At ESC EuroPrevent 12. April, two members of the network, Renate Schnabel and Marius Myrstad, were invited speakers in a very well visited and received special session masterclass on stroke prevention focusing on various aspects of atrial fibrillation (AF). Network member and member of the ESC EuroPrevent congress committee, Maja-Lisa Løchen, chaired the session.
The title of Renate Schnabel’s presentation was “Gender differences in atrial fibrillation and stroke”. About one-half of the AF patients are women that are in general older with more comorbidities compared to men. There is no definitive evidence regarding sex difference in stroke risk in younger women, but probably women aged 75+ years have an increased stroke risk. Sex differences in myocardial and vascular structure and function, inflammation, procoagulatory pathways might explain the different stroke risk. Knowledge gaps are whether sex-specific mechanisms in pathophysiology for stroke risk and effect of medication exist, or whether confounding such as comorbidities explain the observed differences. Both sexes should be included in equal numbers in future studies in order to increase the evidence regarding sex differences in AF and complications in all age groups.
The title of Marius Myrstad’s presentation was “Exercise and atrial fibrillation – What to consider?” It is shown in population studies that exercise compared to sedentary lifestyle reduces the risk of AF, although elite athletes seem to have a higher somewhat AF risk. Myrstad stated the knowledge gap of no hard evidence that exercise in individuals with atrial fibrillation prevents stroke. However, based on a small number of studies, both observational data and randomized controlled trials, he concludes that most individuals with AF should exercise regularly, after evaluation of underlying pathology.
ESC EuroPrevent congress has been held yearly for 15 years and is organized by ESC EAPC which is the European Association of Preventive Cardiology. From next year, the congress changes name to ESC Preventive Cardiology and will be held in Malaga 2. – 4. April 2020. The focus on atrial fibrillation as a congress topic has increased recently. For more information about EAPC, check out https://www.escardio.org/Sub-specialty-communities/European-Association-of-Preventive-Cardiology-(EAPC)?hit=metanav and for ESC EuroPrevent 2019: https://www.escardio.org/Congresses-&-Events/EuroPrevent
Link to PubMed for Renate B. Schnabel and Emelia J. Benjamin’s editorial comment “Sex and Stroke risk in Atrial Fibrillation. More Work to Be Done”: https://www.ncbi.nlm.nih.gov/pubmed/29798788
Link to PubMed for Marius Myrstad and co-authors’ paper “Exercise in individuals with atrial fibrillation”: https://www.ncbi.nlm.nih.gov/pubmed/30135995
Lars Elnan Garnvik presented data from his study on the association between estimated cardiorespiratory fitness and risk of atrial fibrillation (AF).
The main findings from the study was that higher levels of estimated fitness is associated with reduced risk of AF. Further, we found that individuals who improved their fitness levels over a 10-year period (from HUNT2 to HUNT3) had almost 50% reduced risk of AF. The take home message is that estimated cardiorespiratory fitness is a convenient tool to use in primary care settings or in large populations, as an alternative to directly measured VO2peak which is more expensive and time consuming.