The American College of Cardiology/AHA/European Society of Cardiology guidelines included similar risk strati- fication strategies as CHADS2 , with the inclusion of left ven- tricular ejection fraction <35% in the high-risk category. The -VASc score has been recommended recently by the European Society of Cardiology for risk classification.368,384 387 Two large cohort studies have both confirmed an age-sex interaction in patients with AF, which suggests a higher risk of stroke in women 75 years with AF compared with men.372,382 For example, in a large study that included 100802 patients with nonvalvular AF in Sweden, the incident risk of IS was greater in women than in men (6.2% versus 4.2% per year, Another large population-based study comprising 39398 men (47.2%) and 44115 women (52.8%) aged 65 years with AF from Canada showed a higher crude stroke incidence in men (1.61 per 100 person-years; 95% CI, 1.54 1.69; P<0.001). The observed difference was mainly driven by women aged 75 years. The stroke incidence per 100 person- years among participants aged 75 years was 2.38 (95% CI, 2.28 2.49) in women and 1.95 (95% CI, 1.84 2.07) in men (P<0.001). The stroke risk was significantly higher for women both for those taking or not taking warfarin. The multivariable analysis also revealed a similar increased risk of stroke in women (adjusted baseline comorbid conditions, individual components of the score, and warfarin treatment.372 There was a signifi- cant (P=0.02) interaction of age with sex, with the increased stroke risk confined to women aged 75 years. 