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. 2019 Sep 4;14(9):e0222147.
doi: 10.1371/journal.pone.0222147. eCollection 2019.

Sex and racial differences in cardiovascular disease risk in patients with atrial fibrillation

Wesley T O'Neal  1 , Aniqa B Alam  2 , Pratik B Sandesara  1 , J'Neka S Claxton  2 , Richard F MacLehose  3 , Lin Y Chen  4 , Lindsay G S Bengtson  5 , Alanna M Chamberlain  6 , Faye L Norby  3 , Pamela L Lutsey  3 , Alvaro Alonso  2
Affiliations

Sex and racial differences in cardiovascular disease risk in patients with atrial fibrillation

Wesley T O'Neal et al. PLoS One. .

Abstract

Background: Outcomes among atrial fibrillation (AF) patients may differ according to race/ethnicity and sex due to differences in biology, the prevalence of cardiovascular risk factors, and the use and effectiveness of AF treatments. We aimed to characterize patterns of cardiovascular risk across subgroups of AF patients by sex and race/ethnicity, since doing so may provide opportunities to identify interventions. We also evaluated whether these patterns changed over time.

Methods: We utilized administrative claims data from the Optum Clinformatics® Datamart database from 2009 to 2015. Patients with AF with ≥6 months of enrollment prior to the first non-valvular AF diagnosis were included in the analysis. Final analysis utilized Cox proportional hazard models to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for cardiovascular outcomes stratified by sex and race/ethnicity. An additional analysis stratified outcomes by calendar year of AF diagnosis to evaluate changes in outcomes over time.

Results: In a cohort of 380,636 AF patients, women had a higher risk of ischemic stroke [HR (95% CI): 1.25 (1.19, 1.31)] and lower risk of heart failure and myocardial infarction [HR (95% CI): 0.91 (0.88, 0.94) and 0.81 (0.77, 0.86), respectively)] compared to men. Black patients had elevated risk across all endpoints compared to whites, while Hispanics and Asian Americans showed no significant differences in any outcome compared to white patients. These sex and race/ethnic differences did not change over time.

Conclusions: We found sex and race/ethnic differences in risk of cardiovascular outcomes among AF patients, without evidence of improvement over time.

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Conflict of interest statement

LGSB is employed by Optum, but neither they nor the rest of the authors have had special access or privileges to the Optum data that others would not have. This does not alter our adherence to PLOS ONE policies on sharing data and materials, with the restrictions stated above. Authors do not have any other relevant declarations relating to employment, consultancy, patents, products in development, or marketed products.

Figures

Fig 1
Fig 1. Population counts by sex and adjusted HRs (95% CI) for associations of sex with incidence of ischemic stroke in patients with atrial fibrillation by year, Optum Clinformatics 2009–2015.
Fig 2
Fig 2. Population counts by sex and adjusted HRs (95% CI) for associations of sex with incidence of heart failure in patients with atrial fibrillation by year, Optum Clinformatics 2009–2015.
Fig 3
Fig 3. Population counts by sex and adjusted HRs (95% CI) for associations of sex with incidence of myocardial infarction in patients with atrial fibrillation by year, Optum Clinformatics 2009–2015.
Fig 4
Fig 4. Population counts by race/ethnicity and adjusted HRs (95% CI) for associations of race/ethnicity with incidence of ischemic stroke in patients with atrial fibrillation by year, Optum Clinformatics 2009–2015.
Fig 5
Fig 5. Population counts by race/ethnicity and adjusted HRs (95% CI) for associations of race/ethnicity with incidence of heart failure in patients with atrial fibrillation by year, Optum Clinformatics 2009–2015.
Fig 6
Fig 6. Population counts by race/ethnicity and adjusted HRs (95% CI) for associations of race/ethnicity with incidence of myocardial infarction in patients with atrial fibrillation by year, Optum Clinformatics 2009–2015.
See this image and copyright information in PMC

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