Cardiology Department, Meir Medical Center, Kfar Sava, Israel; Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.
JACC Clin Electrophysiol. 2018 May;4(5):604-614. doi: 10.1016/j.jacep.2018.01.014. Epub 2018 Mar 28.
This study sought to identify the differences in stroke, mortality, and bleeding between men and women with atrial fibrillation (AF).
There are inconsistent data regarding the thromboembolic risk difference between men and women with AF. The authors assessed the risk of stroke, death, and bleeding in men and women with incident AF.
The authors employed a prospective historical cohort using an electronic database from a large health maintenance organization. All members with incident AF between 2004 and 2015 were included. Primary endpoints were ischemic stroke, death, and major bleeding.
The authors identified 89,213 members with incident nonvalvular atrial fibrillation (NVAF), 52.3% of whom were women. Women were older, with a higher prevalence of hypertension, whereas more men had diabetes, heart failure, and ischemic heart disease than the women did. Ischemic stroke occurred in 6.4% of the patients: 7.0% of women and 5.8% of men. Sex did not affect adjusted stroke risk (hazard ratio [HR]: 0.91; 95% confidence interval [CI]: 0.77 to 1.06; p = 0.22). However, women 75 years of age and older were at an increased risk (HR: 1.25; 95% CI: 1.17 to 1.34). Mortality rates were higher among women (33.5% vs. 32%; p < 0.001); however, women had a significantly lower adjusted mortality risk (HR: 0.78; 95% CI: 0.71 to 0.86). Women had lower risk of intracranial hemorrhage (HR: 0.81; 95% CI: 0.76 to 0.87) and major gastrointestinal bleeding (HR: 0.78; 95% CI: 0.70 to 0.87).
Men and women with AF had a similar risk of ischemic stroke, except for women 75 years of age or older, who had a higher risk. Our findings support using a similar anticoagulation strategy for prevention of stroke in men and women with a similar number of risk factors.
本研究旨在确定男性和女性心房颤动（AF）患者在卒中、死亡率和出血方面的差异。
关于 AF 男性和女性之间血栓栓塞风险差异的数据不一致。作者评估了新发 AF 男性和女性的卒中、死亡和出血风险。
作者采用前瞻性历史队列研究，使用大型医疗保健组织的电子数据库。纳入 2004 年至 2015 年间新发非瓣膜性心房颤动（NVAF）的所有成员。主要终点为缺血性卒中、死亡和主要出血。
作者确定了 89213 名患有新发 NVAF 的成员，其中 52.3%为女性。女性年龄较大，高血压患病率较高，而男性糖尿病、心力衰竭和缺血性心脏病的患病率高于女性。卒中发生率为 6.4%：女性为 7.0%，男性为 5.8%。性别并未影响调整后的卒中风险（风险比[HR]：0.91；95%置信区间[CI]：0.77 至 1.06；p=0.22）。然而，75 岁及以上的女性风险增加（HR：1.25；95%CI：1.17 至 1.34）。女性死亡率较高（33.5% vs. 32%；p<0.001）；然而，女性的调整后死亡率风险显著降低（HR：0.78；95%CI：0.71 至 0.86）。女性颅内出血（HR：0.81；95%CI：0.76 至 0.87）和主要胃肠道出血（HR：0.78；95%CI：0.70 至 0.87）的风险较低。
除了 75 岁及以上的女性卒中风险较高外，AF 男性和女性的缺血性卒中风险相似。我们的研究结果支持在具有相似危险因素的男性和女性中使用相似的抗凝策略来预防卒中。
