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 Jørgensen; Stefan Söderberg; Kari Kuulasmaa; Tanja Zeller; Licia Iacoviello; Veikko Salomaa; Renate B Schnabel; BiomarCaRE Consortium

doi:10.1161/CIRCULATIONAHA.117.028981

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

105 Citations (Scopus)

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 language	English
Journal	Circulation
Volume	136
Issue number	17
Pages (from-to)	1588-1597
Number of pages	10
ISSN	0009-7322
DOIs	https://doi.org/10.1161/CIRCULATIONAHA.117.028981
Publication status	Published - 24 Oct 2017

Keywords

Adult
Age Factors
Aged
Aged, 80 and over
Atrial Fibrillation
Body Mass Index
Cholesterol
Female
Follow-Up Studies
Humans
Male
Middle Aged
Norway
Risk Factors
Sex Characteristics
Sex Factors
Clinical Trial
Journal Article
Multicenter Study
Observational Study

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Magnussen, C., Niiranen, T. J., Ojeda, F. M., Gianfagna, F., Blankenberg, S., Njølstad, I., Vartiainen, E., Sans, S., Pasterkamp, G., Hughes, M., Costanzo, S., Donati, M. B., Jousilahti, P., Linneberg, A., Palosaari, T., de Gaetano, G., Bobak, M., den Ruijter, H. M., Mathiesen, E., ... 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, 136(17), 1588-1597. https://doi.org/10.1161/CIRCULATIONAHA.117.028981

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 et al.

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

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

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 C, Niiranen TJ, Ojeda FM, Gianfagna F, Blankenberg S, Njølstad I et al. 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. 2017 Oct 24;136(17):1588-1597. doi: 10.1161/CIRCULATIONAHA.117.028981

@article{1f8547b92a124692880b2c809c6e611f,

title = "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)",

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.",

keywords = "Adult, Age Factors, Aged, Aged, 80 and over, Atrial Fibrillation, Body Mass Index, Cholesterol, Female, Follow-Up Studies, Humans, Male, Middle Aged, Norway, Risk Factors, Sex Characteristics, Sex Factors, Clinical Trial, Journal Article, Multicenter Study, Observational Study",

author = "Christina Magnussen and Niiranen, {Teemu J} and Ojeda, {Francisco M} and Francesco Gianfagna and Stefan Blankenberg and Inger Nj{\o}lstad and Erkki Vartiainen and Susana Sans and Gerard Pasterkamp and Maria Hughes and Simona Costanzo and Donati, {Maria Benedetta} and Pekka Jousilahti and Allan Linneberg and Tarja Palosaari and {de Gaetano}, Giovanni and Martin Bobak and {den Ruijter}, {Hester M} and Ellisiv Mathiesen and Torben J{\o}rgensen and Stefan S{\"o}derberg and Kari Kuulasmaa and Tanja Zeller and Licia Iacoviello and Veikko Salomaa and Schnabel, {Renate B} and {BiomarCaRE Consortium}",

note = "{\textcopyright} 2017 American Heart Association, Inc.",

year = "2017",

month = oct,

day = "24",

doi = "10.1161/CIRCULATIONAHA.117.028981",

language = "English",

volume = "136",

pages = "1588--1597",

journal = "Circulation",

issn = "0009-7322",

publisher = "AHA/ASA",

number = "17",

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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 - Adult

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Atrial Fibrillation

KW - Body Mass Index

KW - Cholesterol

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Male

KW - Middle Aged

KW - Norway

KW - Risk Factors

KW - Sex Characteristics

KW - Sex Factors

KW - Clinical Trial

KW - Journal Article

KW - Multicenter Study

KW - Observational Study

U2 - 10.1161/CIRCULATIONAHA.117.028981

DO - 10.1161/CIRCULATIONAHA.117.028981

M3 - Journal article

C2 - 29038167

SN - 0009-7322

VL - 136

SP - 1588

EP - 1597

JO - Circulation

JF - Circulation

IS - 17

ER -