Gender Differences in Atrial Fibrillation Risk Factors and Disease Onset Gender in Medicine Congress

Transcription

1 Gender Differences in Atrial Fibrillation Risk Factors and Disease Onset Gender in Medicine Congress Renate B. Schnabel, MD, MSc Berlin, September 22, 2015

2 Gender Differences in Atrial Fibrillation Risk Factors and Disease Onset Gender in Medicine Congress Renate B. Schnabel, MD, MSc No conflicts of interest to disclos. Berlin, September 22, 2015

3 Cardiovascular Disease Prevalence Myocardial Infarction Stroke Heart Failure Atrial Fibrillation 11,0% 9,5% 6,6% 4,4% 2,3% 0,9% 1,0% 2,4% N=15,000

4 Atrial Fibrillation Pathophysiology Sinus node Normal conduction Atrial fibrillation

5 Atrial Fibrillation Pathophysiology Sinusknoten Normale Reizleitung Vorhofflimmern

6 Atrial Fibrillation Pathophysiology Sinus node Normal conduction Atrial fibrillation Stroke Heart failure Death

7 Complications Blood clot embolisation Irregular heart beat

8 Complications Blood clot embolisation Irregular heart beat Stroke

9 Complications Blood clot embolisation Irregular heart beat Heart failure Stroke

10 Trends in Incidence AF Framingham Heart Study Men Women Incidence Incidence Schnabel RB, Lancet 15

11 Trends Incidence and Prevalence of AF By Sex Prevalence Men Prevalence Women Incidence Incidence Schnabel RB, Lancet 15

12 Trends Incidence and Prevalence of AF By Sex Prevalence Men Prevalence Women Incidence Incidence Schnabel RB, Lancet 15

13 Atrial Fibrillation Prevalence General Population - Gutenberg Health Study N=15000 Frequency, % 1 Decade Shift Years Men Women Schnabel RB, Dtsch Arztebl12

14 Atrial Fibrillation Risk Factors Risk Score Schnabel, Lancet 09; Archives Int. Med. 10; Circulation 10; Alonso et al., Schnabel, JAHA 13

15 Men 35,522 Women 37,494 BiomarCaRE Cohorts Across Europe

16 Body Mass Index and Atrial Fibrillation P interaction Unit: kg/m² Adjusted for examination age, year of study

17 HDL Cholesterol and Atrial Fibrillation P interaction 0.54 Unit: mmol/l Adjusted for examination age, year of study

18 Triglycerides and Atrial Fibrillation P interaction 0.60 Unit: mmol/l Adjusted for examination age, year of study

19 Total Cholesterol and Atrial Fibrillation P interaction Unit: mmol/l Adjusted for examination age, year of study

20 Systolic Blood Pressure P interaction 0.75 Unit: mm Hg Adjusted for examination age, year of study

21 Smoking and Atrial Fibrillation P interaction 0.28 Adjusted for examination age, year of study

22 Atrial Fibrillation Risk Factors Population Attributable Risk Women Men Benjamin, JAMA 1994; Lake, Austr NZ J Med 1989; Psaty, Circ 1997; Sawin, NEJM 1994; Tsang, JACC 2002; Magnani JW Circ 2011; Schnabel RB Arch Int Med 11

23 Symptoms Gutenberg Health Study % % N=15,010 No Atrial Fibrillation Palpitations Chest pain Dyspnoe >NYHA I Men Women Atrial Fibrillation P interaction < Palpitations Chest pain Dyspnoe >NYHA I Men Women N=7,143 N=7,187 N=324 N=142

24 Prognosis Euro Heart Survey Dagres N, JACC 07

25 Prognosis Heart Failure with Preserved Ejection Fraction Schnabel RB, EJHF 13

26 Mortality in Atrial Fibrillation 80% 70% 60% Total Mortality, % 50% 40% 30% 20% 10% Men without AF Females without AF Benjamin EJ Circ 1998

27 Mortality in Atrial Fibrillation 80% 70% Men without AF 60% Total Mortality 50% 40% 30% 20% 10% Women without AF Men without AF Females without AF Benjamin EJ Circ 1998

28 Gender Differences Atrial Fibrillation Pathophysiology Epidemiology Manifestation and symptoms Response to therapy Prognosis, outcome

29 Team Francisco M. Ojeda Nargiz Rzayeva Silke S. Johannsen Sebastian Carl Christoph Niekamp Molekulare Kardiologie Genomik und Systembiologie Tanja Zeller Christian Müller Sebastian Appelbaum Daniela Börnigen Kardiologie Stefan Blankenberg Dirk Westermann Christoph R. Sinning Christoph Waldeyer Christina Baum Hamburg City Health Studie Annika Jagodzinski Elektrophysiologie Boris A. Hoffmann Meike Ramuschkat Marc Lemoine Christian Meyer Stephan Willems Klinische Kohortenstudien Christiane Brodersen SymAtrial Matthias Heinig Arne Schillert Markus Scheinhardt Massachusetts General Hospital Patrick T. Ellinor, Steven A. Lubitz Gutenberg Gesundheitsstudie Philipp S. Wild Andreas Schulz CVRC Framingham Heart Study Emelia J. Benjamin Vasan S. Ramachandran Xiaoyan Yin BiomarCaRE Kari Kuulasmaa Veikko Salomaa ARIC Study Alvaro Alonso CONVERT-AF David Conen INSERM, Paris Laurence Tiret Charité, Berlin Vera Regitz-Zagrosek Ute Seeland Sabine Örtelt-Prigione

30 Thank You for Your Attention Name Affiliation Tanja Zeller Molecular Cardiology, University Heart Center Hamburg Philipp S. Wild University Clinic Mainz, Center for Thrombosis and Hemostasis Claudia Schad Electrophysiology, University Heart Center Hamburg Francisco M. Ojeda General Cardiology, University Heart Center Hamburg Stephan Willems Electrophysiology, University Heart Center Hamburg Dirk Westermann General Cardiology, University Heart Center Hamburg Boris A. Hoffmann Electrophysiology, University Heart Center Hamburg Stefan Blankenberg General Cardiology, University Heart Center Hamburg Stephan Willems Electrophysiology, University Heart Center Hamburg Emelia J. Benjamin Framingham Heart Study, Framingham, MA, USA

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