Sex Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors, and Mortality in Community Cohorts: Results From the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe)

Christina Magnussen, Teemu J. Niiranen, Francisco M. Ojeda, Francesco Gianfagna, Stefan Blankenberg, Inger Njølstad, Erkki Vartiainen, Susana Sans, Gerard Pasterkamp, Maria Hughes, Simona Costanzo, Maria Benedetta Donati, Pekka Jousilahti, Allan Linneberg, Tarja Palosaari, Giovanni de Gaetano, Martin Bobak, Hester M. den Ruijter, Ellisiv Mathiesen, Torben JørgensenStefan Söderberg, Kari Kuulasmaa, Tanja Zeller, Licia Iacoviello, Veikko Salomaa, Renate B. Schnabel, BiomarCaRE Consortium

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Atrial fibrillation (AF) is a common cardiac disease in aging populations with high comorbidity and mortality. Sex differences in AF epidemiology are insufficiently understood.

METHODS: In N=79 793 individuals without AF diagnosis at baseline (median age, 49.6 years; age range, 24.1-97.6 years; 51.7% women) from 4 community-based European studies (FINRISK, DanMONICA, Moli-sani Northern Sweden) of the BiomarCaRE consortium (Biomarker for Cardiovascular Risk Assessment in Europe), we examined AF incidence, its association with mortality, common risk factors, biomarkers, and prevalent cardiovascular disease, and their attributable risk by sex. Median follow-up time was 12.6 (to a maximum of 28.2) years.

RESULTS: Fewer AF cases were observed in women (N=1796; 4.4%), than in men (N=2465; 6.4%). Cardiovascular risk factor distribution and lipid profile at baseline were less beneficial in men than in women, and cardiovascular disease was more prevalent in men. Cumulative incidence increased markedly after the age of 50 years in men and after 60 years in women. The lifetime risk was similar (>30%) for both sexes. Subjects with incident AF had a 3.5-fold risk of death in comparison with those without AF. Multivariable-adjusted models showed sex differences for the association of body mass index and AF (hazard ratio per standard deviation increase, 1.18; 95% confidence interval [CI], 1.12-1.23 in women versus 1.31; 95% CI 1.25-1.38 in men; interaction P value of 0.001). Total cholesterol was inversely associated with incident AF with a greater risk reduction in women (hazard ratio per SD, 0.86; 95% CI, 0.81-0.90 versus 0.92; 95% CI, 0.88-0.97 in men; interaction P value of 0.023). No sex differences were seen for C-reactive protein and N-terminal pro B-type natriuretic peptide. The population-attributable risk of all risk factors combined was 41.9% in women and 46.0% in men. About 20% of the risk was observed for body mass index.

CONCLUSIONS: Lifetime risk of AF was high, and AF was strongly associated with increased mortality both in women and men. Body mass index explained the largest proportion of AF risk. Observed sex differences in the association of body mass index and total cholesterol with AF need to be evaluated for underlying pathophysiology and relevance to sex-specific prevention strategies.

Original languageEnglish
Pages (from-to)1588-1597
Number of pages10
JournalCirculation
Volume136
Issue number17
DOIs
Publication statusPublished - Oct 24 2017

Fingerprint

Sex Characteristics
Atrial Fibrillation
Epidemiology
Biomarkers
Mortality
Body Mass Index
Confidence Intervals
Cardiovascular Diseases
Cholesterol
Brain Natriuretic Peptide
Incidence
European Union
Risk Reduction Behavior
Sweden
C-Reactive Protein
Population
Comorbidity
Heart Diseases
Lipids

Keywords

  • atrial fibrillation
  • biomarkers
  • cohort studies
  • epidemiology
  • mortality
  • risk assessment
  • sex

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Sex Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors, and Mortality in Community Cohorts : Results From the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe). / Magnussen, Christina; Niiranen, Teemu J.; Ojeda, Francisco M.; Gianfagna, Francesco; Blankenberg, Stefan; Njølstad, Inger; Vartiainen, Erkki; Sans, Susana; Pasterkamp, Gerard; Hughes, Maria; Costanzo, Simona; Donati, Maria Benedetta; Jousilahti, Pekka; Linneberg, Allan; Palosaari, Tarja; de Gaetano, Giovanni; Bobak, Martin; den Ruijter, Hester M.; Mathiesen, Ellisiv; Jørgensen, Torben; Söderberg, Stefan; Kuulasmaa, Kari; Zeller, Tanja; Iacoviello, Licia; Salomaa, Veikko; Schnabel, Renate B.; BiomarCaRE Consortium.

In: Circulation, Vol. 136, No. 17, 24.10.2017, p. 1588-1597.

Research output: Contribution to journalArticle

Magnussen, C, Niiranen, TJ, Ojeda, FM, Gianfagna, F, Blankenberg, S, Njølstad, I, Vartiainen, E, Sans, S, Pasterkamp, G, Hughes, M, Costanzo, S, Donati, MB, Jousilahti, P, Linneberg, A, Palosaari, T, de Gaetano, G, Bobak, M, den Ruijter, HM, Mathiesen, E, Jørgensen, T, Söderberg, S, Kuulasmaa, K, Zeller, T, Iacoviello, L, Salomaa, V, Schnabel, RB & BiomarCaRE Consortium 2017, 'Sex Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors, and Mortality in Community Cohorts: Results From the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe)', Circulation, vol. 136, no. 17, pp. 1588-1597. https://doi.org/10.1161/CIRCULATIONAHA.117.028981
Magnussen, Christina ; Niiranen, Teemu J. ; Ojeda, Francisco M. ; Gianfagna, Francesco ; Blankenberg, Stefan ; Njølstad, Inger ; Vartiainen, Erkki ; Sans, Susana ; Pasterkamp, Gerard ; Hughes, Maria ; Costanzo, Simona ; Donati, Maria Benedetta ; Jousilahti, Pekka ; Linneberg, Allan ; Palosaari, Tarja ; de Gaetano, Giovanni ; Bobak, Martin ; den Ruijter, Hester M. ; Mathiesen, Ellisiv ; Jørgensen, Torben ; Söderberg, Stefan ; Kuulasmaa, Kari ; Zeller, Tanja ; Iacoviello, Licia ; Salomaa, Veikko ; Schnabel, Renate B. ; BiomarCaRE Consortium. / Sex Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors, and Mortality in Community Cohorts : Results From the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe). In: Circulation. 2017 ; Vol. 136, No. 17. pp. 1588-1597.
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abstract = "BACKGROUND: Atrial fibrillation (AF) is a common cardiac disease in aging populations with high comorbidity and mortality. Sex differences in AF epidemiology are insufficiently understood.METHODS: In N=79 793 individuals without AF diagnosis at baseline (median age, 49.6 years; age range, 24.1-97.6 years; 51.7{\%} women) from 4 community-based European studies (FINRISK, DanMONICA, Moli-sani Northern Sweden) of the BiomarCaRE consortium (Biomarker for Cardiovascular Risk Assessment in Europe), we examined AF incidence, its association with mortality, common risk factors, biomarkers, and prevalent cardiovascular disease, and their attributable risk by sex. Median follow-up time was 12.6 (to a maximum of 28.2) years.RESULTS: Fewer AF cases were observed in women (N=1796; 4.4{\%}), than in men (N=2465; 6.4{\%}). Cardiovascular risk factor distribution and lipid profile at baseline were less beneficial in men than in women, and cardiovascular disease was more prevalent in men. Cumulative incidence increased markedly after the age of 50 years in men and after 60 years in women. The lifetime risk was similar (>30{\%}) for both sexes. Subjects with incident AF had a 3.5-fold risk of death in comparison with those without AF. Multivariable-adjusted models showed sex differences for the association of body mass index and AF (hazard ratio per standard deviation increase, 1.18; 95{\%} confidence interval [CI], 1.12-1.23 in women versus 1.31; 95{\%} CI 1.25-1.38 in men; interaction P value of 0.001). Total cholesterol was inversely associated with incident AF with a greater risk reduction in women (hazard ratio per SD, 0.86; 95{\%} CI, 0.81-0.90 versus 0.92; 95{\%} CI, 0.88-0.97 in men; interaction P value of 0.023). No sex differences were seen for C-reactive protein and N-terminal pro B-type natriuretic peptide. The population-attributable risk of all risk factors combined was 41.9{\%} in women and 46.0{\%} in men. About 20{\%} of the risk was observed for body mass index.CONCLUSIONS: Lifetime risk of AF was high, and AF was strongly associated with increased mortality both in women and men. Body mass index explained the largest proportion of AF risk. Observed sex differences in the association of body mass index and total cholesterol with AF need to be evaluated for underlying pathophysiology and relevance to sex-specific prevention strategies.",
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TY - JOUR

T1 - Sex Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors, and Mortality in Community Cohorts

T2 - Results From the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe)

AU - Magnussen, Christina

AU - Niiranen, Teemu J.

AU - Ojeda, Francisco M.

AU - Gianfagna, Francesco

AU - Blankenberg, Stefan

AU - Njølstad, Inger

AU - Vartiainen, Erkki

AU - Sans, Susana

AU - Pasterkamp, Gerard

AU - Hughes, Maria

AU - Costanzo, Simona

AU - Donati, Maria Benedetta

AU - Jousilahti, Pekka

AU - Linneberg, Allan

AU - Palosaari, Tarja

AU - de Gaetano, Giovanni

AU - Bobak, Martin

AU - den Ruijter, Hester M.

AU - Mathiesen, Ellisiv

AU - Jørgensen, Torben

AU - Söderberg, Stefan

AU - Kuulasmaa, Kari

AU - Zeller, Tanja

AU - Iacoviello, Licia

AU - Salomaa, Veikko

AU - Schnabel, Renate B.

AU - BiomarCaRE Consortium

PY - 2017/10/24

Y1 - 2017/10/24

N2 - BACKGROUND: Atrial fibrillation (AF) is a common cardiac disease in aging populations with high comorbidity and mortality. Sex differences in AF epidemiology are insufficiently understood.METHODS: In N=79 793 individuals without AF diagnosis at baseline (median age, 49.6 years; age range, 24.1-97.6 years; 51.7% women) from 4 community-based European studies (FINRISK, DanMONICA, Moli-sani Northern Sweden) of the BiomarCaRE consortium (Biomarker for Cardiovascular Risk Assessment in Europe), we examined AF incidence, its association with mortality, common risk factors, biomarkers, and prevalent cardiovascular disease, and their attributable risk by sex. Median follow-up time was 12.6 (to a maximum of 28.2) years.RESULTS: Fewer AF cases were observed in women (N=1796; 4.4%), than in men (N=2465; 6.4%). Cardiovascular risk factor distribution and lipid profile at baseline were less beneficial in men than in women, and cardiovascular disease was more prevalent in men. Cumulative incidence increased markedly after the age of 50 years in men and after 60 years in women. The lifetime risk was similar (>30%) for both sexes. Subjects with incident AF had a 3.5-fold risk of death in comparison with those without AF. Multivariable-adjusted models showed sex differences for the association of body mass index and AF (hazard ratio per standard deviation increase, 1.18; 95% confidence interval [CI], 1.12-1.23 in women versus 1.31; 95% CI 1.25-1.38 in men; interaction P value of 0.001). Total cholesterol was inversely associated with incident AF with a greater risk reduction in women (hazard ratio per SD, 0.86; 95% CI, 0.81-0.90 versus 0.92; 95% CI, 0.88-0.97 in men; interaction P value of 0.023). No sex differences were seen for C-reactive protein and N-terminal pro B-type natriuretic peptide. The population-attributable risk of all risk factors combined was 41.9% in women and 46.0% in men. About 20% of the risk was observed for body mass index.CONCLUSIONS: Lifetime risk of AF was high, and AF was strongly associated with increased mortality both in women and men. Body mass index explained the largest proportion of AF risk. Observed sex differences in the association of body mass index and total cholesterol with AF need to be evaluated for underlying pathophysiology and relevance to sex-specific prevention strategies.

AB - BACKGROUND: Atrial fibrillation (AF) is a common cardiac disease in aging populations with high comorbidity and mortality. Sex differences in AF epidemiology are insufficiently understood.METHODS: In N=79 793 individuals without AF diagnosis at baseline (median age, 49.6 years; age range, 24.1-97.6 years; 51.7% women) from 4 community-based European studies (FINRISK, DanMONICA, Moli-sani Northern Sweden) of the BiomarCaRE consortium (Biomarker for Cardiovascular Risk Assessment in Europe), we examined AF incidence, its association with mortality, common risk factors, biomarkers, and prevalent cardiovascular disease, and their attributable risk by sex. Median follow-up time was 12.6 (to a maximum of 28.2) years.RESULTS: Fewer AF cases were observed in women (N=1796; 4.4%), than in men (N=2465; 6.4%). Cardiovascular risk factor distribution and lipid profile at baseline were less beneficial in men than in women, and cardiovascular disease was more prevalent in men. Cumulative incidence increased markedly after the age of 50 years in men and after 60 years in women. The lifetime risk was similar (>30%) for both sexes. Subjects with incident AF had a 3.5-fold risk of death in comparison with those without AF. Multivariable-adjusted models showed sex differences for the association of body mass index and AF (hazard ratio per standard deviation increase, 1.18; 95% confidence interval [CI], 1.12-1.23 in women versus 1.31; 95% CI 1.25-1.38 in men; interaction P value of 0.001). Total cholesterol was inversely associated with incident AF with a greater risk reduction in women (hazard ratio per SD, 0.86; 95% CI, 0.81-0.90 versus 0.92; 95% CI, 0.88-0.97 in men; interaction P value of 0.023). No sex differences were seen for C-reactive protein and N-terminal pro B-type natriuretic peptide. The population-attributable risk of all risk factors combined was 41.9% in women and 46.0% in men. About 20% of the risk was observed for body mass index.CONCLUSIONS: Lifetime risk of AF was high, and AF was strongly associated with increased mortality both in women and men. Body mass index explained the largest proportion of AF risk. Observed sex differences in the association of body mass index and total cholesterol with AF need to be evaluated for underlying pathophysiology and relevance to sex-specific prevention strategies.

KW - atrial fibrillation

KW - biomarkers

KW - cohort studies

KW - epidemiology

KW - mortality

KW - risk assessment

KW - sex

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