Background and Aims Female sex has been linked with higher risk of ischaemic stroke (IS) in atrial fibrillation (AF), but no prior study has examined temporal trends in the IS risk associated with female sex. Methods The registry-linkage Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study included all patients with AF in Finland from 2007 to 2018. Ischaemic stroke rates and rate ratios were computed. Results Overall, 229 565 patients with new-onset AF were identified (50.0% women; mean age 72.7 years). The crude IS incidence was higher in women than in men across the entire study period (21.1 vs. 14.9 events per 1000 patient-years, P < .001), and the incidence decreased both in men and women. In 2007–08, female sex was independently associated with a 20%–30% higher IS rate in the adjusted analyses, but this association attenuated and became statistically non-significant by the end of the observation period. Similar trends were observed when time with and without oral anticoagulant (OAC) treatment was analysed, as well as when only time without OAC use was considered. The decrease in IS rate was driven by patients with high IS risk, whereas in patients with low or moderate IS risk, female sex was not associated with a higher IS rate. Conclusions The association between female sex and IS rate has decreased and become non-significant over the course of the study period from 2007 to 2018, suggesting that female sex could be omitted as a factor when estimating expected IS rates and the need for OAC therapy in patients with AF.

中文翻译：

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房颤女性缺血性卒中：时间趋势和临床意义

背景和目标 女性与心房颤动 (AF) 中缺血性卒中 (IS) 的较高风险相关，但之前没有研究探讨与女性相关的 IS 风险的时间趋势。方法 登记关联的芬兰房颤抗凝 (FinACAF) 研究纳入了 2007 年至 2018 年芬兰所有房颤患者。计算了缺血性卒中发生率和发生率比率。结果 总体而言，共确定了 229 565 名新发 AF 患者（50.0% 为女性；平均年龄 72.7 岁）。在整个研究期间，女性的 IS 粗发生率高于男性（每 1000 患者年 21.1 例与 14.9 例事件，P < .001），并且男性和女性的发生率均下降。 2007-08 年，在调整后的分析中，女性与高出 20%-30% 的 IS 率独立相关，但这种关联在观察期结束时减弱并变得不显着。当分析使用和不使用口服抗凝剂 (OAC) 治疗的时间以及仅考虑不使用 OAC 的时间时，观察到类似的趋势。 IS 率下降是由高 IS 风险患者驱动的，而在低或中度 IS 风险患者中，女性与较高 IS 率无关。结论 在 2007 年至 2018 年的研究期间，女性性别与 IS 率之间的相关性有所下降，变得不显着，这表明在估计预期 IS 率和 OAC 治疗需求时，可以忽略女性性别这一因素。房颤患者。