Female sex as a risk factor for stroke in atrial fibrillation: a nationwide cohort study
Open accessAbstract
Background Female sex has been suggested as a risk factor for stroke/thromboembolism in patients with non-valvular atrial fibrillation (AF) and has therefore been included within risk scores, e.g., the CHA2 DS2 -VASc score, and guidelines.Objectives To investigate the risk of stroke/thromboembolism associated with female sex in non-valvular AF patients.Patients/methods Using the national Danish registers, we identified non-anticoagulated patients discharged with non-valvular AF (1997-2008), and subdivided the population into three age intervals: < 65, 65-74 and ≥ 75 years. We calculated stroke rates according to sex, and assessed the stroke risk associated with female sex by using Cox regression analysis.Results We included 87,202 AF patients, and 44,744 (51.3%) were female. The rate of stroke/thromboembolism for females aged < 65 and 65-74 years was not increased as compared with men, whereas the rate for females aged ≥ 75 years was increased. At both 1-year and 12-year follow-up, female sex did not increase the risk of stroke for patients aged < 75 years. At 1-year follow-up, the hazard ratios associated with female sex were 0.89 (95% confidence interval [CI] 0.70-1.13) and 0.91 (95 CI 0.79-1.05) for patients aged < 65 and 65-74 years, respectively, and being female and aged ≥ 75 years was associated with an increased risk of stroke of 1.20 (95 CI 1.12-1.28).Conclusion Female sex was only associated with an increased risk of stroke for AF patients aged ≥ 75 years. Our study suggests that female sex should not be automatically included as an independent stroke/thromboembolic risk factor in guidelines or in the CHA2 DS2 -VASc score, without careful prior consideration of the 'age < 65 and lone AF' criterion.
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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 [378]
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Self-citation
- Authors
- MIKKELSEN, A. P., LINDHARDSEN, J., LIP, G. Y. H., GISLASON, G. H., TORP‐PEDERSEN, C., & OLESEN, J. B.
- Affiliations
- Gentofte Hospital (DK)
- Birmingham City Hospital (GB)
- Corresponding author
- MIKKELSEN, A.P.
- Venue
- Journal of Thrombosis and Haemostasis
- Publisher
- Elsevier BV
- Published
- 2012-09
- Volume
- 10
- Issue
- 9
- Pages
- 1745-1751
- ISSN
- 1538-7836 (ISSN-L)
- OpenAlex
- W2155301214
- Cited by
- 137
- References
- 28
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 9 · 2023: 6 · 2022: 7 · 2021: 6 · 2020: 7 · 2019: 16 · 2018: 14 · 2017: 12 · 2016: 13 · 2015: 8 · 2014: 13 · 2013: 5 · 2012: 1
- FWCI
- 5.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thrombosis and Haemostasis (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (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
- female sex, stroke risk, non-valvular atrial fibrillation, thromboembolism, CHA2DS2-VASc score, sex as risk factor, elderly patients, anticoagulation, sex differences
- MeSH terms
- Aged, Aged, 80 and over, Atrial Fibrillation, Denmark, Female, Humans, Regression Analysis, Risk Factors, Cohort Studies, Stroke
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