Interview with Dr. Kavousi: Gender Differences in Afib

What differences exist in symptom manifestation, prognosis, and the effect of lifestyle factors between men and women when it comes to atrial fibrillation (afib)? The AFIP foundation sat down with Dr. Marym Kavousi to delve deep into the topic of gender differences in afib.

“For atrial fibrillation, we don’t know much about sex differences. It is still a field that  is underdeveloped, and a lot of research needs to be done.”

Dr. Maryam Kavousi was a family physician and now specializes in research regarding cardiovascular epidemiology. One of the topics she focuses on is sex differences in cardiovascular disease. Dr. Kavousi is also the chair of the population science division of the European Association of Preventive Cardiology at the Erasmus Medical Center Rotterdam. In this article, we will outline the interesting insights brought up during the interview.

How does atrial fibrillation manifest differently in women compared to men? 

Dr. Kavousi highlighted that despite decades of research done on atrial fibrillation, the role of sex differences in the manifestation as well as treatment of this most common cardiac arrhythmia is still in its infancy. Also, insights into predisposing factors that may lead to different symptomatology in atrial fibrillation have not been elucidated.

Dr. Kavousi explained that what is known when it comes to the underlying pathophysiology of atrial fibrillation, is men tend to have a higher burden of coronary heart disease. Still, women have a higher prevalence of heart failure. Also, it is suggested that the severity of symptoms may vary between women and men.

“Some reports say that women have more severe symptoms during an episode of atrial fibrillation. Also, they seem to have less knowledge about their atrial fibrillation. Some women assume that their palpitations are related to menopausal symptoms.”

Another interesting difference, that is possibly present between men and women, is specific atrial fibrillation-related patterns seen on a higher population level. Dr. Kavousi mentioned a recent study, describing that the risk factors were not particularly the same in men and women. The patterns were a bit different. This is potentially an important observation as this may help to improve the diagnosis of atrial fibrillation.

Dr. Kavousi specifically mentioned gender differences in blood pressure, obesity measures, and body proportions. Her studies mentioned how at an older age, women are more prone to  health issues that come with central body fat, like cardiovascular disease. Learn more about Dr. Kavousi’s studies here and here.

Also, it was proposed that the effect of different lifestyle factors, specifically alcohol consumption, and atrial fibrillation do not show similar patterns in men and women. In men, this relationship tends to be more linear but other patterns are seen in women, for example exponential, J-shaped, or U-shaped trends related to alcohol intake and the risk of atrial fibrillation.

How do treatment outcomes and prognosis differ in women?

As described by Dr. Kavousi, on a general population level, there are a lot of studies showing that women have poorer prognosis when it comes to Afib. Also, in one of the studies that was conducted, researchers found that the multi-morbidity pattern in women and men was different.

Dr. Kavousi described how even though much is not known about specific treatment outcome differences between men and women, generally women tend to have worse long-term prognosis. Specifically, women tend to have more multi-morbidities.

Accompanying conditions along with Afib, for example, other cardiovascular issues, lead to more severe cases and usually also poorer general health status. These multi-morbidities seem to be one of the leading causes for women tending to have a worse prognosis compared to men. In EU-statistics, women have approximately 10% higher mortality than men when it comes to cardiovascular disease.

Dr. Kavousi explained how women tend to develop atrial fibrillation at a higher age so it is more likely for women to have already existing comorbidities. As a result, proper diagnosis may be delayed which in turn causes symptom management and treatment to be postponed.

“Women live longer, so they live the rest of their lives with a condition that has a poor prognosis.”

Multiple possible complications can arise from atrial fibrillation but the most common ones are stroke and heart failure. Dr. Kavousi mentioned how also cognitive decline is considered an atrial fibrillation complication, especially in women.

The scoring system CHA2DS2-VASc that is used for assessing and scoring the stroke risk for Afib includes risk factors such as age, diabetes, and hypertension which increase the possible risk for complications. This is updated when new research finds novel risk factors.

“The female sex has been added to the Afib risk factors for developing stroke”

Learn more about multimorbidities and Afib here and sex differences in cardiovascular disease prognosis here.

What measures ensure that patients with female-specific symptoms are not overlooked?

“This is a work in progress. There’s been a lot of media attention to cardiovascular disease in women.”

The topic of sex differences in cardiovascular disease, particularly when it comes to atrial fibrillation is still a relatively new topic. New endeavors are constantly being developed and put into action to inspect these mechanisms. Dr. Kavousi specifically mentioned that at the Dutch Association of Cardiology, working groups are in place looking at gender and sex differences. The goal of these focus groups, one of which Dr. Kavousi is a part of, is to raise awareness of these topics for the public and cardiologists and also help avoid the misinterpretation of symptoms.

”Diversity is not only about sex and gender, it’s about lots of other aspects. It’s about age, ethnicity, social or religious backgrounds. I think all these aspects require attention”

Dr. Kavousi highlighted how more awareness needs to be raised for both the public and healthcare professionals. Education helps in changing the mindset and new education curriculums should include all these aspects of diversity so that healthcare professionals have an understanding and an eye for symptom variance.

Nowadays when presenting research ideas for grants usually these projects need to include a section for addressing issues of diversity. This is a clear change from before and also helps to bring attention to these issues of diversity and sex differences.

Dr. Kavousi underlined how important it is that these topics do not remain at the research level and that they are translated into strategies to help improve the diagnosis and treatment of women with atrial fibrillation.