性别、中风与心房颤动。

Sex, stroke, and atrial fibrillation.

作者信息

Hart Robert G, Eikelboom John W, Pearce Lesly A

出版信息

Arch Neurol. 2012 Dec;69(12):1641-3. doi: 10.1001/archneurol.2012.2691.

DOI:10.1001/archneurol.2012.2691

PMID:23007639

Abstract

CONTEXT

Stroke is a serious complication associated with atrial fibrillation (AF). Women with AF are at higher risk of stroke compared with men. Reasons for this higher stroke risk in women remain unclear, although some studies suggest that undertreatment with warfarin may be a cause.

OBJECTIVE

To compare utilization patterns of warfarin and the risk of subsequent stroke between older men and women with AF at the population level.

DESIGN, SETTING, AND PATIENTS: Population-based cohort study of patients 65 years or older admitted to the hospital with recently diagnosed AF in the province of Quebec, Canada, 1998-2007, using administrative data with linkage between hospital discharge, physicians, and prescription drug claims databases.

MAIN OUTCOME MEASURES

Risk of stroke.

RESULTS

The cohort comprised 39 398 men (47.2%) and 44 115 women (52.8%). At admission, women were older and had a higher CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack) score than men (1.99 [SD, 1.10] vs 1.74 [SD, 1.13], P < .001). At 30 days postdischarge, 58.2% of men and 60.6% of women had filled a warfarin prescription. In adjusted analysis, women appeared to fill more warfarin prescriptions compared with men (odds ratio, 1.07 [95% CI, 1.04-1.11]; P < .001). Adherence to warfarin treatment was good in both sexes. Crude stroke incidence was 2.02 per 100 person-years (95% CI, 1.95-2.10) in women vs 1.61 per 100 person-years (95% CI, 1.54-1.69) in men (P < .001). The sex difference was mainly driven by the population of patients 75 years or older. In multivariable Cox regression analysis, women had a higher risk of stroke than men (adjusted hazard ratio, 1.14 [95% CI, 1.07-1.22]; P < .001), even after adjusting for baseline comorbid conditions, individual components of the CHADS2 score, and warfarin treatment.

CONCLUSION

Among older patients admitted with recently diagnosed AF, the risk of stroke was greater in women than in men, regardless of warfarin use.

摘要

背景

中风是与心房颤动（AF）相关的一种严重并发症。与男性相比，患有AF的女性中风风险更高。尽管一些研究表明华法林治疗不足可能是一个原因，但女性中风风险较高的原因仍不清楚。

目的

在人群层面比较老年AF男性和女性华法林的使用模式及随后发生中风的风险。

设计、地点和患者：基于人群的队列研究，研究对象为1998 - 2007年在加拿大魁北克省因最近诊断为AF而住院的65岁及以上患者，使用医院出院、医生和处方药索赔数据库之间相链接的行政数据。

主要观察指标

中风风险。

结果

该队列包括39398名男性（47.2%）和44115名女性（52.8%）。入院时，女性年龄更大，CHADS2（充血性心力衰竭、高血压、年龄≥75岁、糖尿病、既往中风或短暂性脑缺血发作）评分高于男性（1.99[标准差，1.10]对1.74[标准差，1.13]，P <.001）。出院后30天，58.2%的男性和60.6%的女性开具了华法林处方。在调整分析中，与男性相比，女性开具的华法林处方似乎更多（优势比，1.07[95%置信区间，1.04 - 1.11]；P <.001）。男女对华法林治疗的依从性都很好。女性的粗中风发病率为每100人年2.02例（95%置信区间，1.95 - 2.10），男性为每100人年1.61例（95%置信区间，1.54 - 1.69）（P <.001）。性别差异主要由75岁及以上的患者群体驱动。在多变量Cox回归分析中，即使在调整了基线合并症、CHADS2评分的各个组成部分和华法林治疗后，女性中风风险仍高于男性（调整后的风险比，1.14[95%置信区间，1.07 - 1.22]；P <.001）。