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To the Editor: Dr Wang and colleagues¹ derived a risk score for predicting stroke and death in patients with new-onset atrial fibrillation (AF). The authors found that female sex decreased the 5-year risk of stroke. It is possible, however, that age may interact with sex in predicting risk. For example, Hart et al² have reported that women with AF had a much higher rate of stroke compared with men among patients aged 75 years or older, but that there was no difference in risk among those younger than 75 years. Those authors concluded that this difference was due to differences in use of postmenopausal hormone therapy (HT). It is controversial whether HT really increases the risk of ischemic stroke.³ Thus, it remains uncertain whether female sex is a risk factor for stroke among women younger than 75 years.

Yujiro Kida, MD, PhD
Department of Internal Medicine
Tokyo Metropolitan Komagome Hospital
Tokyo, Japan

1. Wang TJ, Massaro JM, Levy D, et al. A risk score for predicting stroke or death in individuals with new-onset atrial fibrillation in the community: the Framingham Heart Study. JAMA. 2003;290:1049-1056. FREE FULL TEXT 2. Hart RG, Pearce LA, Mcbrid R, et al, the Stroke Prevention in Atrial Fibrillation (SPAF) Investigators. Factors associated with ischemic stroke during aspirin therapy in atrial fibrillation: analysis of 2012 participants in the SPAF I-III clinical trials. Stroke. 1999;30:1223-1229. FREE FULL TEXT 3. Grodstein F, Stampfer MS, Colditz GA, et al. Postmenopausal estrogen and progestin use and the risk of cardiovascular disease. N Engl J Med. 1996;335:453-461. [published correction appears in N Engl J Med. 1996;335:1406]. FREE FULL TEXT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290:2937.

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