Are there sex differences in stroke outcomes for people with Nonvalvular Atrial Fibrillation?
Research shows that sex can influence stroke outcomes in people with nonvalvular atrial fibrillation (NVAF). Women with NVAF tend to be older and have different risk profiles than men. Some studies find women have worse short-term outcomes after a stroke, while others suggest that after accounting for age and other health factors, women's long-term mortality risk may actually be lower. The picture is complex and depends on the specific outcome measured.
What the research says
A 2025 study of 196 patients with NVAF-related cardioembolic stroke found that women had a higher risk of poor short-term outcomes (modified Rankin Scale score >2 at discharge or day 14) compared to men (55.96% vs 42.53%) 9. The same study also identified an interaction between sex and neutrophil-to-lymphocyte ratio (NLR), a marker of inflammation, suggesting that the combination of female sex and higher NLR was linked to worse outcomes 9.
A large population-based cohort study of over 89,000 people with NVAF found that women had a higher unadjusted rate of ischemic stroke (7.0% vs 5.8%) and higher mortality (33.5% vs 32%) 11. However, after adjusting for age and other risk factors, sex did not significantly affect stroke risk overall, though women aged 75 and older had an increased stroke risk (hazard ratio 1.25) 11. Interestingly, adjusted mortality risk was lower in women (hazard ratio 0.78) 11.
Another study of 387 patients undergoing left atrial appendage closure (a procedure to reduce stroke risk) found no significant sex differences in thromboembolic events or major bleeding after two years of follow-up, but women had a lower risk of all-cause death 10.
A meta-analysis of 23 studies (13,322 patients) found that female sex was a risk factor for post-stroke cognitive impairment (pooled RR 1.23) 1, which is an important outcome for stroke survivors.
What to ask your doctor
- Given my sex and age, what is my personal risk of stroke or poor outcomes from NVAF?
- Are there specific treatments or monitoring strategies that might be more effective for women with NVAF?
- How does my inflammation level (e.g., neutrophil-to-lymphocyte ratio) affect my stroke risk and recovery?
- Should I consider a left atrial appendage closure procedure, and does my sex affect the expected benefits or risks?
- What can I do to reduce my risk of cognitive decline after a stroke?
This question is drawn from common patient questions about Cardiology and answered using cited medical research. We do not provide individualized advice.