Marco Vitolo: The Changing Landscape of Sex Differences in AF-Related Stroke
Marco Vitolo, Attending Cardiologist, Tenure-Track Assistant Professor at University of Modena and Reggio Emilia, shared a post on LinkedIn:
“Excellent and thought-provoking talk by Prof. Gregory Lip at ESC Congress on sex differences in AF-related stroke risk.
Female sex matters but perhaps more importantly, context, population and methodology matter.
A few thoughts:
Contemporary data suggest that the excess stroke risk historically observed in women with AF has declined over time.
But an intriguing question remains:
Why has the gap narrowed?
Better AF care?
Better risk-factor management?
Greater awareness and use of anticoagulation?
Probably a combination.
And this raises a potential paradox.
For years, female sex was explicitly incorporated into stroke risk assessment with CHA₂DS₂-VASc.
Could greater recognition of women at risk have itself contributed, at least partly, to narrowing historical disparities?
Now that ‘Sc’ has been removed in CHA₂DS₂-VA, the key question may not only be predictive performance
Could removing sex from the score inadvertently lead to less OAC treatment in some women, potentially bringing back disparities we have worked to reduce?
This remains to be seen.”
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