21 research outputs found
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)
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=79793 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, Molisani 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 sexspecific prevention strategie
Combined Influence of Waist and Hip Circumference on Risk of Death in a Large Cohort of European and Australian Adults
Background: Waist circumference and hip circumference are both strongly associated with risk of death; however, their joint association has rarely been investigated.Methods and Results: The MONICA Risk, Genetics, Archiving, and Monograph (MORGAM) Project was conducted in 30 cohorts from 11 countries; 90 487 men and women, aged 30 to 74 years, predominantly white, with no history of cardiovascular disease, were recruited in 1986 to 2010 and followed up for up to 24 years. Hazard ratios were estimated using sex-specific Cox models, stratified by cohort, with age as the time scale. Models included baseline categorical obesity measures, age, total and high-density lipoprotein cholesterol, systolic blood pressure, antihypertensive drugs, smoking, and diabetes mellitus. A total of 9105 all-cause deaths were recorded during a median follow-up of 10 years. Hazard ratios for all-cause death presented J- or U-shaped associations with most obesity measures. With waist and hip circumference included in the same model, for all hip sizes, having a smaller waist was strongly associated with lower risk of death, except for men with the smallest hips. In addition, among those with smaller waists, hip size was strongly negatively associated with risk of death, with approximate to 20% more people identified as being at increased risk compared with waist circumference alone.Conclusions: A more complex relationship between hip circumference, waist circumference, and risk of death is revealed when both measures are considered simultaneously. This is particularly true for individuals with smaller waists, where having larger hips was protective. Considering both waist and hip circumference in the clinical setting could help to best identify those at increased risk of death.</div