Research improves assessment of stroke risk in women

Researchers at the Liverpool Centre for Cardiovascular Science have analyzed the impact of atrial fibrillation (AF) related stroke on women and men. Their latest understanding has the potential to change clinical practice by supporting better risk assessment and stroke prevention.

The paper, “Comparing CHA2DS2-VA and CHA2DS2-VASc scores for stroke risk stratification in patients with atrial fibrillation: a temporal trends analysis from the retrospective Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) cohort,” was published in The Lancet Regional Health Europe.

AF is a common heart condition that causes an irregular and often abnormally fast heart rate, which increases the risk of stroke by five times. Adults have a 1 in 3 lifetime risk of developing AF, leading to a high burden of stroke, heart failure and dementia.

Previously it was recognized that being female is associated with a higher risk of AF- related stroke. Not only that, but female AF patients conversely tended to be undermedicated with oral anticoagulants—'”blood thinners” prescribed to reduce blood clots and stroke. Also, AF-related strokes tended to be more severe in women compared to men.

In general, the overall rate of AF-related stroke is on the decline in recent years, with increased awareness and risk factor management, as well as improved risk assessment tools such as the CHA2DS2-VASc score, where sex category (Sc, for female sex) was incorporated into its calculation. In more recent years, the differential in AF-related stroke rates between women and men has become non-significant, such that a non-sex CHA2DS2-VASc score (i.e., CHA2DS2-VA) may offer better simplicity for decision-making.

Professor Gregory Lip, Director of the Liverpool Centre for Cardiovascular Science who led the research said, “This significant analysis shows that previously women were at higher risk of AF-related stroke but tend to be under prescribed potentially life-saving ‘blood thinner’ preventative medication. Hence, using the CHA2DS2-VASc score made sense. With more contemporary data, the female-male difference in stroke risk is less evident, hence a non-sex CHA2DS2-VASc score (i.e., CHA2DS2-VASc) may offer better simplicity and practicality for decision-making.”