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Gender Differences in Risk Factors for Atrial Fibrillation
1Niigata University Graduate School of Medical and Dental Sciences, Department of Cardiovascular Biology and Medicine - Niigata - Japan
2Niigata Health Foundation - Niigata - Japan
3Tachikawa General Hospital - Nagaoka - Japan
Introduction: There have been various risk factors for atrial fibrillation (AF) such as cardiac and non-cardiac diseases, and atherosclerotic factors (e.g., diabetes, hypertension, and obesity). The aim of this study was to investigate the gender differences in the impact of risk factors on development of AF in the general population.
Methods: This community-based prospective observational cohort study was based upon an annual health check-up program in Niigata, Japan. The annual examination consists of interviews about medical history, physical examinations, blood examinations, urine tests, chest radiographs, and 12-lead electrocardiograms. This study included 223,877 individuals without AF at baseline who were followed more than one year (152,322 women [68%]; age, 61±12 years).
Results: During a follow up of 5.9±2.4 years, AF developed in 1,840 men (incidence, 4.55; 95% confidence interval, 4.34-4.76) and 1,107 women (incidence, 1.21; 95% confidence interval, 1.14-1.28). Men developed AF from younger age compared to women. In women, development of AF was rare before the age of 60 years and thereafter the incidence of AF increased steeply. Among atherosclerotic risk factors, obesity and hypertension were associated with risk of development of AF in both genders. However, impaired glucose tolerance was associated with AF only in men but not in women, and low HDL-cholesterol was associated with AF only in women but not in men. Elevated triglycerides were not associated with AF in each gender. Decreased LDL-cholesterol was associated with AF in both genders, supporting the cholesterol paradox in AF as we and others have recently identified. Heart disease and metabolic syndrome were associated with increased risk of AF in both genders. Elevated uric acid was associated with AF in women but not in men, and chronic kidney disease was associated with AF in women but the association was weak in men. Non-alcoholic fatty liver disease was associated with risk of AF in women but not in men.
Conclusion: The age-dependent trends in the incidence of AF and the effects of various risk factors on development of AF were different between men and women. Our study indicates that the pathogenic of AF is affected by gender.
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