Gender differences and daily variation in atrial fibrillation risk factor profiles: Considerations for risk factor management

Gender differences and daily variation in atrial fibrillation risk factor profiles: Considerations for risk factor management Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with significant morbidity, increased risk of stroke, reduced quality of life, and increased mortality [1][2][3][4].Several studies suggest, that there are significant gender differences in clinical presentation of AF, utilization of AF therapy and clinical management of AF and outcomes [5].On top of a higher AF-associated stroke risk, women have higher rates of dementia over time than men [6].Additionally, in women, AF is associated with more severe or non-traditional symptoms and worse prognosis which negatively affects health-related quality of life measures [7].Despite these gender-differences in AF symptoms and stroke risk, the AF progression rate, its mechanisms and impact on outcomes in AF in women versus men is unclear.Progression from paroxysmal to persistent or permanent AF may occur in 1-15% of the general AF population annually depending on definition of progression.Additionally, the rate of AF progression is dependent on the presence of specific risk factors [8], the number of concomitant risk factors [9] or certain combinations of risk factors, where individual risk factors may act as disease modifiers.Young-onset AF may represent a scenario, where AF is mainly maintained by concomitant or underlying risk factors rather than by increased ageing.Women are underrepresented in major AF trials, and therefore it remains unclear whether there are risk factors that specifically affect AF progression in women with young-onset AF.In this Issue of the IJC Heart & Vasculature, Marcos et al.[10] investigated gender-differences in clinical AF risk factor profiles, AF progression rates and cardiovascular outcomes between sexes in a prospective cohort study including 497 patients with youngonset AF <60 years of age, a quarter of whom were women.Most conventional risk factors, including age, hypertension, heart failure and diabetes mellitus, were not different between sexes at baseline.However, there were a few gender-specific differences in risk factor profile: men were taller, more often presented with coronary artery disease, had a longer PR interval and higher left ventricular mass index, while women reported more often familial AF and were more likely obese.During a median follow-up of 7 years, AF progression was seen in 12% and there was no significant difference in AF progression in men compared to women.Despite these gender-specific differences in the AF risk factor profile, the absolute number of comorbidities and the mean age was comparable in men and women.This suggests, that not one individual risk factor, but more likely the absolute number of concomitant risk factors is more relevant for AF progression in young-onset AF patients and may explain the similar AF progression in this cohort of young-onset AF patients.It is also of interest that in this cohort