Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies

Connor A Emdin; Christopher X Wong; Allan J Hsiao; Douglas G Altman; Sanne Ae Peters; Mark Woodward; Ayodele A Odutayo

doi:10.1136/bmj.h7013

Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies

Connor A Emdin, Christopher X Wong, Allan J Hsiao, Douglas G Altman, Sanne Ae Peters, Mark Woodward, Ayodele A Odutayo

Research output: Contribution to journal › Review article › peer-review

Abstract

OBJECTIVE: To determine whether atrial fibrillation is a stronger risk factor for cardiovascular disease and death in women compared with men.

DESIGN: Meta-analysis of cohort studies.

DATA SOURCES: Studies published between January 1966 and March 2015, identified through a systematic search of Medline and Embase and review of references.

ELIGIBILITY FOR SELECTING STUDIES: Cohort studies with a minimum of 50 participants with and 50 without atrial fibrillation that reported sex specific associations between atrial fibrillation and all cause mortality, cardiovascular mortality, stroke, cardiac events (cardiac death and non-fatal myocardial infarction), and heart failure.

DATA EXTRACTION: Two independent reviewers extracted study characteristics and maximally adjusted sex specific relative risks. Inverse variance weighted random effects meta-analysis was used to pool sex specific relative risks and their ratio.

RESULTS: 30 studies with 4,371,714 participants were identified. Atrial fibrillation was associated with a higher risk of all cause mortality in women (ratio of relative risks for women compared with men 1.12, 95% confidence interval 1.07 to 1.17) and a significantly stronger risk of stroke (1.99, 1.46 to 2.71), cardiovascular mortality (1.93, 1.44 to 2.60), cardiac events (1.55, 1.15 to 2.08), and heart failure (1.16, 1.07 to 1.27). Results were broadly consistent in sensitivity analyses.

CONCLUSION: Atrial fibrillation is a stronger risk factor for cardiovascular disease and death in women compared with men, though further research would be needed to determine any causality.

Original language	English
Pages (from-to)	h7013
Journal	BMJ (Clinical research ed.)
Volume	532
DOIs	https://doi.org/10.1136/bmj.h7013
Publication status	Published - 19 Jan 2016

Keywords

Atrial Fibrillation/epidemiology
Cardiovascular Diseases/epidemiology
Death, Sudden, Cardiac/epidemiology
Female
Heart Failure/epidemiology
Humans
Male
Myocardial Infarction/epidemiology
Risk Factors
Sex Factors
Stroke/epidemiology

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@article{859f4377764049eebbe8ac7521b3a870,

title = "Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies",

abstract = "OBJECTIVE: To determine whether atrial fibrillation is a stronger risk factor for cardiovascular disease and death in women compared with men.DESIGN: Meta-analysis of cohort studies.DATA SOURCES: Studies published between January 1966 and March 2015, identified through a systematic search of Medline and Embase and review of references.ELIGIBILITY FOR SELECTING STUDIES: Cohort studies with a minimum of 50 participants with and 50 without atrial fibrillation that reported sex specific associations between atrial fibrillation and all cause mortality, cardiovascular mortality, stroke, cardiac events (cardiac death and non-fatal myocardial infarction), and heart failure.DATA EXTRACTION: Two independent reviewers extracted study characteristics and maximally adjusted sex specific relative risks. Inverse variance weighted random effects meta-analysis was used to pool sex specific relative risks and their ratio.RESULTS: 30 studies with 4,371,714 participants were identified. Atrial fibrillation was associated with a higher risk of all cause mortality in women (ratio of relative risks for women compared with men 1.12, 95\% confidence interval 1.07 to 1.17) and a significantly stronger risk of stroke (1.99, 1.46 to 2.71), cardiovascular mortality (1.93, 1.44 to 2.60), cardiac events (1.55, 1.15 to 2.08), and heart failure (1.16, 1.07 to 1.27). Results were broadly consistent in sensitivity analyses.CONCLUSION: Atrial fibrillation is a stronger risk factor for cardiovascular disease and death in women compared with men, though further research would be needed to determine any causality.",

keywords = "Atrial Fibrillation/epidemiology, Cardiovascular Diseases/epidemiology, Death, Sudden, Cardiac/epidemiology, Female, Heart Failure/epidemiology, Humans, Male, Myocardial Infarction/epidemiology, Risk Factors, Sex Factors, Stroke/epidemiology",

author = "Emdin, \{Connor A\} and Wong, \{Christopher X\} and Hsiao, \{Allan J\} and Altman, \{Douglas G\} and Peters, \{Sanne Ae\} and Mark Woodward and Odutayo, \{Ayodele A\}",

note = "Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.",

year = "2016",

month = jan,

day = "19",

doi = "10.1136/bmj.h7013",

language = "English",

volume = "532",

pages = "h7013",

journal = "BMJ (Clinical research ed.)",

issn = "1756-1833",

publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men

T2 - systematic review and meta-analysis of cohort studies

AU - Emdin, Connor A

AU - Wong, Christopher X

AU - Hsiao, Allan J

AU - Altman, Douglas G

AU - Peters, Sanne Ae

AU - Woodward, Mark

AU - Odutayo, Ayodele A

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2016/1/19

Y1 - 2016/1/19

N2 - OBJECTIVE: To determine whether atrial fibrillation is a stronger risk factor for cardiovascular disease and death in women compared with men.DESIGN: Meta-analysis of cohort studies.DATA SOURCES: Studies published between January 1966 and March 2015, identified through a systematic search of Medline and Embase and review of references.ELIGIBILITY FOR SELECTING STUDIES: Cohort studies with a minimum of 50 participants with and 50 without atrial fibrillation that reported sex specific associations between atrial fibrillation and all cause mortality, cardiovascular mortality, stroke, cardiac events (cardiac death and non-fatal myocardial infarction), and heart failure.DATA EXTRACTION: Two independent reviewers extracted study characteristics and maximally adjusted sex specific relative risks. Inverse variance weighted random effects meta-analysis was used to pool sex specific relative risks and their ratio.RESULTS: 30 studies with 4,371,714 participants were identified. Atrial fibrillation was associated with a higher risk of all cause mortality in women (ratio of relative risks for women compared with men 1.12, 95% confidence interval 1.07 to 1.17) and a significantly stronger risk of stroke (1.99, 1.46 to 2.71), cardiovascular mortality (1.93, 1.44 to 2.60), cardiac events (1.55, 1.15 to 2.08), and heart failure (1.16, 1.07 to 1.27). Results were broadly consistent in sensitivity analyses.CONCLUSION: Atrial fibrillation is a stronger risk factor for cardiovascular disease and death in women compared with men, though further research would be needed to determine any causality.

AB - OBJECTIVE: To determine whether atrial fibrillation is a stronger risk factor for cardiovascular disease and death in women compared with men.DESIGN: Meta-analysis of cohort studies.DATA SOURCES: Studies published between January 1966 and March 2015, identified through a systematic search of Medline and Embase and review of references.ELIGIBILITY FOR SELECTING STUDIES: Cohort studies with a minimum of 50 participants with and 50 without atrial fibrillation that reported sex specific associations between atrial fibrillation and all cause mortality, cardiovascular mortality, stroke, cardiac events (cardiac death and non-fatal myocardial infarction), and heart failure.DATA EXTRACTION: Two independent reviewers extracted study characteristics and maximally adjusted sex specific relative risks. Inverse variance weighted random effects meta-analysis was used to pool sex specific relative risks and their ratio.RESULTS: 30 studies with 4,371,714 participants were identified. Atrial fibrillation was associated with a higher risk of all cause mortality in women (ratio of relative risks for women compared with men 1.12, 95% confidence interval 1.07 to 1.17) and a significantly stronger risk of stroke (1.99, 1.46 to 2.71), cardiovascular mortality (1.93, 1.44 to 2.60), cardiac events (1.55, 1.15 to 2.08), and heart failure (1.16, 1.07 to 1.27). Results were broadly consistent in sensitivity analyses.CONCLUSION: Atrial fibrillation is a stronger risk factor for cardiovascular disease and death in women compared with men, though further research would be needed to determine any causality.

KW - Atrial Fibrillation/epidemiology

KW - Cardiovascular Diseases/epidemiology

KW - Death, Sudden, Cardiac/epidemiology

KW - Female

KW - Heart Failure/epidemiology

KW - Humans

KW - Male

KW - Myocardial Infarction/epidemiology

KW - Risk Factors

KW - Sex Factors

KW - Stroke/epidemiology

U2 - 10.1136/bmj.h7013

DO - 10.1136/bmj.h7013

M3 - Review article

C2 - 26786546

SN - 1756-1833

VL - 532

SP - h7013

JO - BMJ (Clinical research ed.)

JF - BMJ (Clinical research ed.)

ER -

Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies

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