Sex differences in atrial fibrillation incidence among individuals with metabolic syndrome: a narrative mini review
4 affiliations
- 1Department of Cardiology, IRCCS Sacro Cuore - Don Calabria
- 2Department of Medicine, University of Verona
- 3Metabolic Diseases Research Unit, IRCCS Sacro Cuore - Don Calabria Hospital
- 4Department of Cardiology, AOOR Villa Sofia-Cervello
Abstract
Background: Sex differences influence the development and clinical expression of many chronic cardiometabolic diseases. Atrial fibrillation (AF), the most common sustained arrhythmia, frequently coexists with metabolic syndrome (MetS), yet whether MetS confers different AF risk in men and women remains incompletely understood.
Content: Epidemiological evidence consistently demonstrates that MetS increases the risk of incident AF by approximately 1.4- to 1.9-fold. Among MetS components, elevated blood pressure and abdominal obesity show the strongest associations with AF onset. Most studies also reveal that men have higher rates of AF than women across all age groups, although AF incidence in women rises sharply after menopause. In individuals with MetS, similar sex-related trends are observed: men typically exhibit a higher and earlier AF incidence, whereas women experience a delayed but steep increase in older age.
Biological differences—particularly sex hormone–driven variations in fat distribution, lipid metabolism, insulin sensitivity, and inflammation—may underlie these patterns. Premenopausal women tend to accumulate subcutaneous, metabolically benign fat, whereas men preferentially store visceral fat, promoting earlier metabolic dysfunction and AF susceptibility. After menopause, declining estrogen levels shift women toward central adiposity and cardiometabolic deterioration, narrowing the AF incidence gap. Sex-related differences in autonomic balance and adiposity-related sympathetic activation may further modulate AF risk.
Conclusion: While MetS increases AF risk in both sexes, accumulating evidence suggests that the magnitude, timing, and underlying mechanisms of this risk differ between men and women. Better integration of sex-specific biological pathways into AF prevention strategies is warranted.
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BibTeX
@article{bonapace2026differences,
title = {{Sex differences in atrial fibrillation incidence among individuals with metabolic syndrome: a narrative mini review}},
author = {Stefano Bonapace and Giulio Molon and Paolo Tosi and Esther Campopiano and Alessandro Costa and Antonio Pepe and Riccardo Morandin and Alessio Marinelli and Giovanni Targher and Alessandro Mantovani},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1969128},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1969128/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Sex differences in atrial fibrillation incidence among individuals with metabolic syndrome: a narrative mini review
AU - Stefano Bonapace
AU - Giulio Molon
AU - Paolo Tosi
AU - Esther Campopiano
AU - Alessandro Costa
AU - Antonio Pepe
AU - Riccardo Morandin
AU - Alessio Marinelli
AU - Giovanni Targher
AU - Alessandro Mantovani
PY - 2026
DA - 2026/10/28
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1969128
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1969128/full
AB - Background: Sex differences influence the development and clinical expression of many chronic cardiometabolic diseases. Atrial fibrillation (AF), the most common sustained arrhythmia, frequently coexists with metabolic syndrome (MetS), yet whether MetS confers different AF risk in men and women remains incompletely understood. Content: Epidemiological evidence consistently demonstrates that MetS increases the risk of incident AF by approximately 1.4- to 1.9-fold. Among MetS components, elevated blood pressure and abdominal obesity show the strongest associations with AF onset. Most studies also reveal that men have higher rates of AF than women across all age groups, although AF incidence in women rises sharply after menopause. In individuals with MetS, similar sex-related trends are observed: men typically exhibit a higher and earlier AF incidence, whereas women experience a delayed but steep increase in older age. Biological differences—particularly sex hormone–driven variations in fat distribution, lipid metabolism, insulin sensitivity, and inflammation—may underlie these patterns. Premenopausal women tend to accumulate subcutaneous, metabolically benign fat, whereas men preferentially store visceral fat, promoting earlier metabolic dysfunction and AF susceptibility. After menopause, declining estrogen levels shift women toward central adiposity and cardiometabolic deterioration, narrowing the AF incidence gap. Sex-related differences in autonomic balance and adiposity-related sympathetic activation may further modulate AF risk. Conclusion: While MetS increases AF risk in both sexes, accumulating evidence suggests that the magnitude, timing, and underlying mechanisms of this risk differ between men and women. Better integration of sex-specific biological pathways into AF prevention strategies is warranted.
SN - 2297-055X
ER -