Search

Aims: Atrial fibrillation (AF) patients frequently require active rhythm control therapy to maintain sinus rhythm and reduce symptom burden. Our study assessed whether antiarrhythmic therapies (AATs) are used disproportionately between men and women after new-onset AF., Methods and Results: The nationwide Finnish anticoagulation in AF registry-based linkage study covers all patients with new-onset AF in Finland during 2007-2018. Study outcomes included initiation of AATs in the form of antiarrhythmic drugs (AADs), cardioversion, or catheter ablation. The study population constituted of 229 565 patients (50% females). Women were older than men (76.6 ± 11.8 vs. 68.9 ± 13.4 years) and had higher prevalence of hypertension or hyperthyroidism, but lower prevalence of vascular disease, diabetes, renal disease, and cardiomyopathies than men. Overall, 17.6% of women and 25.1% of men were treated with any AAT. Women were treated with AADs more often than men in all age groups [adjusted subdistribution hazard ratio (aSHR) 1.223, 95% confidence interval (CI) 1.187-1.261]. Cardioversions were also performed less often on women than on men aged <65 years (aSHR 0.722, 95% CI 0.695-0.749), more often in patients ≥ 75 years (aSHR 1.166, 95% CI 1.108-1.227), while no difference between the sexes existed in patients aged 65-74 years. Ablations were performed less often in women aged <65 years (aSHR 0.908, 95% CI 0.826-0.998) and ≥75 years (aSHR 0.521, 95% CI 0.354-0.766), whereas there was no difference in patients aged 65-74 years., Conclusion: Women used more AAD than men in all age groups but underwent fewer cardioversion and ablation procedures when aged <65 years., Competing Interests: Conflict of interest: B.S.: speaker—BMS-Pfizer Alliance and Boehringer Ingelheim; member of advisory board—Pfizer; educational grants—Medtronic and Abbott. K.K.: Finnish Foundation for Cardiovascular Research. J.I.: speaker—Boehringer Ingelheim, BMS-Pfizer Alliance, and Boston Scientific; educational grants—Boston Scientific, Johnson & Johnson, and Medtronic. A.L.A.: research grants—Finnish Foundation for Cardiovascular Research and Sigrid Juselius Foundation; speaker—Abbott, Johnson & Johnson, Sanofi, Bayer, and Boehringer Ingelheim. K.T.: research grants—the Finnish Foundation for Cardiovascular Research, Aarne and Aili Turunen Foundation, and Finnish State Research funding. T.P.: BMS-Pfizer Alliance and Boehringer Ingelheim. J.P.: speaker—Bayer, Boehringer Ingelheim, BMS-Pfizer Alliance, and Abbott; advisory board—Portola, Novo Nordisk, and Herantis Pharma; visiting editor—Terve Media; stock ownership—VitalSignum. M.Li.: speaker—BMS-Pfizer Alliance, Bayer, and Boehringer Ingelheim. P.M.: consultant—Roche, BMS-Pfizer Alliance, Novartis Finland, Boehringer Ingelheim, and MSD Finland. J.H.: research grants—the Finnish Foundation for Cardiovascular Research; advisory board member—BMS-Pfizer Alliance, Novo Nordisk, and Amgen; speaker—Cardiome and Bayer. K.E.J.A.: research grants—the Finnish Foundation for Cardiovascular Research; speaker—Bayer, Pfizer, and Boehringer Ingelheim; advisory board member—Bayer, Pfizer, and AstraZeneca. M.Le.: consultant—BMS-Pfizer Alliance, Bayer, Boehringer Ingelheim, and MSD; speaker—BMS-Pfizer Alliance, Bayer, Boehringer Ingelheim, MSD, Terve Media, and Orion Pharma; research grants—Aarne Koskelo Foundation, the Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund. All remaining authors have declared no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

The relationship of thyroid autoantibodies and elevated TSH level to indices of cardiovascular diseases was studied in two population series monitored for 5 years and in a cross-sectional hospital series. In a cohort of 1105 males, initially 55-74 years of age, deaths due to cardiovascular causes occurred in 19% of subjects with thyroid autoantibodies and in 11% of controls matched for age (P less than 0.05). In another cohort of 1045 males and 1223 females, initially 40-64 years of age, no difference emerged in males, while 6 out of 20 females who died of cardiovascular causes had thyroid autoantibodies, compared with 18% in the whole series. In a series of 97 hospital patients with myocardial infarction, 7 patients had thyroid autoantibodies as opposed to 12 antibody-positive subjects among controls matched for age and sex. Elevated TSH level appeared to be no better an indicator of cardiovascular morbidity or mortality than thyroid autoantibodies. It is concluded that thyroid autoimmunity may act as a cardiovascular risk factor under certain circumstances, but it does not have any general significance and the mechanism of action remains unclear.

In a double-blind trial, 327 patients (57 men) over 65 (mean age 79.5) years received all possible combinations of calcium carbonate 3 g, vitamin D3 1000 iu, methandienone 2.5 mg and/or placebos daily for 9 months. The higher incidence of bone fractures in the placebo group was not significant. Serum calcium, phosphorus, creatinine, aspartate aminotransferase and alkaline phosphatase were followed: the greatest changes occurred with methandienone, which thus reduced osteoporotic activity and increased the muscular mass most effectively; calcium carbonate had the poorest effect. Surprisingly, coronary mortality was higher among those taking all three active substances. With two treatments the increase was not significant, but when both the groups receiving a combination of any two of the treatments were compared with those taking only one or neither of these two treatments, a significant increase in coronary deaths was seen, most significant (P less than 0.001) in those receiving vitamin D3 and methandienone.