Sex and racial differences in cardiovascular disease risk in patients with atrial fibrillation

Wesley T. O'Neal, Aniqa B. Alam, Pratik B. Sandesara, J'Neka S. Claxton, Richard F. MacLehose, Lin Y. Chen, Lindsay G.S. Bengtson, Alanna M. Chamberlain, Faye L. Norby, Pamela L. Lutsey, Alvaro Alonso

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13 Scopus citations


Background Outcomes among atrial fibrillation (AF) patients may differ according to race/ethnicity and sex due to differences in biology, the prevalence of cardiovascular risk factors, and the use and effectiveness of AF treatments. We aimed to characterize patterns of cardiovascular risk across subgroups of AF patients by sex and race/ethnicity, since doing so may provide opportunities to identify interventions. We also evaluated whether these patterns changed over time. Methods We utilized administrative claims data from the Optum Clinformatics® Datamart database from 2009 to 2015. Patients with AF with ≥6 months of enrollment prior to the first non-valvular AF diagnosis were included in the analysis. Final analysis utilized Cox proportional hazard models to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for cardiovascular outcomes stratified by sex and race/ethnicity. An additional analysis stratified outcomes by calendar year of AF diagnosis to evaluate changes in outcomes over time. Results In a cohort of 380,636 AF patients, women had a higher risk of ischemic stroke [HR (95% CI): 1.25 (1.19, 1.31)] and lower risk of heart failure and myocardial infarction [HR (95% CI): 0.91 (0.88, 0.94) and 0.81 (0.77, 0.86), respectively)] compared to men. Black patients had elevated risk across all endpoints compared to whites, while Hispanics and Asian Americans showed no significant differences in any outcome compared to white patients. These sex and race/ethnic differences did not change over time. Conclusions We found sex and race/ethnic differences in risk of cardiovascular outcomes among AF patients, without evidence of improvement over time.

Original languageEnglish (US)
Article numbere0222147
JournalPloS one
Issue number9
StatePublished - Sep 1 2019

Bibliographical note

Funding Information:
Research reported in this publication was funded by the National Heart, Lung, And Blood Institute of the National Institutes of Health under award numbers R01-HL122200 [authors ABA, JSC, RFM, LYC, FLN, PLL, AND AA] and F32-HL134290 [author WTO], and from the American Heart Association under award number 16EIA26410001 [author AA]. The funders provided support in the form of salaries for the authors attached to each grant, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Though author LGSB is employed by Optum, Optum did not provide funding for this publication. The specific roles of these authors are articulated in the ‘author contributions’ section. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the American Heart Association.

Publisher Copyright:
© 2019 O’Neal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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