Is female sex a risk factor for stroke and thromboembolism in patients with atrial fibrillation? A systematic review and meta-analysis
Abstract
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. METHODS: A systematic literature search was conducted using Medline. The search term 'atrial fibrillation' was used in combination with 'stroke risk', 'thromboembolism', 'female' and 'gender differences' and returned 735 articles, of which 17 were appraised and included. Females with AF were compared with males with AF for the outcome of stroke/thromboembolism. RESULTS: Seventeen studies, 5 randomized-controlled trials and 12 prospective observational studies were included; 10 demonstrated an increased risk of stroke in women. Meta-analysis of the 17 studies revealed a 1.31-fold (95% confidence intervals (CIs) 1.18-1.46) elevated risk of stroke in women with AF; the risk appearing greatest for women aged ≥75 years. Only three studies compared entirely anticoagulated populations; stroke rates among these patients varied from 1.2-1.44% per-patient year for men and 2.08-2.43% per-patient year for women. Risk of stroke in women appeared similar regardless of oral anticoagulation therapy [risk ratio (95% CI 1.29 (1.09-1.52) and 1.49 (1.17-1.90) in non-anticogulated vs. anticoagulated/mixed cohorts, respectively). CONCLUSIONS: Women with AF are at increased risk of stroke, particularly elderly women. Comprehensive stroke risk assessment, including sex as a risk factor, should be undertaken in all AF patients.
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Female sex does not appear to increase stroke risk in the absence of other stroke risk factors.
“Female sex does not appear to increase stroke risk in the absence of other stroke risk factors (Web Addenda Table 1).378,379”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [379]
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Self-citationFemale gender as a risk factor for stroke associated with atrial fibrillation
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Hormone Replacement Therapy and Adverse Outcomes in Women With Atrial Fibrillation
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Self-citationThe risk of stroke and associated risk factors in a health examination population
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Self-citationStroke Prevention in Atrial Fibrillation
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Self-citationSex-related differences in prevalence, treatment and outcomes in patients with atrial fibrillation
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Sex Difference in the Risk of Dementia in Patients with Atrial Fibrillation
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Gender specific considerations in atrial fibrillation treatment: a review
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Emerging Tools for Stroke Prevention in Atrial Fibrillation
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Comparing Management and Outcomes in Men and Women With Nonvalvular Atrial Fibrillation
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- Authors
- Wagstaff, A. J., Overvad, T. F., Lip, G. Y. H., & Lane, D. A.
- Affiliations
- Aalborg University Hospital (DK)
- Birmingham City Hospital (GB)
- Venue
- QJM
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-03-14
- Volume
- 107
- Issue
- 12
- Pages
- 955-967
- ISSN
- 0033-5622 (ISSN-L)
- 1460-2725
- 1460-2393
- OpenAlex
- W2136273801
- Cited by
- 176
- References
- 40
- Citations by year
- 2026: 9 · 2025: 18 · 2024: 14 · 2023: 14 · 2022: 9 · 2021: 9 · 2020: 13 · 2019: 20 · 2018: 23 · 2017: 16 · 2016: 13 · 2015: 12 · 2014: 5
- FWCI
- 2.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- QJM (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- atrial fibrillation, stroke risk, thromboembolism, female sex, sex differences, stroke risk assessment, oral anticoagulation, older women, gender differences
- MeSH terms
- Aged, Aged, 80 and over, Anticoagulants, Atrial Fibrillation, Epidemiologic Methods, Female, Humans, Male, Middle Aged, Sex Factors, Thromboembolism, Stroke
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