Article Text

other Versions

Original article
Risk factors for atrial fibrillation and their population burden in postmenopausal women: the Women's Health Initiative Observational Study
  1. Marco V Perez1,
  2. Paul J Wang1,
  3. Joseph C Larson2,
  4. Elsayed Z Soliman3,
  5. Marian Limacher4,
  6. Beatriz Rodriguez5,
  7. Liviu Klein6,
  8. JoAnn E Manson7,
  9. Lisa W Martin8,
  10. Ronald Prineas3,
  11. Stephanie Connelly9,
  12. Mark Hlatky1,
  13. Sylvia Wassertheil-Smoller10,
  14. Marcia L Stefanick11
  1. 1Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA
  2. 2Data Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
  3. 3Departments of Epidemiology, Prevention and Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Epidemiological Cardiology Research Center (EPICARE), Winston Salem, North Carolina, USA
  4. 4Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida, USA
  5. 5Departments of Geriatric Medicine and Epidemiology, University of Hawaii, Honolulu, Hawaii, USA
  6. 6Department of Medicine, University of California San Francisco, San Francisco, California, USA
  7. 7Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
  8. 8Division of Cardiology, Department of Medicine, George Washington University, Washington, District of Columbia, USA
  9. 9Department of Medicine, University of Tennessee, Knoxville, Tennessee, USA
  10. 10Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
  11. 11Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, California, USA
  1. Correspondence to Dr Marco V Perez, Stanford University Medical Center, Cardiac Electrophysiology and Arrhythmia Service, 300 Pasteur Drive #H2146, Stanford, CA 94305, USA; mvperez{at}


Objective Atrial fibrillation (AF) is the most common arrhythmia in women. Large studies evaluating key AF risk factors in older women are lacking. We aimed to identify risk factors for AF in postmenopausal women and measure population burden of modifiable risk factors.

Design Prospective observational study.

Setting The Women's Health Initiative (WHI) Observational Study.

Patients 93 676 postmenopausal women were followed for an average of 9.8 years for cardiovascular outcomes. After exclusion of women with prevalent AF or incomplete data, 8252 of the remaining 81 892 women developed incident AF.

Main outcome measures Incident AF was identified by WHI-ascertained hospitalisation records and diagnosis codes from Medicare claims. Multivariate Cox hazard regression analysis identified independent risk factors for incident AF.

Results Age, hypertension, obesity, diabetes, myocardial infarction and heart failure were independently associated with incident AF. Hypertension and overweight status accounted for 28.3% and 12.1%, respectively, of the population attributable risk. Hispanic and African–American participants had lower rates of incident AF (HR 0.58, 95% CI 0.47 to 0.70 and HR 0.59, 95% CI 0.53 to 0.65, respectively) than Caucasians.

Conclusions Caucasian ethnicity, traditional cardiovascular risk factors and peripheral arterial disease were independently associated with higher rates of incident AF in postmenopausal women. Hypertension and overweight status accounted for a large proportion of population attributable risk. Measuring burden of modifiable AF risk factors in older women may help target interventions.

Statistics from

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.