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Name
Nolan Breault

Mon, 11/15/2021 - 12:46

Hi Kyla,

Thank you for hosting this week's MGR discussion! In spite of the relatively short notice and additional challenge of having a guest join us over Zoom, I thought you did an excellent job of setting the scene for Dr. Conen and productively moving the conversation along. While the outcomes data of the rounds talk was very telling and highlighted the importance of conducting ASPIRE-AF and COP-AF, I found myself thinking more about a theme that was implied but not really touched on, this being sex differences.

As Dr. Conen alluded to, atrial fibrillation (AF) is predominantly a phenomenon of middle-aged and elderly individuals. Men are more likely to develop AF in general and in surgical settings, though women often report more drastic reductions in quality of life and have poorer prognoses (1-3). This is believed to partially be due to differences in average estrogen levels across a woman's lifespan, with postmenopausal women theorized to not benefit as much from the cardioprotective effects of estrogen, such as vasodilation and reduced TNF-alpha-mediated inflammation (4). Estrogen levels and their effects on signaling/the vasculature alone most likely don't account for the different presentations of AF in men and women, but it is interesting to note that this dichotomy of the sexes is precisely opposite of what is seen in pulmonary arterial hypertension (PAH), which has also been suggested to be affected by estrogen levels. With PAH, women are more likely to be given a diagnosis, yet fare better than male counterparts.

Outside of the certainly relevant lifestyle factors that differ between the sexes, such as BMI, exercise levels, and substance usage, it will be interesting to see if the therapeutic landscape for both AF and PAH evolve to consider hormonal differences. We presently have more broadly-acting approaches, such as the anticoagulants used for AF, and vasodilators for PAH, but again, this angle is interesting.

If anyone has any other thoughts on the matter, I'd be happy to discuss. Thanks again to Kyla!

Best,

Nolan

References
1. Chugh, S. S., et al. (2014) Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 129:839-847.
2. Matthew, J. P., et al. (1996) Atrial fibrillation following coronary artery bypass graft surgery: Predictors, outcomes, and resource utilization. JAMA 276: 300-306.
3. Paquette, M., et al. (2000) Role of gender and personality on quality-of-life impairment in intermittent atrial fibrillation. Am. J. Cardiol. 86: 764-768
4. Ko, D., et al. (2016) Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis. Nat. Rev. Cardiol. 13: 321-332.

Name
Nolan Breault

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