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AF prevalence elevated in women with fewer reproductive years
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Women with fewer total reproductive years may experience elevated risk for atrial fibrillation and subsequent ischemic stroke, according to findings published in Circulation: Arrhythmia and Electrophysiology.
Researchers found that women with fewer than 30 total reproductive years, caused by shorter lifetime exposure to endogenous sex hormone, have a 7% elevated risk for AF (adjusted HR = 1.07; 95% CI, 1.05-1.09). Also, risk for AF declined for every additional 5-year increment of total reproductive years after 30 years (P < .001).
Moreover, the risk for ischemic stroke after AF development decreased with each 5-yearly increment in total reproductive years (P < .001) compared with women who had fewer than 30 reproductive years:
- for 30 to 34 years (aHR = 0.93; 95% CI, 0.88-0.99);
- 35 to 39 years (aHR = 0.84; 95% CI, 0.79-0.89); and
- 40 years or more (aHR = 0.88; 95% CI, 0.80-0.97).
“Based on the analyses over 4 million women who experienced natural menopause, shorter total reproductive years showed a higher risk of incident AF, with a subsequent higher risk of ischemic stroke,” Seokhun Yang, MD, of the department of internal medicine at the Seoul National University Hospital, South Korea, and colleagues wrote. “These results suggest that extended exposure to endogenous estrogen during the life span of women with natural menopause is protective against incident AF and subsequent ischemic stroke.”
In other findings, use of hormone therapy at least 2 years after menopause was paradoxically associated with a 3% elevated risk for AF (aHR = 1.03; 95% CI, 1.01-1.05), according to the study.
“Although we could not specify the types of hormone replacement therapy used in each subject, it is likely that estrogen plus progesterone regimen would be the predominant regimen given the lower rate of hysterectomy and market-sharing data in Korea,” the researchers wrote.
Researchers analyzed 4.6 million women (mean age, 61 years; 3% current smoking; 14% with diabetes) who experienced natural menopause, had no prior history of AF and received a breast cancer checkup between 2009 and 2014. The aim of this study was to evaluate the relationship between total reproductive years and incident AF and subsequent ischemic stroke. The primary endpoint was AF and the secondary endpoint was ischemic stroke.
“Exogenous hormone replacement therapy paradoxically increased incident AF, and thus should not be used for the primary prevention of AF,” the researchers wrote. “Further studies are warranted to suggest appropriate hormone replacement strategy without increasing the risk of incident AF in women with natural menopause.” – by Scott Buzby
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