title: Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies.
abstract: OBJECTIVE
  To determine whether atrial fibrillation is a stronger risk factor for cardiovascular disease and death in women compared with men.
  
  
  METHODS
  Meta-analysis of cohort studies.
  
  
  METHODS
  Studies published between January 1966 and March 2015, identified through a systematic search of Medline and Embase and review of references.
  Cohort studies with a minimum of 50 participants with and 50 without atrial fibrillation that reported sex specific associations between atrial fibrillation and all cause mortality, cardiovascular mortality, stroke, cardiac events (cardiac death and non-fatal myocardial infarction), and heart failure.
  
  
  METHODS
  Two independent reviewers extracted study characteristics and maximally adjusted sex specific relative risks. Inverse variance weighted random effects meta-analysis was used to pool sex specific relative risks and their ratio.
  
  
  RESULTS
  30 studies with 4,371,714 participants were identified. Atrial fibrillation was associated with a higher risk of all cause mortality in women (ratio of relative risks for women compared with men 1.12, 95% confidence interval 1.07 to 1.17) and a significantly stronger risk of stroke (1.99, 1.46 to 2.71), cardiovascular mortality (1.93, 1.44 to 2.60), cardiac events (1.55, 1.15 to 2.08), and heart failure (1.16, 1.07 to 1.27). Results were broadly consistent in sensitivity analyses.
  
  
  CONCLUSIONS
  Atrial fibrillation is a stronger risk factor for cardiovascular disease and death in women compared with men, though further research would be needed to determine any causality.
authors.affiliation: George Institute for Global Health, University of Oxford, Oxford, UK cemdin@georgeinstitute.org.uk.
authors.forename: Connor A
authors.initials: CA
authors.lastname: Emdin
authors.affiliation: Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Christopher X
authors.initials: CX
authors.lastname: Wong
authors.affiliation: Department of Economics, Massachusetts Institute of Technology, Cambridge, MA, USA.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Hsiao
authors.affiliation: Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Altman
authors.affiliation: George Institute for Global Health, University of Oxford, Oxford, UK.
authors.forename: Sanne Ae
authors.initials: SA
authors.lastname: Peters
authors.affiliation: George Institute for Global Health, University of Oxford, Oxford, UK George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.affiliation: Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Ayodele A
authors.initials: AA
authors.lastname: Odutayo
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000401:mortality; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality