Abstract
Female patients with atrial fibrillation (AF) are at increased risk of stroke. It is unclear what contributes to the gender-related differences in stroke and mortality amongst AF patients. This is pertinent since oral anticoagulation use results in a significant reduction in stroke, as well as all-cause mortality. We investigated gender-related risk factors for stroke and mortality in a cohort of Chinese patients with AF. We studied 1034 AF patients (27% females, median age 75 years) who were followed-up for an average of 1.9 years for the principal primary endpoint of 'ischaemic stroke and death'. Gender-specific effect of risk factors for stroke and death was analyzed. Patients at high stroke risk (CHADS2 or CHADS2-VASc ≥ 2) and HAS-BLED ≥ 3 had higher rates of ischaemic stroke and death, but ischaemic stroke rates in females with HAS-BLED ≥ 3 did not differ between CHADS2 0-1 and ≥ 2 (~3 per 100 person-years). On multivariate analysis of non-anticoagulated patients (n=885), independent predictors of 'ischaemic stroke and death' in both males and females were age>75, prior stroke and renal dysfunction (all p<0.05). Independent predictors of 'ischaemic stroke' in females were prior stroke, vascular disease and renal dysfunction (all p<0.05). When females were compared to males, adjusted for baseline characteristics, independent predictors for 'ischaemic stroke and death' amongst females were prior stroke (hazard ratio, HR 2.40; 95% confidence interval, CI, 1.17-4.91, p=0.017) and renal dysfunction (HR 5.30; 95%CI 2.39-11.74, p<0.001). When females were compared to males, renal dysfunction remained a predictor for the secondary endpoints of ischaemic stroke (HR 4.37, p=0.05) and all-cause mortality (HR 4.15, p=0.003). Renal dysfunction may be a contributor to the greater risk of stroke and death in female Chinese patients with AF. This increased risk is largely driven by the impact on all-cause mortality.
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