Association of Atrial Fibrillation Without Cardiovascular Comorbidities and Stroke Risk: From the REGARDS Study
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‐ch...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.016380 |
| _version_ | 1819178709435809792 |
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| author | Matthew J. Singleton Muhammad Imtiaz‐Ahmad Hooman Kamel Wesley T. O'Neal Suzanne E. Judd Virginia J. Howard George Howard Elsayed Z. Soliman Prashant D. Bhave |
| author_facet | Matthew J. Singleton Muhammad Imtiaz‐Ahmad Hooman Kamel Wesley T. O'Neal Suzanne E. Judd Virginia J. Howard George Howard Elsayed Z. Soliman Prashant D. Bhave |
| author_sort | Matthew J. Singleton |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-22T21:46:52Z |
| format | Article |
| id | doaj.art-51f5eade8aa542ac8aea9030e8bb4960 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T21:46:52Z |
| publishDate | 2020-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-51f5eade8aa542ac8aea9030e8bb49602022-12-21T18:11:28ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-06-0191210.1161/JAHA.120.016380Association of Atrial Fibrillation Without Cardiovascular Comorbidities and Stroke Risk: From the REGARDS StudyMatthew J. Singleton0Muhammad Imtiaz‐Ahmad1Hooman Kamel2Wesley T. O'Neal3Suzanne E. Judd4Virginia J. Howard5George Howard6Elsayed Z. Soliman7Prashant D. Bhave8Section of Cardiology Wake Forest School of Medicine Winston‐Salem NCSection of Hospital Medicine Wake Forest School of Medicine Winston‐Salem NCDepartment of Neurology Weill Cornell Medical College New York NYDivision of Cardiology Department of Internal Medicine Emory University School of Medicine Atlanta GADepartment of Biostatistics University of Alabama at Birmingham ALDepartment of Epidemiology University of Alabama at Birmingham ALDepartment of Biostatistics University of Alabama at Birmingham ALDepartment of Internal Medicine and Epidemiological Cardiology Research Center Wake Forest School of Medicine Winston‐Salem NCSection of Cardiology Wake Forest School of Medicine Winston‐Salem NCBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.120.016380arrhythmiaatrial fibrillationcomorbiditiesriskstroke |
| spellingShingle | Matthew J. Singleton Muhammad Imtiaz‐Ahmad Hooman Kamel Wesley T. O'Neal Suzanne E. Judd Virginia J. Howard George Howard Elsayed Z. Soliman Prashant D. Bhave Association of Atrial Fibrillation Without Cardiovascular Comorbidities and Stroke Risk: From the REGARDS Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease arrhythmia atrial fibrillation comorbidities risk stroke |
| title | Association of Atrial Fibrillation Without Cardiovascular Comorbidities and Stroke Risk: From the REGARDS Study |
| title_full | Association of Atrial Fibrillation Without Cardiovascular Comorbidities and Stroke Risk: From the REGARDS Study |
| title_fullStr | Association of Atrial Fibrillation Without Cardiovascular Comorbidities and Stroke Risk: From the REGARDS Study |
| title_full_unstemmed | Association of Atrial Fibrillation Without Cardiovascular Comorbidities and Stroke Risk: From the REGARDS Study |
| title_short | Association of Atrial Fibrillation Without Cardiovascular Comorbidities and Stroke Risk: From the REGARDS Study |
| title_sort | association of atrial fibrillation without cardiovascular comorbidities and stroke risk from the regards study |
| topic | arrhythmia atrial fibrillation comorbidities risk stroke |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.016380 |
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