title: Relation of renal dysfunction to the increased risk of stroke and death in female patients with atrial fibrillation.
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.
authors: Haemostasis, Thrombosis and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom; Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China.
authors: Yutao
authors: Y
authors: Guo
authors: Haijun
authors: H
authors: Wang
authors: Xiaoning
authors: X
authors: Zhao
authors: Yu
authors: Y
authors: Zhang
authors: Dexian
authors: D
authors: Zhang
authors: Jingling
authors: J
authors: Ma
authors: Yutang
authors: Y
authors: Wang
authors: Gregory Y H
authors: GY
authors: Lip
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000208:ethnology; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality*
keywords: Atrial fibrillation; Gender; Mortality; Renal dysfunction; Stroke