From the University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham B18 7QH, UK, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK, Department of Cardiology, Aalborg University Hospital, Forskningens Hus, Søndre Skovvej 15, 9000 Aalborg, Denmark and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Forskningens Hus, Søndre Skovvej 15, 9000 Aalborg, Denmark From the University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham B18 7QH, UK, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK, Department of Cardiology, Aalborg University Hospital, Forskningens Hus, Søndre Skovvej 15, 9000 Aalborg, Denmark and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Forskningens Hus, Søndre Skovvej 15, 9000 Aalborg, Denmark.
From the University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham B18 7QH, UK, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK, Department of Cardiology, Aalborg University Hospital, Forskningens Hus, Søndre Skovvej 15, 9000 Aalborg, Denmark and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Forskningens Hus, Søndre Skovvej 15, 9000 Aalborg, Denmark From the University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham B18 7QH, UK, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK, Department of Cardiology, Aalborg University Hospital, Forskningens Hus, Søndre Skovvej 15, 9000 Aalborg, Denmark and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Forskningens Hus, Søndre Skovvej 15, 9000 Aalborg, Denmark From the University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham B18 7QH, UK, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK, Department of Cardiology, Aalborg University Hospital, Forskningens Hus, Søndre Skovvej 15, 9000 Aalborg, Denmark and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Forskningens Hus, Søndre Skovvej 15, 9000 Aalborg, Denmark.
QJM. 2014 Dec;107(12):955-67. doi: 10.1093/qjmed/hcu054. Epub 2014 Mar 14.
Atrial fibrillation (AF) increases the risk of stroke, but this risk is not homogenous. Many risk factors contribute to stroke risk however, the evidence for female sex as a risk factor is less well-established.
To perform a systematic review and meta-analysis of the available evidence to establish if female sex is a risk factor for stroke/thromboembolism among patients with AF.
A systematic literature search was conducted using Medline. The search term 'atrial fibrillation' was used in combination with 'stroke risk', 'thromboembolism', 'female' and 'gender differences' and returned 735 articles, of which 17 were appraised and included. Females with AF were compared with males with AF for the outcome of stroke/thromboembolism.
Seventeen studies, 5 randomized-controlled trials and 12 prospective observational studies were included; 10 demonstrated an increased risk of stroke in women. Meta-analysis of the 17 studies revealed a 1.31-fold (95% confidence intervals (CIs) 1.18-1.46) elevated risk of stroke in women with AF; the risk appearing greatest for women aged ≥75 years. Only three studies compared entirely anticoagulated populations; stroke rates among these patients varied from 1.2-1.44% per-patient year for men and 2.08-2.43% per-patient year for women. Risk of stroke in women appeared similar regardless of oral anticoagulation therapy [risk ratio (95% CI 1.29 (1.09-1.52) and 1.49 (1.17-1.90) in non-anticogulated vs. anticoagulated/mixed cohorts, respectively).
Women with AF are at increased risk of stroke, particularly elderly women. Comprehensive stroke risk assessment, including sex as a risk factor, should be undertaken in all AF patients.
心房颤动（AF）会增加中风的风险，但这种风险并非均匀分布。许多风险因素会增加中风风险，然而，女性性别作为风险因素的证据还不够充分。
对现有证据进行系统回顾和荟萃分析，以确定女性性别是否是 AF 患者中风/血栓栓塞的危险因素。
使用 Medline 进行系统文献检索。使用“心房颤动”一词与“中风风险”、“血栓栓塞”、“女性”和“性别差异”组合进行搜索，共返回 735 篇文章，其中评估并纳入了 17 篇。将 AF 女性与 AF 男性进行比较，以观察中风/血栓栓塞的结局。
纳入了 17 项研究，包括 5 项随机对照试验和 12 项前瞻性观察性研究；其中 10 项研究表明女性中风风险增加。对这 17 项研究进行荟萃分析显示，AF 女性中风风险增加 1.31 倍（95%置信区间（CI）1.18-1.46）；对于年龄≥75 岁的女性，风险似乎最大。只有 3 项研究比较了完全抗凝的人群；这些患者的中风发生率在男性中为每患者年 1.2-1.44%，女性中为每患者年 2.08-2.43%。女性中风风险似乎与口服抗凝治疗无关[风险比（95%CI）分别为 1.29（1.09-1.52）和 1.49（1.17-1.90）在未抗凝与抗凝/混合队列中]。
AF 女性中风风险增加，尤其是老年女性。应在所有 AF 患者中进行全面的中风风险评估，包括将性别作为风险因素。
