Sex Effect In Atrial Fibrillation: Is It All About Atrial Function?

Over the past 25 years, our knowledge concerning embolic stroke, secondary to atrial fibrillation, has increased exponentially. Although it is well accepted that atrial fibrillation increases the risk of stroke in aggregate in a population ≈5-fold, several risk score models exist to further predict who will benefit from stroke prophylaxis with anticoagulants. The CHADS2 risk score had been the standard in assessing risk in any individual patient with atrial fibrillation for several years. More recently, the CHADS2VASC score has become favored by more recent guidelines as the recommended algorithm to guide oral anticoagulant decisions.1,2 This risk model importantly includes female sex as an important risk factor in stroke secondary to atrial fibrillation. This inclusion of female sex as a risk factor was formed on the basis of multiple studies.See Article by Yoshida et al Fang et al studied sex differences in over 13 000 patients3 in the ATRIA study (Anticoagulation and Risk Factors in Atrial Fibrillation). His group found almost double the risk of stroke in women compared with men when off warfarin. In studying over 5000 patients taking part in the Euro Heart Survey, Dagres et al4 also found that women had almost twice the risk of stroke. However, in this study, the risk was highest …