• BMJ · Jan 2016

    Review Meta Analysis

    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, and Ayodele A Odutayo.
    • George Institute for Global Health, University of Oxford, Oxford, UK cemdin@georgeinstitute.org.uk.
    • BMJ. 2016 Jan 1; 532: h7013.

    ObjectiveTo determine whether atrial fibrillation is a stronger risk factor for cardiovascular disease and death in women compared with men.DesignMeta-analysis of cohort studies.Data SourcesStudies published between January 1966 and March 2015, identified through a systematic search of Medline and Embase and review of references.Eligibility For Selecting StudiesCohort 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 ExtractionTwo 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.Results30 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.ConclusionAtrial 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.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.

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