Sex-Specific Cardiometabolic Determinants of Postoperative Atrial Fibrillation After Cardiac Surgery

Background Cardiometabolic diseases increase the risk of postoperative atrial fibrillation (POAF), a complication leading to higher long-term risk of major cardiovascular events (MACE). It remains unknown whether the impact of these risk factors differs according to sex. We sought to evaluate the sex-specific predictors of POAF after coronary artery bypass grafting (CABG). Methods In a prospective registry of patients undergoing isolated CABG, we compared predictors of POAF between sexes with logistic regression models. Due to high prevalence of abdominal obesity in women, >80% having a waist circumference (WC) ≥88cm, median WC values were used to define abdominal obesity (men ≥102 cm, women ≥100 cm). Results This analysis included 6,177 individuals (17% women). Mean age was 65.6±8.9 years. POAF occurred in 32% of men and 28% of women (p<0.05). Compared to men, women with POAF had similar WC, higher prevalence of hypertension and diabetes, lower HDL-cholesterol and higher glucose, triglyceride, LDL-cholesterol, and C-reactive protein levels (all p<0.05). After adjustment, age and abdominal obesity were associated with POAF in both sexes (p<0.05). The interaction of WC with sex suggested a worse impact of WC on POAF risk among women (adjusted OR=1.97[95%CI 1.48-2.62] vs. in men 1.33[95%CI 1.17-1.50], p for interaction=0.01). Conclusions Abdominal obesity is a major predictor of POAF in both sexes, with higher risk in women. These results emphasize the need for enhanced strategies to manage abdominal obesity and its cardiometabolic consequences in the general population, and the potential to develop sex-specific preventive interventions to reduce POAF risk.