Impact of gender on the prognosis of patients with nonvalvular atrial fibrillation.
Treatment guidelines for atrial fibrillation (AF) used in Western countries describe female gender as a risk factor for thromboembolic events in patients with nonvalvular AF (NVAF). The present study aimed to determine the impact of gender on prognosis of Japanese patients with NVAF. A subanalysis of 7,406 patients with NVAF (mean age 70 years) who were followed-up prospectively for 2 years was performed using data from the J-RHYTHM registry. The primary end points were thromboembolic events, major hemorrhaging, total mortality, and cardiovascular mortality. Compared with male subjects (n = 5,241), female subjects (n = 2,165) were older and displayed greater prevalences of paroxysmal AF, heart failure, and hypertension but less prevalences of diabetes, previous cerebral infarction, and coronary artery disease. Male and female patients had mean CHADS2 (Congestive heart failure, Hypertension, Age of 75 years or more, Diabetes mellitus and prior Stroke or transient ischemic attack) scores of 1.6 and 1.8, respectively (p <0.001). Warfarin was given to 87% of male patients and 86% of female patients (p = 0.760), and the 2 genders displayed similar mean international normalized ratio of prothrombin time values at baseline (1.91 vs 1.90, respectively, p = 0.756). Multivariate logistic regression analysis indicated that male gender was an independent risk factor for major hemorrhaging (odds ratio 1.59, 95% confidence interval 1.05 to 2.40, p = 0.027) and all-cause mortality (odds ratio 1.78, 95% confidence interval 1.25 to 2.55, p <0.002) but not for thromboembolic events (odds ratio 1.24, 95% confidence interval 0.83 to 1.86, p = 0.297) or cardiovascular mortality (odds ratio 0.96, 95% confidence interval 0.56 to 1.66, p = 0.893). In conclusion, female gender is not a risk factor for thromboembolic events among Japanese patients with NVAF who were treated mostly with warfarin. However, male gender is a risk factor for major hemorrhaging and all-cause mortality.
Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan. Electronic address: hiroshi@med.u-toyama.ac.jp.
Hiroshi
H
Inoue
Nippon Medical School, Tama-Nagayama Hospital, Tokyo, Japan.
Hirotsugu
H
Atarashi
Department of Cardiology, Hirosaki University Graduate School of Medicine, Aomori, Japan.
Ken
K
Okumura
The Cardiovascular Institute, Tokyo, Japan.
Takeshi
T
Yamashita
Division of Biostatistics and Clinical Epidemiology, University of Toyama, Toyama, Japan.
Hideki
H
Origasa
Kochi Medical School Clinical Research Center, Japan University, Kochi, Japan.
Naoko
N
Kumagai
Department of Cardiology, Hokko Memorial Hospital, Hokkaido, Japan.
Masayuki
M
Sakurai
Health Administration Center, Asahikawa Medical University, Hokkaido, Japan.
Yuichiro
Y
Kawamura
Internal Medicine 1, Yamagata University School of Medicine, Yamagata, Japan.
Isao
I
Kubota
Department of Cardiology, International Medical Center, Saitama Medical University, Saitama, Japan.
Kazuo
K
Matsumoto
Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Gunma, Japan.
Yoshiaki
Y
Kaneko
International University of Health and Welfare, Mita Hospital, Tokyo, Japan.
Satoshi
S
Ogawa
Division of Cardiology, Niigata University Graduate School of Medicine and Dental Science, Niigata, Japan.
Yoshifusa
Y
Aizawa
Graduate School of Health Science, Niigata University School of Medicine, Niigata, Japan.
Masaomi
M
Chinushi
Nagoya University, Aichi, Japan.
Itsuo
I
Kodama
Department of Cardiology, Fujita Health University School of Medicine, Aichi, Japan.
Eiichi
E
Watanabe
Institute for Clinical Research, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
Yukihiro
Y
Koretsune
Department of Cardiology, Osaka General Medical Center, Osaka, Japan.
Yuji
Y
Okuyama
Faculty of Health Sciences, Yamaguchi Graduate School of Medicine, Yamaguchi, Japan.
Akihiko
A
Shimizu
Department of Cardiovascular Medicine, Tottori University Hospital, Tottori, Japan.
Osamu
O
Igawa
Kagawa Prefectural Shiratori Hospital, Kagawa, Japan.
Shigenobu
S
Bando
Department of Cardiology, Chikamori Hospital, Kochi, Japan.
Masahiko
M
Fukatani
Department of Clinical Examination and Diagnostics, Oita University, Oita, Japan.
Tetsunori
T
Saikawa
Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
Akiko
A
Chishaki
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D015996:Survival Rate / Q000639:trends