Sex differences revealed in AF determinants and AF progression

The progression of atrial fibrillation (AF) was more prevalent in men than in women, despite the higher average age of the investigated women in the RACE V project. Different AF progression determinants were identified for women and men, indicating that there might be different pathophysiological mechanisms at play.

AF often progresses from the paroxysmal type to the persistent type, which is related to different cardiovascular outcomes [1]. Prior studies revealed sex-specific differences in patients with AF regarding comorbidities, received therapies, and cardiovascular outcomes [2]. The current pre-specified analysis of the RACE V research group investigated sex differences in AF progression and associated comorbidities in 417 patients with paroxysmal AF [3]. The primary endpoint of the study was the AF progression rate. Prof. Michiel Rienstra (University Medical Center Groningen, Netherlands) presented the results.

Baseline characteristics revealed that women were on average 4 years older than men, had a higher symptom burden according to the European Heart Rhythm Association (EHRA) score (68% vs 49%), and were more likely to have a BMI >30 kg/m² (32% vs 21%). In contrast, men were more likely to have concomitant coronary artery disease (16% vs 6%), higher volumes of epicardial fat (105 mL vs 89 mL) and pericardial fat (199 mL vs 144 mL), higher mean PR intervals (172 ms vs 672 ms), and larger left atrial volumes (61 mL vs 54 mL).

AF progression was more common in men (15.1%) than in women (8.4%; P=0.032). The corresponding annual AF progression rates were 6.9% in men and 3.8% in women. Interestingly, men and women displayed different determinants of AF progression. In women, AF progression was related to a reduction of tissue factor pathway inhibitor (OR 2.22; P=0.008), PR interval increase (OR 1.72; P=0.034), and an increase of NT-proBNP (OR 2.10; P=0.016). Whereas, in men, significant predictors of AF progression were an increase in PCSK9 (OR 1.60; P=0.011), Factor XIIa C1-esterase inhibitor below the median level (OR 3.06; P=0.009), and an increase in NT-proBNP (OR 2.01; P<0.001). According to Prof. Rienstra, these results indicate that different pathophysiological mechanisms may influence the progression of AF in men and women.

“Further study of differences between men and women regarding the clinical profile and the progression of AF are needed because these differences are of importance when applying personalised management decisions for patients with AF,” concluded Prof. Rienstra.

1. Kato T, et al. Circ J. 2004;68(6):568–72.
2. Westerman S & Wenger N. Curr Cardiol Rev. 2019;15(2):136–144.
3. Rienstra M, et al. Prevalence and determinants of atrial fibrillation progression in women and men with paroxysmal atrial fibrillation: RACE V. Late-breaking science 2, EHRA 2022, 3–5 April, Copenhagen, Denmark.

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Posted on 1 June 202213 June 2022