Larger women are particularly susceptible

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Recent studies point out that a major risk factor for health problems for Pennsylvania Democratic Senate candidate John Fetterman is something over which he has no control: his height.

Cardiologists have known for years that taller people, like the 6-foot-8 Fetterman, who is taller than all but a tiny fraction of adult men, are at higher risk of developing an irregular heartbeat called atrial fibrillation (A -fib). This heart disease in turn increases the risk of a stroke, like the one Fetterman suffered on May 13.

Fetterman said he has ongoing speech and communication problems, and his health remains under scrutiny as he draws criticism from Republican opponent Mehmet Oz for not yet engaging in the proposed debates.

In 2020, a study by Penn Medicine researchers suggested that this link between height and A-fib isn’t just a coincidence — that being very tall can actually cause A-fib. The apparent reason is that taller people have larger and more elongated hearts, which increases the risk of irregular functioning in a heart chamber called the left atrium.

And in a new study, researchers at Cedars-Sinai Medical Center have found that the risk of extreme height can be particularly acute for women. On average, women of all ages have a three times lower risk of developing fibrosis A than men. But when the researchers controlled for height, that is, using statistical techniques to account for height, it turned out that for a given height, women were almost 40% more likely to develop disease than men.

Although this fact has not been documented before, it makes sense, said study lead author Christine M. Albert, chair of cardiology at the Smidt Heart Institute in Cedars-Sinai. Take a woman who is 6 feet 1 inches tall. She’s on the extreme end of height for women – well into the 99th percentile – whereas a man this size is simply a bit tall.

“If you take a tall woman who’s the same height as a tall man, that’s really tall,” she said.

The discovery, published in JAMA Cardiologysuggests that height should be used to help predict who is at risk for A-fib, as well as other risk factors such as smoking and alcohol consumption, she said.

The good news is that although being very tall increases the risk of FIB A, which in turn increases the risk of stroke, people can take steps to reduce the risk of stroke.

One option is to take medication, including blood thinners which “thin” the blood, reducing the risk of an abnormal clot which can form in the heart and travel to the brain (the definition of a stroke). A statement from Fetterman’s doctor suggests he was not taking these drugs.

Being overweight also increases the risk of A-fib, and years ago Fetterman weighed over 400 pounds before embarking on a weight loss program.

But he couldn’t have done anything about his size. According to a graph from the Cedars-Sinai study, Fetterman’s risk of developing A-fib was about twice that of a man who is 10 inches shorter (being 5 foot 10 inches tall).

An adult American male who is 6 feet 3½ inches tall is in the 99th percentile, which means he is taller than 99% of his peers.

Fetterman is way beyond that.

Exactly how much is unclear, said Steve Wang, professor of statistics at Swarthmore College.

People of Fetterman’s height are so unusual that they are not included in standard growth charts. But using a formula derived from CDC statistics and making some assumptions, Wang estimated (very roughly) that Fetterman could be anywhere between the 99.95th and 99.99th percentile.

If he is at the high end of that range, he would be taller than all but 1 in about 7,000 adult American men.

Recently, President Joe Biden expressed it in more everyday terms. At an Aug. 30 campaign event, he simply called Fetterman “that big boy.”

Gender differences and atrial fibrillation: new study overturns conventional wisdom

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