Study: Women With This Common Heart Disorder Experience Faster Cognitive Decline Than Men

Fact checked by Nick Blackmer

• A new study found that atrial fibrillation (AFib) is linked to higher rates of cognitive decline in women than in men.

• Women are often diagnosed with AFib at a later age, which can contribute to a delay in care.

• Experts recommend women advocate for their own AFib care, as well as prioritize routine checkups and blood thinner treatment.

Atrial fibrillation (AFib), a condition that causes the heart to quiver or beat irregularly, is linked with higher rates of cognitive decline in women, a new study shows.

The new research highlights one of the many sex-based disparities in recognizing and treating heart disease. For example, women under age 55 who are having a heart attack are less likely than men to be diagnosed with one and present with different symptoms.

“This likely exists for atrial fibrillation as well,” said Jessica A. Hennessey, MD, PhD, a cardiologist at the Columbia University Irving Medical Center.

While women’s heart health is often at a medical disadvantage, but many details between AFib and cognitive decline—based on gender—are still unclear.

“For the past 10 years, we’ve known that atrial fibrillation causes a higher rate of cognitive dysfunction, but nobody has looked at gender differences,” said Kathryn Wood, PhD, RN, an associate professor in the Nell Hodgson Woodruff School of Nursing at Emory University, who led the study.

Related: Women More Than Twice as Likely to Die After Heart Attack Than Men, Study Finds

Women Generally Diagnosed With AFib Later in Life

Wood and her team recruited nearly 44,000 people from the National Alzheimer’s Coordinating Center (NACC) cohort to conduct their study. The average age was 72 years and about half were women and 11%—about 5,000 people—had AFib at the time of recruitment.

Each participant’s cognition was assessed over three doctors’ visits. By the end, each was determined to have either healthy cognition, mild cognitive impairment or dementia.

Compared to men with AFib and women without the condition, women who had AFib were more likely to have cognitive impairment or dementia. Their condition also appeared to progress more quickly.

Women with AFib are more likely than men to have atypical symptoms, such as weakness and fatigue. Additionally, women with AFib are commonly diagnosed at an older age, typically after menopause.

“We don’t know if that’s because they manifest it later in life or it’s because of the social factors that make it gets missed earlier, which are even worse in Black, Hispanic and AI/AN women,” said Johanna Contreras, MD, a cardiologist at Mount Sinai Morningside in New York.

A late diagnosis causes delays in care if the condition has gone years without being detected, she said.

How AFib symptoms differ in women isn’t well understood. The CDC lists general symptoms of AFib as heart palpitations, lightheadedness, extreme fatigue, shortness of breath and chest pain.

“A lot of the data we have about cardiovascular disease is collected from white men,” Contreras said.

Some AFib symptoms women experience may also be brushed off at the doctor’s office.

“Women are more likely to complain of palpitations in general, therefore it may be chalked up to other issues and not necessarily atrial fibrillation immediately,” said Hennessey.

Silent Strokes Could Be a Contributing Factor

The American Heart Association predicts that over 12 million people are projected to have AFib by 2030.

According to Wood, when someone has AFib, blood pools in the chamber of the heart, allowing a clot to form. These clots can travel to the brain and cause stroke. They are also one way researchers are beginning to believe AFib could be causing cognitive decline.

The connection between AFib and higher rates of cognitive decline in women may be connected to the fact that women are more likely to have silent strokes, which are caused by small blood clots that get lodged in the brain but do not cause any noticeable symptoms. These clots do, however, prevent enough blood, and therefore oxygen, from reaching the brain.

According to Wood, the treatment for AFib is blood thinners to prevent clots from forming. But since women are more likely to have a delayed diagnosis, and are less likely to be prescribed blood thinners once they are, blood clots that cut off oxygen to the brain may be behind the accelerated cognitive decline.

Because the heart chambers quiver, it’s also possible that not enough blood is getting to the brain, which can be remedied with a pacemaker in some patients, said Contreras.

Having AFib as a female does not automatically mean a person will develop cognitive impairment, but it is important to recognize the potential risk so physicians can determine whether or not the cause may be treatable.

New research is also showing that blood thinners may be able to prevent AFib-related cognitive decline.

One clinical trial that completed in 2021 found that blood thinners may be protective against cognitive decline among people with AFib. Another trial that is currently underway is testing whether or not anticoagulants can improve dementia in people who have AFib.

The mounting data shows that women should make sure they are speaking up if they don’t feel they’re getting adequate AFib care.

“We need to screen all people, but especially women, for cognitive disease on a routine basis when they have AFib," Wood said. "We should teach women that they should be asking, ‘Should I be on blood thinners in this situation, or why am I not on blood thinners?’”

AFib Can Serve as a Warning Sign for Other Conditions

AFib is often the first warning sign of heart failure in women and people who have AFib usually have multiple comorbidities.

“AFib is paired with so many other diseases, it’s tricky to just measure cognitive decline related to AFib,” said Contreras.

People with AFib commonly also have obesity and sleep apnea, all of which can affect cognitive decline. Sleep apnea in particular may be at play, Contreras said.

“We have been under-diagnosing this because people think sleep apnea can only happen in people who are overweight, but it can happen to anyone,” she added. “And we know that if you treat sleep apnea, AFib gets better.”

Further research will need to study a direct correlation, but Contreras called the new study a “warning sign” that should prompt more research into what causes cognitive decline in people with AFib, and why women seem to be at higher risk than men.

Related: How To Identify Strokes and Stroke-Like Symptoms—Even in Young People

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