Stroke risk in women with atrial fibrillation.

Autor:	Buhari H; Department of Medicine, Women's College Hospital, Room 6452, 76 Grenville Street, Toronto, ON M5S 1B2, Canada.; Department of Medicine, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada., Fang J; Cardiovascular Research Program, ICES, V1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada., Han L; Cardiovascular Research Program, ICES, V1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada., Austin PC; Cardiovascular Research Program, ICES, V1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.; Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada., Dorian P; Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, Third Floor, Toronto, ON M5S 3H2, Canada.; Division of Cardiology, Unity Health, 30 Bond St., Toronto, ON M5B 1W8, Canada., Jackevicius CA; Department of Medicine, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.; Cardiovascular Research Program, ICES, V1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.; Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada.; Department of Pharmacy Practice and Administration, Western University of Health Sciences, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA., Yu AYX; Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, Third Floor, Toronto, ON M5S 3H2, Canada.; Evaluative Clinical Sciences, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada., Kapral MK; Cardiovascular Research Program, ICES, V1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.; Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, Third Floor, Toronto, ON M5S 3H2, Canada., Singh SM; Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, Third Floor, Toronto, ON M5S 3H2, Canada.; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Hospital Road, Toronto, ON M4N 3M5, Canada., Tu K; Department of Medicine, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.; Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada.; Research and Innovation Department, North York General Hospital, Room LE-140, 4001 Leslie Street, Toronto, ON M2K 1E1, Canada.; Department of Family and Community Medicine, University of Toronto, 500 University Ave, 5th Floor, Toronto, ON M5G 1V7, Canada., Ko DT; Cardiovascular Research Program, ICES, V1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.; Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada.; Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, Third Floor, Toronto, ON M5S 3H2, Canada.; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Hospital Road, Toronto, ON M4N 3M5, Canada., Atzema CL; Cardiovascular Research Program, ICES, V1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.; Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada.; Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, Third Floor, Toronto, ON M5S 3H2, Canada.; Evaluative Clinical Sciences, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada., Benjamin EJ; Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, 715 Albany St, E-113, Boston, MA 02118, USA.; Department of Epidemiology, Boston University School of Public, 677 Huntington Ave, Boston, MA 02115, USA., Lee DS; Department of Medicine, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.; Cardiovascular Research Program, ICES, V1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.; Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada.; Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, Third Floor, Toronto, ON M5S 3H2, Canada., Abdel-Qadir H; Department of Medicine, Women's College Hospital, Room 6452, 76 Grenville Street, Toronto, ON M5S 1B2, Canada.; Department of Medicine, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.; Cardiovascular Research Program, ICES, V1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.; Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada.; Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, Third Floor, Toronto, ON M5S 3H2, Canada.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2024 Jan 07; Vol. 45 (2), pp. 104-113.
DOI:	10.1093/eurheartj/ehad508
Abstrakt:	Background and Aims: Female sex is associated with higher rates of stroke in atrial fibrillation (AF) after adjustment for other CHA2DS2-VASc factors. This study aimed to describe sex differences in age and cardiovascular care to examine their relationship with stroke hazard in AF. Methods: Population-based cohort study using administrative datasets of people aged ≥66 years diagnosed with AF in Ontario between 2007 and 2019. Cause-specific hazard regression was used to estimate the adjusted hazard ratio (HR) for stroke associated with female sex over a 2-year follow-up. Model 1 included CHA2DS2-VASc factors, with age modelled as 66-74 vs. ≥ 75 years. Model 2 treated age as a continuous variable and included an age-sex interaction term. Model 3 further accounted for multimorbidity and markers of cardiovascular care. Results: The cohort consisted of 354 254 individuals with AF (median age 78 years, 49.2% female). Females were more likely to be diagnosed in emergency departments and less likely to receive cardiologist assessments, statins, or LDL-C testing, with higher LDL-C levels among females than males. In Model 1, the adjusted HR for stroke associated with female sex was 1.27 (95% confidence interval 1.21-1.32). Model 2 revealed a significant age-sex interaction, such that female sex was only associated with increased stroke hazard at age >70 years. Adjusting for markers of cardiovascular care and multimorbidity further decreased the HR, so that female sex was not associated with increased stroke hazard at age ≤80 years. Conclusion: Older age and inequities in cardiovascular care may partly explain higher stroke rates in females with AF. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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