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Cited by 41Cardiovascular Effects of ExerciseAtrial Fibrillation Management and OutcomesPhysical Activity and Health

Elite female endurance athletes are at increased risk of atrial fibrillation compared to the general population: a matched cohort study

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Drca, Nikola, Larsson, Susanna C, Grannas, David, Jensen-Urstad, Mats·2023·British Journal of Sports Medicine
DOI 10.1136/bjsports-2022-106035PMC PMC10579174
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Abstract

Objective: Previous studies have found that endurance sport activity is associated with an increased risk of atrial fibrillation (AF) in men. However, it remains unclear whether endurance sports also influence the risk of AF in women. We aimed to examine whether participation in endurance sports may affect the risk of AF in female athletes. Methods: We conducted a retrospective matched cohort study of top Swedish female endurance athletes (n=228) and reference individuals (n=1368) from the general population using the Swedish Total Population Register individually matched with a 6:1 ratio of female athletes. The athlete cohort was created by combining all Swedish women who ran the Stockholm Marathon faster than 3 hours 15 min in any of the races between 1979 and 1991, all women competing in the Swedish athletic national championships in the 10 000 metre race, and the top-ranked Swedish cyclists during the same period. We used the National Patient Register to determine whether the participants were diagnosed with AF. Results: Mean age at the start of follow-up was 32 (SD±8.5) years. During follow-up (mean 28.8 years; SD±4.4), 33 cases of AF were diagnosed, including 10 (4.4%) among athletes and 23 (1.7%) among references. The HR for female athletes compared with the reference population was 2.56 (95% CI 1.22 to 5.37) in the univariable model and 3.67 (95% CI 1.71 to 7.87) after adjustment for hypertension. Conclusion: Elite female endurance athletes are at increased risk of AF than the general population.

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  • Retrospective studies with small sample sizes comparing men and women showed that AF incidence may be higher in female endurance athletes compared to males.

    “Only retrospective studies with small sample sizes that have been conducted over the last 2 decades, which compared men and women, showed that AF incidence may be higher in female endurance athletes compared to males [28,29].”

    From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [28]

    The Introduction says earlier studies found increased AF risk in male endurance athletes, while that association had not been observed in women. The Discussion > Limitations states that this study had no comparable male athlete cohort, so it could not directly compare men and women. Its finding concerns female athletes versus female controls, not higher AF incidence in women than men; page numbers were not available in our copy. (LLM, conf=0.88)

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Research works printed but not linked: 19

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Authors
Drca, N., Larsson, S. C., Grannas, D., & Jensen-Urstad, M.
Affiliations
  • Karolinska University Hospital (SE)
  • Uppsala University (SE)
  • Karolinska Institutet (SE)
Corresponding author
Drca, Nikola
ORCID
Venue
British Journal of Sports Medicine
Publisher
BMJ
Published
2023-07-10
Volume
57
Issue
18
Pages
1175-1179
ISSN
  • 0306-3674 (ISSN-L)
  • 1473-0480
DOI
10.1136/bjsports-2022-106035
PMC
PMC10579174
OpenAlex
W4383998830
Cited by
41
References
9
Citations by year
2026: 9 · 2025: 16 · 2024: 14 · 2023: 2
FWCI
8.07
Type
journal article
Language
en
Open access
Licence
Locations
  • British Journal of Sports Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Uppsala University Publications (Uppsala University) (submittedVersion, other-oa)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • Hjärt-Lungfonden (20210351)
  • The Swedish Research Council for Sport Science
  • Vetenskapsrådet (2019-00977)
  • Swedish Research Council for Health, Working Life and Welfare (2018-00123)
  • Kvinnor och Hälsa
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
Keywords
atrial fibrillation, female endurance athletes, elite athletes, marathon runners, cycling, hypertension, cardiovascular risk, sex differences
MeSH terms
Atrial Fibrillation, Female, Humans, Male, Physical Endurance, Retrospective Studies, Risk Factors, Cohort Studies, Athletes

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