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  • Review Article
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Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis

Nature Reviews Cardiology volume 13, pages 321–332 (2016)Cite this article

Subjects

Key Points

  • Women generally have lower age-adjusted incidence and prevalence of atrial fibrillation (AF) than men; however, given the greater longevity of women, the absolute number of men and women with AF is similar

  • The prevalence of major risk factors differ by sex; women have higher prevalence of hypertension and valvular heart disease, and lower prevalence of coronary heart disease, than men

  • Women are more likely to present with atypical symptoms, such as weakness and fatigue, have longer duration of symptoms, and report worse quality of life and more-frequent depression than men

  • Female sex has been shown to be a risk factor for AF-related stroke or thromboembolism, myocardial infarction, and mortality, but has not been associated with incident heart failure or dementia

  • Future research is needed to address the knowledge gaps in sex-specific differences in AF

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia in women and men worldwide. During the past century, a range of risk factors has been associated with AF, severe complications from the arrhythmia have been identified, and its prevalence has been increasing steadily. Whereas evidence has accumulated regarding sex-specific differences in coronary heart disease and stroke, the differences between women and men with AF has received less attention. We review the current literature on sex-specific differences in the epidemiology of AF, including incidence, prevalence, risk factors, and genetics, and in the pathophysiology and the clinical presentation and prognosis of patients with this arrhythmia. We highlight current knowledge gaps and areas that warrant future research, which might advance understanding of variation in the risk factors and complications of AF, and ultimately aid more-tailored management of the arrhythmia.

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Figure 1: Overview of atrial fibrillation in women compared with in men.
Figure 2: Prevalence of atrial fibrillation in women and men.
Figure 3: Risk factors for atrial fibrillation in women and men.
Figure 4: Potential sex-specific differences in pathophysiological mechanisms of atrial fibrillation (AF).

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Acknowledgements

D.K. is supported by the National Heart, Lung, and Blood Institute award 5T32HL007224-38 and the National Institutes of Health Clinical and Translational Science Award programme award UL1-TR000157. R.B.S. is supported by European Research Council under the European Union's Horizon 2020 research and innovation programme (agreement No 648131), and Junior Research Alliance symAtrial project funded by the German Ministry of Research and Education (BMBF 01ZX1408A) e:Med – Systems Medicine programme and by Deutsche Forschungsgemeinschaft (German Research Foundation) Emmy Noether Program SCHN 1149/3-1. E.J.B. is supported in part through NIH/NHLBI HHSN268201500001I; N01-HC25195, 2R01HL092577, 1R01 HL102214, 1R01HL128914, and 1RC1HL101056. I.E.C. is supported by a mobility grant from the Research Council of Norway (240149/F20).

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Author notes

  1. Darae Ko and Faisal Rahman: These authors contributed equally to this work.

Authors and Affiliations

  1. Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine,

    Darae Ko

  2. Department of Internal Medicine, Boston Medical Center, Boston University School of Medicine,

    Faisal Rahman

  3. Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistrasse 52, Hamburg, 20246, Germany

    Renate B. Schnabel

  4. DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Oudenarder Strasse 16, Berlin, 13347, Germany

    Renate B. Schnabel

  5. Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, 73 Mount Wayte Avenue Framingham, 01702, Massachusetts, USA

    Xiaoyan Yin & Emelia J. Benjamin

  6. Department of Biostatistics, Boston University School of Public Health,

    Xiaoyan Yin

  7. Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center, Boston University School of Medicine, 72 East Concord Street, Boston, 02118, Massachusetts, USA

    Emelia J. Benjamin

  8. Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, 02118, Massachusetts, USA

    Emelia J. Benjamin

  9. Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, 02129, Massachusetts, USA

    Ingrid E. Christophersen

  10. Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Sogneprest Munthe-kaas vei 100, Gjettum, 1346, Norway

    Ingrid E. Christophersen

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Contributions

D.K., F.R., E.J.B., and I.E.C. researched data for the article, discussed its content, and wrote, reviewed and edited the manuscript before submission. X.Y. researched data for the article. R.B.S. discussed the content of the article, and wrote, reviewed, and edited the manuscript before submission.

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Supplementary information

Supplementary information S1 (table)

Incidence of AF in women and men, age-pooled (PDF 71 kb)

Supplementary information S2 (table)

Incidence of AF in women and men, age-specific (PDF 117 kb)

Supplementary information S3 (table)

Prevalence of AF in women and men, age-pooled (PDF 82 kb)

Supplementary information S4 (table)

Prevalence of AF in women and men, age-specific (PDF 204 kb)

Supplementary information S5 (table)

Genetics (PDF 82 kb)

Supplementary information S6 (table)

Stroke and thromboembolism (PDF 188 kb)

Supplementary information S7 (table)

Dementia (PDF 58 kb)

Supplementary information S8 (table)

Heart failure (PDF 85 kb)

Supplementary information S9 (table)

Myocardial infarction (PDF 67 kb)

Supplementary information S10 (table)

Mortality (PDF 119 kb)

Supplementary information S11 (table)

Search strategies (PDF 76 kb)

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Ko, D., Rahman, F., Schnabel, R. et al. Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis. Nat Rev Cardiol 13, 321–332 (2016). https://doi.org/10.1038/nrcardio.2016.45

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