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Original research article
Established and novel risk factors for atrial fibrillation in women compared with men
  1. Sanne A E Peters1,
  2. Mark Woodward1,2,3,4
  1. 1 The George Institute for Global Health, University of Oxford, Oxford, UK
  2. 2 Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, UK
  3. 3 The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
  4. 4 Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr Sanne A E Peters, The George Institute for Global Health, University of Oxford, Oxford OX1 3QX, UK; sanne.peters{at}


Background Atrial fibrillation (AF) is a stronger risk factor for cardiovascular disease in women than men. We assessed whether there are sex differences in the effects of 43 established and novel risk factors and the risk of incident AF.

Methods Data were used from the Scottish Heart Health Extended Cohort, a prospective cohort study with over 20 years of follow-up for AF incidence. Cox regression models were used to obtain the adjusted sex-specific HRs and 95% CIs, and the women-to-men ratio of HRs (RHRs), of incident AF associated with personal characteristics, smoking, physical measurements, diabetes mellitus, lipid, inflammatory, cardiac, and diet- and renal-related markers.

Results Overall, 15 737 participants (52% women) were included. There were sex differences in the relationship between a 1 SD increase in body mass index (BMI), NT-pro-BNP, uric acid, and cystatin-C and the risk of AF. The HRs were 1.17 (95% CI 1.08 to 1.27) in women and 1.36 (95% CI 1.24 to 1.49) in men for BMI (RHR 0.86, 95% CI 0.77 to 0.97); 1.84 (95% CI 1.62 to 2.09) in women and 1.54 (95% CI 1.40 to 1.68) in men for NT-pro-BNP (RHR 1.22, 95% CI1.05 to 1.42); 1.27 (95% CI 1.14 to 1.41) in women and 1.10 (95% CI 1.00 to 1.20) in men for uric acid (RHR 1.17, 95% CI 1.01 to 1.35); and 1.22 (95% CI 1.13 to 1.32) in women and 1.07 (95% CI 0.96 to 1.18) in men for cystatin-C (RHR 1.16, 95% CI 1.05 to1.27).

Conclusion Higher BMI is a stronger risk factor for AF in men whereas elevated NT-pro-BNP, uric acid and cystatin-C were more strongly associated with the risk of AF in women.

  • atrial fibrillation
  • epidemiology

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  • Contributors SAEP and MW conceived and designed the study. SAEP analysed the data and drafted the manuscript. SAEP and MW interpreted the results and contributed to critical revision of the manuscript.

  • Funding The Scottish Heart Health Extended Cohort (SHHEC) was funded by the Scottish Health Department Chief Scientist Organization, the British Heart Foundation and the FP Fleming Trust. The MORGAM collaboration was funded by the European Commission Seventh Framework Programme, references FP7/2007-2013 (HEALTH-F4-2007-2014113, ENGAGE; HEALTH-F3-2010-242244, CHANCES). The MORGAM Biomarker Study (serum biomarkers in the MORGAM populations) was funded by the Medical Research Council, London (reference G0601463, No 80983). The BiomarCaRE Project (Biomarkers for Cardiovascular Risk Assessment in Europe) was funded by the European Commission Seventh Framework Programme FP7/2007-2013 (reference HEALTHF2-2011-278913). SP is supported by a UK Medical Research Council Skills Development Fellowship (MR/P014550/1).

  • Disclaimer Funding bodies had no role in the planning of the study, analyses, interpretation, writing or publication of the manuscript, or recruitment of participants.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval was received from all relevant medical research ethics committees covering the individual populations involved.

  • Provenance and peer review Not commissioned; externally peer reviewed.