Unraveling Sex Disparities of Atrial Fibrillation/Flutter in Asia: Contributions of Lifestyle Factors (Smoking, Excessive Alcohol Intake) and Life Expectancy

BACKGROUND: The burden of atrial fibrillation/atrial flutter (AF/AFL) continues to increase globally, particularly in rapidly ageing regions such as Asia. However, the contributions of population aging, life expectancy, and lifestyle-related risk factors to sex-specific disparities in AF/AFL burden remain poorly understood. OBJECTIVES: To investigate sex-specific differences in AF/AFL burden across Asia and evaluate the contributions of population ageing, life expectancy, and modifiable risk factors using Global Burden of Disease (GBD) data. METHODS AND RESULTS: GBD data were used to assess AF/AFL prevalence, incidence, disability-adjusted life years (DALYs), mortality, and attributable risk factors across 34 Asian countries and regions, stratified by sex and age. In 2023, AF/AFL affected 59.10 million individuals worldwide, with Asia accounting for nearly half of the global burden. Prevalence and incidence were consistently higher in males, whereas females, particularly at older ages, experienced a greater burden of DALYs and mortality. Marked heterogeneity was observed across Asian countries. Population ageing emerged as a major driver of AF/AFL burden, with most Asian countries classified as aging or aged societies. Hypertension was the leading attributable risk factor overall, while smoking and excessive alcohol consumption contributed disproportionately to the male burden. Forecasting analyzes projected a continued increase in AF/AFL burden through 2036. CONCLUSION: AF/AFL remains a growing public health challenge across Asia. Although prevalence is higher in males, elderly females bear a disproportionately greater burden of disability and mortality. Population ageing, together with smoking and excessive alcohol consumption in men, may contribute substantially to these sex disparities. Sex- and age-specific prevention and management strategies are needed to reduce the future burden of AF/AFL in Asia.