Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
BMJ. 2012 May 30;344:e3522. doi: 10.1136/bmj.e3522.
To determine whether women with atrial fibrillation have a higher risk of stroke than men.
Nationwide retrospective cohort study.
Patients with a diagnosis of atrial fibrillation in the Swedish hospital discharge register between 1 July 2005 and 31 December 2008. Information about drug treatment taken from the Swedish drug register.
100,802 patients with atrial fibrillation at any Swedish hospital or hospital affiliated outpatient clinic with a total follow-up of 139,504 years at risk (median 1.2 years). We excluded patients with warfarin at baseline, mitral stenosis, previous valvular surgery, or who died within 14 days from baseline.
Incidence of ischaemic stroke.
Ischaemic strokes were more common in women than in men (6.2% v 4.2% per year, P<0.0001). The univariable hazard ratio for women compared with men was 1.47 (95% confidence 1.40 to 1.54), indicating a 47% higher incidence of ischaemic stroke in women than in men. Stratification according to the CHADS(2) scheme showed increased stroke rates for women in all strata. After multivariable adjustment for 35 cofactors for stroke, an increased risk of stroke in women remained (1.18, 1.12 to 1.24). Among patients with "lone atrial fibrillation" (age <65 years and no vascular disease), the annual stroke rate tended to be higher in women than in men, although this difference was not significant (0.7% v 0.5%, P=0.09). When low risk patients with CHADS(2) scores of 0-1 were stratified according to their CHA(2)DS(2)-VASc scores, women did not have higher stroke incidence than men at CHA(2)DS(2)-VASc scores of 2 or less.
Women with atrial fibrillation have a moderately increased risk of stroke compared with men, and thus, female sex should be considered when making decisions about anticoagulation treatment. However, women younger than 65 years and without other risk factors have a low risk for stroke, and do not need anticoagulant treatment.
确定心房颤动女性患者发生卒中的风险是否高于男性。
全国性回顾性队列研究。
2005 年 7 月 1 日至 2008 年 12 月 31 日期间，在瑞典住院患者登记处诊断为心房颤动的患者；药物治疗信息来自瑞典药物登记处。
在任何一家瑞典医院或附属门诊接受治疗的 100802 例心房颤动患者，中位随访时间为 1.2 年（共 139504 年风险）。我们排除了基线时使用华法林、二尖瓣狭窄、既往瓣膜手术或基线后 14 天内死亡的患者。
缺血性卒中发生率。
女性缺血性卒中发生率高于男性（每年 6.2%比 4.2%，P<0.0001）。与男性相比，女性的单变量危险比为 1.47（95%置信区间 1.40 至 1.54），表明女性缺血性卒中的发生率比男性高 47%。根据 CHADS（2）方案分层，所有分层的女性卒中发生率均增加。经 35 个卒中相关因素的多变量调整后，女性卒中风险仍增加（1.18，1.12 至 1.24）。在“孤立性心房颤动”（年龄<65 岁且无血管疾病）患者中，女性的年卒中发生率虽高于男性，但差异无统计学意义（0.7%比 0.5%，P=0.09）。当 CHADS（2）评分 0-1 的低危患者根据 CHA（2）DS（2）-VASc 评分分层时，在 CHA（2）DS（2）-VASc 评分≤2 时，女性的卒中发生率并未高于男性。
与男性相比，心房颤动女性患者发生卒中的风险中度增加，因此在决定抗凝治疗时应考虑女性性别因素。然而，年龄<65 岁且无其他危险因素的女性卒中风险较低，无需抗凝治疗。
