Relation of renal dysfunction to the increased risk of stroke and death in female patients with atrial fibrillation

Int J Cardiol. 2013 Sep 30;168(2):1502-8. doi: 10.1016/j.ijcard.2012.12.099. Epub 2013 Jan 30.

Abstract

Background: Female patients with atrial fibrillation (AF) are at increased risk of stroke. It is unclear what contributes to the gender-related differences in stroke and mortality amongst AF patients. This is pertinent since oral anticoagulation use results in a significant reduction in stroke, as well as all-cause mortality.

Objective: We investigated gender-related risk factors for stroke and mortality in a cohort of Chinese patients with AF.

Methods: We studied 1034 AF patients (27% females, median age 75 years) who were followed-up for an average of 1.9 years for the principal primary endpoint of 'ischaemic stroke and death'. Gender-specific effect of risk factors for stroke and death was analyzed.

Results: Patients at high stroke risk (CHADS2 or CHADS2-VASc ≥ 2) and HAS-BLED ≥ 3 had higher rates of ischaemic stroke and death, but ischaemic stroke rates in females with HAS-BLED ≥ 3 did not differ between CHADS2 0-1 and ≥ 2 (~3 per 100 person-years). On multivariate analysis of non-anticoagulated patients (n=885), independent predictors of 'ischaemic stroke and death' in both males and females were age>75, prior stroke and renal dysfunction (all p<0.05). Independent predictors of 'ischaemic stroke' in females were prior stroke, vascular disease and renal dysfunction (all p<0.05). When females were compared to males, adjusted for baseline characteristics, independent predictors for 'ischaemic stroke and death' amongst females were prior stroke (hazard ratio, HR 2.40; 95% confidence interval, CI, 1.17-4.91, p=0.017) and renal dysfunction (HR 5.30; 95%CI 2.39-11.74, p<0.001). When females were compared to males, renal dysfunction remained a predictor for the secondary endpoints of ischaemic stroke (HR 4.37, p=0.05) and all-cause mortality (HR 4.15, p=0.003).

Conclusions: Renal dysfunction may be a contributor to the greater risk of stroke and death in female Chinese patients with AF. This increased risk is largely driven by the impact on all-cause mortality.

Keywords: Atrial fibrillation; Gender; Mortality; Renal dysfunction; Stroke.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Asian People* / ethnology
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / ethnology
  • Atrial Fibrillation / mortality*
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Kidney Diseases / diagnosis
  • Kidney Diseases / ethnology
  • Kidney Diseases / mortality*
  • Male
  • Middle Aged
  • Mortality / trends
  • Risk Factors
  • Sex Factors
  • Stroke / diagnosis
  • Stroke / ethnology
  • Stroke / mortality*