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Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies
Open accessAbstract
OBJECTIVE: To determine whether atrial fibrillation is a stronger risk factor for cardiovascular disease and death in women compared with men. DESIGN: Meta-analysis of cohort studies. DATA SOURCES: Studies published between January 1966 and March 2015, identified through a systematic search of Medline and Embase and review of references. ELIGIBILITY FOR SELECTING STUDIES: Cohort studies with a minimum of 50 participants with and 50 without atrial fibrillation that reported sex specific associations between atrial fibrillation and all cause mortality, cardiovascular mortality, stroke, cardiac events (cardiac death and non-fatal myocardial infarction), and heart failure. DATA EXTRACTION: Two independent reviewers extracted study characteristics and maximally adjusted sex specific relative risks. Inverse variance weighted random effects meta-analysis was used to pool sex specific relative risks and their ratio. RESULTS: 30 studies with 4,371,714 participants were identified. Atrial fibrillation was associated with a higher risk of all cause mortality in women (ratio of relative risks for women compared with men 1.12, 95% confidence interval 1.07 to 1.17) and a significantly stronger risk of stroke (1.99, 1.46 to 2.71), cardiovascular mortality (1.93, 1.44 to 2.60), cardiac events (1.55, 1.15 to 2.08), and heart failure (1.16, 1.07 to 1.27). Results were broadly consistent in sensitivity analyses. CONCLUSION: Atrial fibrillation is a stronger risk factor for cardiovascular disease and death in women compared with men, though further research would be needed to determine any causality.
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“In both developed and developing countries, the age-adjusted incidence and prevalence of AF are lower in women, while the risk of death in women with AF is similar to or higher than that in men with AF. 1,46,47”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [46]
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“In both developed and developing countries, the age-adjusted incidence and prevalence of AF are lower in women, while the risk of death in women with AF is similar to or higher than that in men with AF. 1,46,47”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [46]
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Metadata
- Authors
- Emdin, C. A., Wong, C. X., Hsiao, A. J., Altman, D. G., Peters, S. A., Woodward, M., & Odutayo, A. A.
- Affiliations
- The George Institute for Global Health (GB)
- University of Oxford (GB)
- Massachusetts Institute of Technology (US)
- The University of Sydney (AU)
- University of Toronto (CA)
- Corresponding author
- Emdin, Connor A
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2016-01-19
- Volume
- 532
- Pages
- h7013
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC5482349
- OpenAlex
- W2283863574
- Cited by
- 452
- References
- 65
- Citations by year
- 2026: 35 · 2025: 60 · 2024: 70 · 2023: 43 · 2022: 58 · 2021: 42 · 2020: 37 · 2019: 30 · 2018: 28 · 2017: 32 · 2016: 17
- FWCI
- 6.23
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by-nc)
- DSpace@MIT (Massachusetts Institute of Technology) (submittedVersion, cc-by-nc)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Canadian Stroke Network
- National Institute for Health and Care Research
- Rhodes Scholarships
- King's College London
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- atrial fibrillation, sex differences, cardiovascular disease, all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, heart failure, women, cardiovascular risk factors
- MeSH terms
- Atrial Fibrillation, Cardiovascular Diseases, Female, Heart Failure, Humans, Male, Myocardial Infarction, Risk Factors, Sex Factors, Death, Sudden, Cardiac, Stroke
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