Affiliation:
1. Section of Cardiology Wake Forest School of Medicine Winston‐Salem NC
2. Section of Hospital Medicine Wake Forest School of Medicine Winston‐Salem NC
3. Department of Neurology Weill Cornell Medical College New York NY
4. Division of Cardiology Department of Internal Medicine Emory University School of Medicine Atlanta GA
5. Department of Biostatistics University of Alabama at Birmingham AL
6. Department of Epidemiology University of Alabama at Birmingham AL
7. Department of Internal Medicine and Epidemiological Cardiology Research Center Wake Forest School of Medicine Winston‐Salem NC
Abstract
Background
Atrial fibrillation (
AF
) is associated with a 5‐fold increased stroke risk. While most patients with
AF
warrant anticoagulation, optimal treatment remains uncertain for patients with
AF
without cardiovascular comorbidities because the risk of stroke in this population has not been well‐characterized.
Methods and Results
Participants (N=28 253; 55% women, mean age 64.6±9.4 years), from the
REGARDS
(Reasons for Geographic and Racial Differences in Stroke) study (2003–present) were classified into 1 of 4 groups based on the presence or absence of
AF
and the presence or absence of cardiovascular comorbidities. Cox proportional hazards analysis was used to compare the risk of stroke between groups. During 244 560 person‐years of follow‐up (median 8.7 years), 1206 strokes occurred. Compared with patients with neither
AF
nor cardiovascular comorbidities, we did not find an increased stroke risk (hazard ratio [HR], 1.23; 95%
CI
, 0.62–2.18 [
P
=0.511]) among participants with
AF
alone. Participants without
AF
but with cardiovascular comorbidities had both an elevated stroke risk (HR, 1.77; 95%
CI
, 1.48–2.18 [
P
<0.0001]) and an increased risk of cardioembolic stroke (HR, 2.34; 95%
CI
, 1.48–3.90 [
P
=0.0002]).
Conclusions
In this large cohort of participants with
AF
without cardiovascular comorbidities, we found that
AF
itself, without cardiovascular comorbidities, did not confer increased risk of stroke. Cardiovascular comorbidities, however, were associated with an increased risk of both stroke of any type and cardioembolic stroke, even in the absence of
AF
.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
13 articles.
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