, T. & Jensen, G. B. Comparison of the impact of atrial fibrillation on the risk of stroke and cardiovascular death in women versus men (The Copenhagen City Heart Study). Am. J. Cardiol. 94, 889–894 (2004). source

In the paper

“Notably, a nationwide register study of >120,000 individuals with AF in Denmark found a rate of thromboembolism as high as 1.24/100 person–years among women aged < 65 years with lone AF at 1-year follow-up.86 In contrast, however, a Swedish nationwide study of >140,000 individuals with AF showed that the annual stroke risk for women with AF who were aged <65 years was 0.1–0.2%.85”

What the sources say

• Not checked yetcites [86] Panwar, B. et al. Fibroblast growth factor 23 and risk of incident stroke in community-living adults. Stroke 46, 322–328 (2015). source
• Not checked yetcites [85] Patel, P., Dokainish, H., Tsai, P. & Lakkis, N. Update on the association of inflammation and atrial fibrillation. J. Cardiovasc. Electrophysiol. 21, 1064–1070 (2010). source

In the paper

“Data from the REGARDS and Atherosclerosis Risk in Communities studies indicated that the association between AF and MI was greater in women than in men.104,105”

What the sources say

• Not checked yetcites [104] Tsuneda, T. et al. Deficiency of testosterone associates with the substrate of atrial fibrillation in the rat model. J. Cardiovasc. Electrophysiol. 20, 1055–1060 (2009). source
• Not checked yetcites [105] Cove, C. L. et al. Female sex as an independent risk factor for stroke in atrial fibrillation: possible mechanisms. Thromb. Haemost. 111, 385–391 (2014). source

In the paper

“All three studies identified through our search suggested that sex is not a significant modifier of dementia in individuals with AF.88–90”

What the sources say

• Not checked yetcites [88] Takigawa, M. et al. Differences in catheter ablation of paroxysmal atrial fibrillation between males and females. Int. J. Cardiol. 168, 1984–1991 (2013). source
• Not checked yetcites [89] Yang, P. C., Kurokawa, J., Furukawa, T. & Clancy, C. E. Acute effects of sex steroid hormones on susceptibility to cardiac arrhythmias: a simulation study. PLoS Comput. Biol. 6, e1000658 (2010). source
• Not checked yetcites [90] Nakamura, H. et al. Progesterone regulates cardiac repolarization through a nongenomic pathway: an in vitro patch-clamp and computational modeling study. Circulation 116, 2913–2922 (2007). source

In the paper

“On the other hand, the Cardiovascular Health Study of older adults has shown a significant sex interaction (P = 0.02) such that women with AF had a higher risk of coronary heart disease (HR 2.3) than their male counterparts (HR 1.6).106”

What the sources say

• Not checked yetcites [106] Soliman, E. Z. et al. Atrial fibrillation and risk of ST-segment-elevation versus non-ST-segment-elevation myocardial infarction: the Atherosclerosis Risk in Communities (ARIC) Study. Circulation 131, 1843–1850 (2015). source

In the paper

“The true prevalence is likely to be substantially higher given that many individuals remain undiagnosed.2”

What the sources say

• Not checked yetcites [2] Friberg, L. et al. Population screening of 75- and 76-year-old men and women for silent atrial fibrillation (STROKESTOP). Europace 15, 135–140 (2013). source

In the paper

“some studies have suggested differences in AF genetics between women and men7–9.”

What the sources say

• Not checked yetcites [7] Chen, Y. C. et al. Heterogeneous expression of potassium currents and pacemaker currents potentially regulates arrhythmogenesis of pulmonary vein cardiomyocytes. J. Cardiovasc. Electrophysiol. 20, 1039–1045 (2009). source
• Not checked yetcites [8] Oyen, N. et al. Familial aggregation of lone atrial fibrillation in young persons. J. Am. Coll. Cardiol. 60, 917–921 (2012). source
• Not checked yetcites [9] Zoller, B., Ohlsson, H., Sundquist, J. & Sundquist, K. High familial risk of atrial fibrillation/atrial flutter in multiplex families: a nationwide family study in Sweden. J. Am. Heart Assoc. 2, e003384 (2013). source

In the paper

“AF has been demonstrated to be partially heritable,6”

What the sources say

• Not checked yetcites [6] Christophersen, I. E. & Ellinor, P. T. Genetics of atrial fibrillation: from families to genomes. J. Hum. Genet. 61, 61–70 (2015). source

In the paper

“The study findings indicated that part of the increased risk of AF observed in men was related to body size.”

What the sources say

• Not checked yetcites [32] Guo, Y. et al. Prevalence, incidence, and lifetime risk of atrial fibrillation in China: new insights into the global burden of atrial fibrillation. Chest 147, 109–119 (2015). source

In the paper

“The link between female sex and stroke might vary across populations and age groups.75–84”

What the sources say

• Not checked yetcites [75] Remes, J. et al. Persistent atrial fibrillation in a goat model of chronic left atrial overload. J. Thorac. Cardiovasc. Surg. 136, 1005–1011 (2008). source
• Not checked yetcites [76] Ravens, U. Antiarrhythmic therapy in atrial fibrillation. Pharmacol. Ther. 128, 129–145 (2010). source
• Not checked yetcites [77] Sanfilippo, A. J. et al. Atrial enlargement as a consequence of atrial fibrillation. A prospective echocardiographic study. Circulation 82, 792–797 (1990). source
• Not checked yetcites [78] Kishi, S. et al. Race-ethnic and sex differences in left ventricular structure and function: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. J. Am. Heart Assoc. 4, e001264 (2015). source
• Not checked yetcites [79] Tsang, T. S. et al. Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women. Mayo Clin. Proc. 76, 467–475 (2001). source
• Not checked yetcites [80] Hudsmith, L. E., Petersen, S. E., Francis, J. M., Robson, M. D. & Neubauer, S. Normal human left and right ventricular and left atrial dimensions using steady state free precession magnetic resonance imaging. J. Cardiovasc. Magn. Reson. 7, 775–782 (2005). source
• Not checked yetcites [81] McManus, D. D. et al. Longitudinal tracking of left atrial diameter over the adult life course: clinical correlates in the community. Circulation 121, 667–674 (2010). source
• Not checked yetcites [82] Cochet, H. et al. Age, atrial fibrillation, and structural heart disease are the main determinants of left atrial fibrosis detected by delayed-enhanced magnetic resonance imaging in a general cardiology population. J. Cardiovasc. Electrophysiol. 26, 484–492 (2015). source
• Not checked yetcites [83] Khera, A. et al. Race and gender differences in C-reactive protein levels. J. Am. Coll. Cardiol. 46, 464–469 (2005). source
• Not checked yetcites [84] Mathew, J. S. et al. Fibroblast growth factor-23 and incident atrial fibrillation: the Multi-Ethnic Study of Atherosclerosis (MESA) and the Cardiovascular Health Study (CHS). Circulation 130, 298–307 (2014). source

In the paper

“The presence of atypical symptoms might contribute to the worse outcomes seen in women, as they might delay diagnosis and care.”

In the paper

“In addition, female sex is a well-known risk factor for HF with preserved ejection fraction, possibly attributable to hemodynamic changes and cardiovascular remodelling post menopause.165,166”

What the sources say

• Not checked yetcites [165] Zubaid, M. et al. Management and 1-year outcomes of patients with atrial fibrillation in the Middle East: Gulf survey of atrial fibrillation events. Angiology 66, 464–471 (2015). source
• Not checked yetcites [166] Badheka, A. O. et al. Influence of obesity on outcomes in atrial fibrillation: yet another obesity paradox. Am. J. Med. 123, 646–651 (2010). source

In the paper

“Another limitation of the AF epidemiological literature is the paucity of data from outside North America and Europe.1,169”

What the sources say

• Not checked yetcites [1] Chugh, S. S. et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 129, 837–847 (2014). source
• Not checked yetcites [169] Rahman, F., Kwan, G. F. & Benjamin, E. J. Global epidemiology of atrial fibrillation. Nat. Rev. Cardiol. 11, 639–654 (2014). source

In the paper

“most studies report an increased risk of stroke in women.68–71”

What the sources say

• Not checked yetcites [68] Platonov, P. G., Mitrofanova, L. B., Orshanskaya, V. & Ho, S. Y. Structural abnormalities in atrial walls are associated with presence and persistency of atrial fibrillation but not with age. J. Am. Coll. Cardiol. 58, 2225–2232 (2011). source
• Not checked yetcites [69] Henry, W. L. et al. Relation between echocardiographically determined left atrial size and atrial fibrillation. Circulation 53, 273–279 (1976). source
• Not checked yetcites [70] Vasan, R. S., Larson, M. G., Levy, D., Evans, J. C. & Benjamin, E. J. Distribution and categorization of echocardiographic measurements in relation to reference limits: the Framingham Heart Study: formulation of a height- and sex-specific classification and its prospective validation. Circulation 96, 1863–1873 (1997). source
• Not checked yetcites [71] Vaziri, S. M., Larson, M. G., Benjamin, E. J. & Levy, D. Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation 89, 724–730 (1994). source

In the paper

“Compared with our understanding of sex differences in coronary heart disease and stroke,168 substantial gaps exist in our knowledge of sex differences in AF (Table 1).”

What the sources say

• Not checked yetcites [168] Mosca, L., Barrett-Connor, E. & Kass Wenger, N. Sex/gender differences in cardiovascular disease prevention: what a difference a decade makes. Circulation 124, 2145–2154 (2011). source

In the paper

“Evidence for sex differences in the incidence, prevalence, population-attributable risks of major risk factors of AF, and in the clinical presentation and prognosis of patients with this arrhtyhmia is accumulating.”