| Clin Res Cardiol 107, Suppl 1, April 2018 |
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Temporal relations between atrial fibrillation and ischemic stroke and their prognostic impact on mortality |
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| S. Camen1, F. Ojeda-Echevarria1, T. J. Niiranen2, F. Gianfagna3, J. K. Vishram-Nielsen4, S. Constanzo5, S. Söderberg6, E. Vartiainen7, M. B. Donati5, M.-L. Løchen8, G. Pasterkamp9, A. Ohlrogge1, F. Kee10, P. Jousilahti7, M. F. Hughes10, J. Kontto7, E. B. Mathiesen11, W. Koenig12, T. Palosaari7, S. Blankenberg1, G. de Gaetano13, T. Jørgensen4, T. Zeller1, K. Kuulasmaa7, A. Linneberg14, V. Salomaa15, L. Iacoviello3, R. Schnabel1, für die Studiengruppe: BiomarCaRE | ||
| 1Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg GmbH, Hamburg; 2Boston University School of Medicine, Boston, MA, US; 3Research Centre in Epidemiology and Preventive Medicine - EPIMED, Department of Clinical and Experimental Medicine, University of Insubria, Varese, IT; 4Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, DK; 5Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli (Isernia), IT; 6Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Faculty of Medicine, Umeå SE, SE; 7National Institute for Health and Welfare, Helsinki, FI; 8Department of Community Medicine, UiT The Arctic University of Norway, Tromsø; 9Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, NL; 10Queens University of Belfast, UK Clinical Research Collaboration Centre of Excellence for Public Health, Belfast, UK; 11Brain and Circulation Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, NO; 12Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München; 13Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Depar, Pozzilli (Isernia), IT; 14Research Centre for Prevention and Health, Copenhagen University Hospital, Rigshospitalet, Kopenhagen, DK; 15National Institute for Health and Welfare, Helsinki; | ||
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Introduction Atrial fibrillation (AF) and stroke are common diseases and AF is a well-established risk factor for stroke. The pathophysiological mechanism of atrial dysfunction, disturbed hemodynamics and arterial thromboembolism appears to be obvious. However, limited evidence is available on the temporal relationship between stroke and AF and the impact of subsequent disease onset on mortality in the community. Methods and Results Across five prospective community cohorts (DanMONICA, FINRISK, Moli-Sani project, Northern Sweden MONICA study, The Tromsø Study) of the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE)-project we assessed baseline cardiovascular risk factors in 95137 individuals, median age 45.9 (25th, 75th percentile 35.7, 57.3) years, 48.3% men. We followed them for incident stroke and AF and determined the relation of subsequent disease onset with overall mortality. Over a median follow-up of 17.9 years N=4410 individuals were diagnosed solely with AF, N=2196 had a stroke but no AF diagnosed, and N=875 developed both stroke and AF during follow-up. Participants who developed either AF or stroke as the index event revealed a similar baseline risk factor profile. Temporal relations showed a peak of the diagnosis of both diseases within the years around the diagnosis of the other disease. The highest incidence rates of stroke were observed within a five-year interval prior to AF diagnosis. Cox regression showed an association of baseline stroke with incident AF (hazard ratio (HR) 1.25; 95% confidence interval (CI) 1.07-1.46; p=0.004). In multivariable-adjusted 30-days landmark analyses with time-dependent covariates excluding individuals with diagnosis of both AF and stroke or death within 30 days, subsequent AF after stroke was associated with a higher overall mortality (HR 3.66, 95% CI 1.85-7.24; p<0.001); subsequent stroke after the diagnosis of AF was associated with a HR of 2.52 (95% CI 1.66-3.83; p<0.001). Conclusions Stroke and AF are common comorbidities in older adults with an overlapping risk factor profile. The temporal relations are not unidirectional. Stroke may precede diagnosis of AF by years. The subsequent occurrence of both diseases significantly increases mortality risk. Whether targeting modifiable risk factors or improved screening for AF after stroke improves survival, needs to be demonstrated. |
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http://www.abstractserver.de/dgk2018/jt/abstracts//V473.htm |