Stroke Risk Lower For Women With Heart Failure Interview with:
Torben Bjerregaard Larsen
Associate professor, MD, PhD, FESC
Aalborg University Hospital Department of Cardiology
Aalborg Thrombosis Research Unit Denmark

Medical Research: What is the background for this study? What are the main findings?

Dr. Larsen: Heart failure is a major public health issue with an increasing prevalence. Heart failure is associated with an increased risk of stroke, also in patients without concomitant atrial fibrillation. However, recent prospective randomized controlled trials investigating the effect of antithrombotic therapy in heart failure patients in sinus rhythm revealed that the benefit of warfarin in reducing stroke was counterbalanced by an increased risk of bleeding. Whether subgroups within the heart failure population would benefit from antithrombotic therapy is currently unknown. Therefore, possible subgroups with a higher risk of stroke within the heart failure population must be identified. We investigated whether female sex was associated with a higher risk of stroke, since female sex has been associated with an increased stroke risk among patients with atrial fibrillation.

In our study, we found an association between female sex and decreased stroke risk in heart failure patients in sinus rhythm which persisted after adjustment for concomitant cardiovascular risk factors. This association was attenuated with increasing age which could possibly be due to competing risks of death, since competing risk of death was substantial among males in the older age groups.

Medical Research: What should clinicians and patients take away from your report?

Dr. Larsen: Our finding of a lower risk of stroke in females with heart failure compared to males may have prognostic value for clinicians in daily practice: even if the same comorbidities are present, males are at a higher risk of stroke. This may warrant focus on modifiable risk factors in male heart failure patients compared to female heart failure patients in order to reduce the risk of stroke, especially if the etiology of heart failure is due to ischemic heart disease.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Larsen: Our prognostic findings do not permit etiological conclusions; therefore, other studies are needed to elucidate biological reasons for the differences in male and female heart failure patients. Additionally, we were unable to distinguish between heart failure with preserved and reduced ejection fraction which could have influenced our results since heart failure with preserved ejection fraction are more common in females than males; therefore, we suggest that future studies take into account these differences.


Female Sex is Associated with a Lower Risk of Stroke in Patients with Heart Failure

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