Female sex as an independent risk factor for stroke in atrial fibrillation: Possible mechanisms
Por:
Covel, CL, Albert, CM, Andreotti, F, Badimon, L, Van Gelder, IC, Hylek, EM
Publicada:
1 mar 2014
Resumen:
Atrial fibrillation (AF) is an independent risk factor for thromboembolism and stroke. Women with AF are at a higher overall risk for thromboembolic stroke when compared to men with AF. Recent evidence suggests that female sex, after adjusting for stroke risk profile and sex differences in utilisation of anticoagulation, is an independent stroke risk factor in AF. The inclusion of female sex has improved the accuracy of the CHADS(2) stroke risk stratification schema (Congestive heart failure, Hypertension, Age 75 years or greater, Diabetes mellitus, and prior Stroke or TIA). The newly revised and validated schema, CHA(2)DS(2)-VASc, dichotomises age and incorporates female sex and vascular disease history. The pathophysiological mechanisms to explain this increased risk in women are not well understood. According to Virchow's triad, thrombosis that leads to stroke in AF should arise from three co-existing phenomena: structural abnormalities, blood stasis, and a hypercoagulable state. Herein, we explore the sex differences in the biological processes that lead to thrombus formation as applied to Virchow's Triad. The objective of this review is to describe the potential mechanisms behind the increased risk of stroke in AF associated with female sex.
Filiaciones:
Covel, CL:
Boston Univ, Med Ctr, Dept Cardiovasc Med, Boston, MA USA
Albert, CM:
Harvard Univ, Brigham & Womens Hosp, Sch Med, Dept Med,Cardiovasc Div, Boston, MA 02115 USA
Harvard Univ, Brigham & Womens Hosp, Sch Med, Dept Med,Div Prevent Med, Boston, MA 02115 USA
Andreotti, F:
Catholic Univ, Dept Cardiovasc Sci, Rome, Italy
Badimon, L:
Hosp Santa Crue & San Pau, CSIC ICCC, Cardiovasc Res Ctr, Barcelona, Spain
Van Gelder, IC:
Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands
Hylek, EM:
Boston Univ, Med Ctr, Dept Internal Med, Boston, MA USA
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