Female sex as an independent risk factor for stroke in atrial fibrillation: Possible mechanisms
Abstract
Summary: Atrial fibrillation (AF) is an independent risk factor for thromboembolism and stroke. Women with AF are at a higher overall risk for thromboembolic stroke when compared to men with AF. Recent evidence suggests that female sex, after adjusting for stroke risk profile and sex differences in utilisation of anticoagulation, is an independent stroke risk factor in AF. The inclusion of female sex has improved the accuracy of the CHADS2 stroke risk stratification schema (Congestive heart failure, Hypertension, Age 75 years or greater, Diabetes mellitus, and prior Stroke or TIA). The newly revised and validated schema, CHA2DS2-VASc, dichotomises age and incorporates female sex and vascular disease history. The pathophysiological mechanisms to explain this increased risk in women are not well understood. According to Virchow’s triad, thrombosis that leads to stroke in AF should arise from three co-existing phenomena: structural abnormalities, blood stasis, and a hypercoagulable state. Herein, we explore the sex differences in the biological processes that lead to thrombus formation as applied to Virchow’s Triad. The objective of this review is to describe the potential mechanisms behind the increased risk of stroke in AF associated with female sex.
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Data from the REGARDS and Atherosclerosis Risk in Communities studies indicated that the association between AF and myocardial infarction was greater in women than in men.
“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”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [105]
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References 85 · Cited by 116
- Authors
- Albert, C. M., Andreotti, F., Badimon, L., Van Gelder, I. C., Hylek, E. M., & Cove, C. L.
- Affiliations
- Brigham and Women's Hospital (US)
- Università Cattolica del Sacro Cuore (IT)
- Boston University (US)
- Boston Medical Center (US)
- Corresponding author
- Cove, Christina L.
- Venue
- Thrombosis and Haemostasis
- Publisher
- Georg Thieme Verlag KG
- Published
- 2014
- Volume
- 112
- Issue
- 03
- Pages
- 385-391
- ISSN
- 0340-6245 (ISSN-L)
- 2567-689X
- OpenAlex
- W1976210867
- Cited by
- 116
- References
- 85
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 5 · 2023: 9 · 2022: 9 · 2021: 7 · 2020: 7 · 2019: 9 · 2018: 14 · 2017: 13 · 2016: 13 · 2015: 14 · 2014: 7
- FWCI
- 1.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thrombosis and Haemostasis (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- NIH-sponsored Boston University Medical Center Leadership Program (K12 HL083781)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Blood properties and coagulation
- Keywords
- atrial fibrillation, stroke risk, female sex, sex differences, thromboembolism, CHA2DS2-VASc score, CHADS2 score, anticoagulation, Virchow's triad, hypercoagulability, stroke pathophysiology
- MeSH terms
- Atrial Fibrillation, Estradiol, Female, Humans, Male, Menopause, Risk Factors, Sex Factors, Cytokines, Inflammation Mediators, Thrombophilia, Stroke
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