Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
J Thromb Haemost. 2012 Sep;10(9):1745-51. doi: 10.1111/j.1538-7836.2012.04853.x.
Female sex has been suggested as a risk factor for stroke/thromboembolism in patients with non-valvular atrial fibrillation (AF) and has therefore been included within risk scores, e.g., the CHA2 DS2 -VASc score, and guidelines.
To investigate the risk of stroke/thromboembolism associated with female sex in non-valvular AF patients.
PATIENTS/METHODS: Using the national Danish registers, we identified non-anticoagulated patients discharged with non-valvular AF (1997-2008), and subdivided the population into three age intervals: < 65, 65-74 and ≥ 75 years. We calculated stroke rates according to sex, and assessed the stroke risk associated with female sex by using Cox regression analysis.
We included 87,202 AF patients, and 44,744 (51.3%) were female. The rate of stroke/thromboembolism for females aged < 65 and 65-74 years was not increased as compared with men, whereas the rate for females aged ≥ 75 years was increased. At both 1-year and 12-year follow-up, female sex did not increase the risk of stroke for patients aged < 75 years. At 1-year follow-up, the hazard ratios associated with female sex were 0.89 (95% confidence interval [CI] 0.70-1.13) and 0.91 (95 CI 0.79-1.05) for patients aged < 65 and 65-74 years, respectively, and being female and aged ≥ 75 years was associated with an increased risk of stroke of 1.20 (95 CI 1.12-1.28).
Female sex was only associated with an increased risk of stroke for AF patients aged ≥ 75 years. Our study suggests that female sex should not be automatically included as an independent stroke/thromboembolic risk factor in guidelines or in the CHA2 DS2 -VASc score, without careful prior consideration of the 'age < 65 and lone AF' criterion.
女性被认为是非瓣膜性心房颤动（AF）患者中风/血栓栓塞的危险因素，因此已被纳入风险评分，例如 CHA2 DS2 -VASc 评分和指南。
研究非瓣膜性 AF 患者中女性性别与中风/血栓栓塞风险的关系。
患者/方法：使用丹麦全国登记处，我们确定了非抗凝治疗的非瓣膜性 AF 出院患者（1997-2008 年），并将人群分为三个年龄组：<65 岁、65-74 岁和≥75 岁。我们根据性别计算中风发生率，并使用 Cox 回归分析评估女性性别与中风风险的关系。
我们纳入了 87202 例 AF 患者，其中 44744 例（51.3%）为女性。<65 岁和 65-74 岁女性的中风/血栓栓塞发生率与男性相比没有增加，而≥75 岁女性的发生率增加。在 1 年和 12 年随访时，女性性别并未增加<75 岁患者中风的风险。在 1 年随访时，<65 岁和 65-74 岁女性的性别相关风险比分别为 0.89（95%置信区间 [CI] 0.70-1.13）和 0.91（95%CI 0.79-1.05），而≥75 岁的女性与中风风险增加 1.20（95%CI 1.12-1.28）相关。
女性仅与≥75 岁 AF 患者的中风风险增加相关。我们的研究表明，在没有仔细考虑“年龄<65 岁和孤立性 AF”标准的情况下，女性性别不应自动被视为指南或 CHA2 DS2 -VASc 评分中风/血栓栓塞的独立危险因素。
