ABSTRACT NUMBER: ESOC2026A91 SEX-SPECIFIC RISK PROFILES AND ESTIMATED STROKE PREVENTION POTENTIAL IN INCIDENT ATRIAL FIBRILLATION

Abstract Background and aims Sex-related differences in atrial fibrillation epidemiology and comorbidity profiles may influence the real-world potential for stroke prevention. This study examined the sex-specific risk distribution for incident AF and estimated the number of ischemic strokes potentially preventable through optimized AF detection and anticoagulation by sex. Methods A retrospective, community-based cohort of 40,077 adults aged 65–90 years was followed from 2015–2024. Incident AF (n = 3,370; 8.4%) was identified from electronic health records. Cardiovascular comorbidities, CHA₂DS₂-VASc and CHA₂DS₂-VA scores, and observed stroke incidence (per 100 person-years) were analyzed by sex. Preventable strokes were estimated assuming a 65% risk reduction from oral anticoagulation in eligible patients. Results Men (57.2%) showed higher AF incidence (9.9%vs7.0%) and greater prevalence of diabetes, coronary, and peripheral vascular disease. Women were older (80.9 ± 6.1 vs. 79.5 ± 6.2 years; p < 0.001) and had more dyslipidaemia and cognitive impairment, leading to higher CHA₂DS₂-VASc scores (4.5 vs. 3.6; p < 0.001). Based on population risk profiles, the estimated annual stroke incidence attributable to untreated AF was 5.1/100 person-years in women and 4.3/100 person-years in men. Applying anticoagulation efficacy, approximately 33 preventable strokes per 1,000 AF women and 28 per 1,000 AF men could be avoided annually Conclusions AF incidence and risk composition differ significantly by sex. Women present with older age and higher thromboembolic risk, suggesting that equitable AF detection and anticoagulation could prevent a greater absolute number of strokes among women, despite lower AF prevalence Conflict of interest ALL AUTHORS HAVE NOTHING TO DISCLOSE