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Israeli Study Contradicts Recent CHA2DS2-VASc Guidelines: Being Female Not a Risk Factor for Stroke

by Steve S. Ryan, May 2015

This is another powerful study contradicting the recent CHA₂DS₂-VASc guidelines which gives every women with A-Fib one point on the stroke risk scale because of her female gender, no matter how healthy she is otherwise.

An Israeli study tracked nearly 100,000 patients who developed A-Fib. They were followed for approximately four years between 2004 and 2011. The purpose of this observational study was to re-evaluate the risk of ischemic stroke, major bleeding and death in men and women with A-Fib.

Controversial CHA₂DS₂-VASc Risk Data and Analyses?

Previous controversial data and analyses showed an increased risk of stroke among women. The recent CHA₂DS₂-VASc risk score states that being a female is a risk factor for stroke.

“In light of our findings, we suggest to use a similar anticoagulant strategy in [both] men and women with atrial fibrillation over the age of 65.”

But in this Israeli study, “the risk of ischemic stroke was similar in men and women.” Women who developed A-Fib were older than men by four years (74 vs, 70) and had more hypertension, but lower prevalence of diabetes, congestive heart failure and ischemic heart disease. The rates of ischemic stroke were identical between male and female patients, 5.3% for both genders.

Factors associated with increased stroke risk were previous stroke, age older than 65, hypertension, congestive heart failure and diabetes. Adjusting for the age difference between the men and women who developed A-Fib in this study, death risk was associated with male gender, age over 65, previous stroke or heart attack, and diabetes.

Study Conclusion

The authors concluded, “In light of our findings, we suggest to use a similar anticoagulant strategy in men and women with atrial fibrillation over the age of 65.”

Editor’s Comments:

Intuitively it doesn’t make sense that simply being a woman makes you more at risk of having an A-Fib stroke. This study seems to confirm what common sense would indicate.

Women in their child-bearing years are much less at risk of stroke because of the blood-thinning effect of losing blood each month. And even after menopause women have less risk of stroke. But eventually they do have more strokes. But not because of an innate inferiority, but because women live longer than men. Stroke and hypertension are age related. In this israeli study women who developed A-Fib were four years older than men.

Be advised that the original European guidelines were written by doctors with major conflicts of interest. These guidelines may be a not so very subtle form of gender bias. Also, just adding one point to a person’s stroke risk score translates into a huge increase in sales for pharmaceutical companies.

References for this article

Amson, Yoav et al. Are There Gender-Related Differences In Management, And Outcome Of Patients With Atrial Fibrillation? A Prospective National Study. Arrhythmias and Clinical EP. Acc.15. JACC. March 17, 2015, Volume 65, Issue 10S. doi: 10.1016/S0735-1097(15)60469-7 Last accessed March 23, 2016. URL:http://content.onlinejacc.org/article.aspx?articleid=2198096&resultClick=3

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