Temporal trends in ischemic stroke and female sex as a risk modifier in atrial fibrillation: insights from non-anticoagulated Asian patients in a nationwide cohort studyResearch in context
Summary: Background: Previous studies from Western populations have reported changing temporal trends in ischemic stroke (IS) incidence in females with atrial fibrillation (AF) when compared with males. Nationwide data on such temporal trends in AF-related IS incidence by sex are limited in Asian p...
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Elsevier
2025-07-01
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| Series: | The Lancet Regional Health. Western Pacific |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666606525001567 |
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| author | Dong-Seon Kang Pil-Sung Yang Jinseob Kim Daehoon Kim Eunsun Jang Hee Tae Yu Tae-Hoon Kim Jung Hoon Sung Hui-Nam Pak Gregory Y.H. Lip Boyoung Joung |
| author_facet | Dong-Seon Kang Pil-Sung Yang Jinseob Kim Daehoon Kim Eunsun Jang Hee Tae Yu Tae-Hoon Kim Jung Hoon Sung Hui-Nam Pak Gregory Y.H. Lip Boyoung Joung |
| author_sort | Dong-Seon Kang |
| collection | DOAJ |
| description | Summary: Background: Previous studies from Western populations have reported changing temporal trends in ischemic stroke (IS) incidence in females with atrial fibrillation (AF) when compared with males. Nationwide data on such temporal trends in AF-related IS incidence by sex are limited in Asian populations. Methods: This population-based retrospective cohort study included patients with incident AF diagnosed between 2005 and 2016 from the Korean National Health Insurance Service. Patients with valvular heart disease, prior IS, or anticoagulant use were excluded. Incidence rates (IRs) per 100 person-years and hazard ratios (HRs) for IS were calculated by Fine and Gray competing risk regression. Findings: After exclusions, 290,081 females (mean age: 64.4 years, SD 16.3) and 338,100 males (mean age: 60.1 years, SD 14.9) were included. The mean follow-up duration was 5.7 (SD 4.1) years. At baseline, the CHA2DS2-VA scores were higher in females than in males (2.0 vs. 1.6, P < 0.0001). IRs for IS declined over time in both sexes (P for trend < 0.0001). The IS incidence in females compared to males was significantly higher in 2005–2006 (1.55 vs. 1.40; HRunadj: 1.12, 95% confidence interval: 1.06–1.19); however, it was no longer significant in 2015–2016 (1.20 vs. 1.17; HRunadj: 1.03, 95% confidence interval: 0.99–1.08). The reduction in relative risk primarily originated from the subgroup with CHA2DS2-VA scores 0–1. Females with CHA2DS2-VA scores ≥3 consistently showed higher IRs for IS compared to males regardless of adjustment. Interpretation: Sex differences in IS incidence decreased over calendar-year intervals, mainly in low-risk patients with AF. The persistently high IS incidence in high-risk females with AF suggests that sex still remains an important risk modifier. Funding: Patient-Centered Clinical Research Coordinating Center, Republic of Korea. |
| format | Article |
| id | doaj-art-e0dd729a25a94d6d998154b99e1a8a2b |
| institution | DOAJ |
| issn | 2666-6065 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
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| series | The Lancet Regional Health. Western Pacific |
| spelling | doaj-art-e0dd729a25a94d6d998154b99e1a8a2b2025-08-20T03:17:38ZengElsevierThe Lancet Regional Health. Western Pacific2666-60652025-07-016010161910.1016/j.lanwpc.2025.101619Temporal trends in ischemic stroke and female sex as a risk modifier in atrial fibrillation: insights from non-anticoagulated Asian patients in a nationwide cohort studyResearch in contextDong-Seon Kang0Pil-Sung Yang1Jinseob Kim2Daehoon Kim3Eunsun Jang4Hee Tae Yu5Tae-Hoon Kim6Jung Hoon Sung7Hui-Nam Pak8Gregory Y.H. Lip9Boyoung Joung10Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of KoreaDivision of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of KoreaZarathu Co., Ltd, Seoul, Republic of KoreaDivision of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of KoreaDivision of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of KoreaDivision of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of KoreaDivision of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of KoreaDivision of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of KoreaDivision of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of KoreaDivision of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Medical University of Bialystok, Bialystok, PolandDivision of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Corresponding author. 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.Summary: Background: Previous studies from Western populations have reported changing temporal trends in ischemic stroke (IS) incidence in females with atrial fibrillation (AF) when compared with males. Nationwide data on such temporal trends in AF-related IS incidence by sex are limited in Asian populations. Methods: This population-based retrospective cohort study included patients with incident AF diagnosed between 2005 and 2016 from the Korean National Health Insurance Service. Patients with valvular heart disease, prior IS, or anticoagulant use were excluded. Incidence rates (IRs) per 100 person-years and hazard ratios (HRs) for IS were calculated by Fine and Gray competing risk regression. Findings: After exclusions, 290,081 females (mean age: 64.4 years, SD 16.3) and 338,100 males (mean age: 60.1 years, SD 14.9) were included. The mean follow-up duration was 5.7 (SD 4.1) years. At baseline, the CHA2DS2-VA scores were higher in females than in males (2.0 vs. 1.6, P < 0.0001). IRs for IS declined over time in both sexes (P for trend < 0.0001). The IS incidence in females compared to males was significantly higher in 2005–2006 (1.55 vs. 1.40; HRunadj: 1.12, 95% confidence interval: 1.06–1.19); however, it was no longer significant in 2015–2016 (1.20 vs. 1.17; HRunadj: 1.03, 95% confidence interval: 0.99–1.08). The reduction in relative risk primarily originated from the subgroup with CHA2DS2-VA scores 0–1. Females with CHA2DS2-VA scores ≥3 consistently showed higher IRs for IS compared to males regardless of adjustment. Interpretation: Sex differences in IS incidence decreased over calendar-year intervals, mainly in low-risk patients with AF. The persistently high IS incidence in high-risk females with AF suggests that sex still remains an important risk modifier. Funding: Patient-Centered Clinical Research Coordinating Center, Republic of Korea.http://www.sciencedirect.com/science/article/pii/S2666606525001567Atrial fibrillationIschemic strokeTemporal trendFemales |
| spellingShingle | Dong-Seon Kang Pil-Sung Yang Jinseob Kim Daehoon Kim Eunsun Jang Hee Tae Yu Tae-Hoon Kim Jung Hoon Sung Hui-Nam Pak Gregory Y.H. Lip Boyoung Joung Temporal trends in ischemic stroke and female sex as a risk modifier in atrial fibrillation: insights from non-anticoagulated Asian patients in a nationwide cohort studyResearch in context The Lancet Regional Health. Western Pacific Atrial fibrillation Ischemic stroke Temporal trend Females |
| title | Temporal trends in ischemic stroke and female sex as a risk modifier in atrial fibrillation: insights from non-anticoagulated Asian patients in a nationwide cohort studyResearch in context |
| title_full | Temporal trends in ischemic stroke and female sex as a risk modifier in atrial fibrillation: insights from non-anticoagulated Asian patients in a nationwide cohort studyResearch in context |
| title_fullStr | Temporal trends in ischemic stroke and female sex as a risk modifier in atrial fibrillation: insights from non-anticoagulated Asian patients in a nationwide cohort studyResearch in context |
| title_full_unstemmed | Temporal trends in ischemic stroke and female sex as a risk modifier in atrial fibrillation: insights from non-anticoagulated Asian patients in a nationwide cohort studyResearch in context |
| title_short | Temporal trends in ischemic stroke and female sex as a risk modifier in atrial fibrillation: insights from non-anticoagulated Asian patients in a nationwide cohort studyResearch in context |
| title_sort | temporal trends in ischemic stroke and female sex as a risk modifier in atrial fibrillation insights from non anticoagulated asian patients in a nationwide cohort studyresearch in context |
| topic | Atrial fibrillation Ischemic stroke Temporal trend Females |
| url | http://www.sciencedirect.com/science/article/pii/S2666606525001567 |
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