Although non-stroke outcomes are more common, stroke risk scores can be used for prediction in patients with atrial fibrillation

McAlister, Finlay A.; Wiebe, Natasha; Ronksley, Paul E.; Healey, Jeff S.

doi:10.1016/j.ijcard.2018.07.128

Cited by 5 publications

(9 citation statements)

References 41 publications

(42 reference statements)

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“…Although most of the educational messaging for physicians and patients about AF focuses on thromboprophylaxis management, our data suggests the need for increased attention to other atherosclerotic risk factors such as hypertension, particularly since non-stroke cardiovascular outcomes are more common than stroke in AF patients. [26,27] Supporting information…”

Section: Resultsmentioning

confidence: 99%

Hypertension prevalence but not control varies across the spectrum of risk in patients with atrial fibrillation: A RE-LY atrial fibrillation registry sub-study

et al. 2020

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Background Although hypertension is the most common risk factor for atrial fibrillation (AF), whether blood pressure (BP) control varies across the spectrum of stroke risk in patients with AF or by adequacy of their thromboprophylaxis management is unclear. Methods We examined data from the RELY AF registry conducted at 164 emergency departments (EDs) in 47 countries between December 2007 and October 2011. Results Of the 15,400 patients in the registry, we analyzed the 9929 (mean age 67.5 years, 51.9% men) with a prior history of AF and complete BP data. While 6508 (66.5%) AF patients had hypertension, the prevalence varied widely depending on comorbidity profiles: from 45.4% in those without other cardiovascular risk factors to 82.5% in those with AF and diabetes. Although 93.9% of AF patients with hypertension were on at least one antihypertensive agent, fewer than half had BP levels � 140/90 with no difference across risk profiles: 45.9% of those with NVAF and CHADS 2 scores of 1 and 45.6% of those with NVAF and CHADS 2 scores of 2 or more (46.9% and 45.3% for CHA 2 DS 2-VASc scores of 1 versus 2 or more). BP control rates were not significantly better in those NVAF patients receiving guideline concordant thromboprophylaxis management (47.2%, aOR 1.03, 95%CI 0.89-1.20) than in those not receiving guideline-concordant antithrombotic therapy (45.3%).

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Section: Resultsmentioning

confidence: 99%

Hypertension prevalence but not control varies across the spectrum of risk in patients with atrial fibrillation: A RE-LY atrial fibrillation registry sub-study

et al. 2020

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“…Non-stroke MACE was defined as a separate endpoint in order to determine whether childlessness modifies the risk of other types of MACE except stroke events [18].…”

Section: Retrieval Of Cardiovascular Disease Endpoints and Mortalitymentioning

confidence: 99%

“…The aim was to investigate whether male childlessness per se predicted an additional risk increase. Since previous research has pointed to different causation as considering stroke events [18] a separate end point was evaluated excluding the latter from the composite MACE end point (referred to as non-stroke MACE).…”

Section: Introductionmentioning

confidence: 99%

Male childlessness as independent predictor of risk of cardiovascular and all-cause mortality: A population-based cohort study with more than 30 years follow-up

et al. 2020

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In a recent population-based study, an elevated risk of the Metabolic syndrome (MetS) and type 2 diabetes was found in childless men compared to those who have fathered one or more children. Therefore, by using a larger cohort of more than 22 000 men from the Malmo Preventive Project (MPP) we aimed to expand our observations in order to evaluate the metabolic profile of childless men and to evaluate if childlessness is an additional and independent predictor of major adverse cardiovascular events (MACE), mortality and incident diabetes when accounting for well-known biochemical, anthropometric, socioeconomic and lifestyle related known risk factors. Logistic regression was used to assess risk of MACE, diabetes and MetS at baseline. Multivariate Cox regression was used to evaluate the risks of MACE and mortality following the men from baseline screening until first episode of MACE, death from other causes, emigration, or end of follow-up (31 st December 2016) adjusting for age, family history, marital status, smoking, alcohol consumption, educational status, body mass index, prevalent diabetes, high blood lipids, increased fasting glucose and hypertension. Childless men presented with a worse metabolic profile than fathers at the baseline examination, with elevated risk of high triglycerides, odds ratio (OR) 1.24 (95% CI: 1.10-1.42), high fasting glucose OR 1.23 (95%CI: 1.05-1.43) and high blood pressure, OR 1.28 (95%CI: 1.14-1.45), respectively. In the fully adjusted prospective analysis, childless men presented with elevated risk of cardiovascular mortality, HR: 1.33 (95% CI: 1.18-1.49) and all-cause mortality, HR 1.23 (95%CI: 1.14-1.33), respectively. In conclusion, these results add to previous studies showing associations between male reproductive health, morbidity and mortality. Male childlessness, independently of well-known socioeconomic , behavioral and metabolic risk factors, predicts risk of cardiovascular disease and

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“…End-stage renal disease (ESRD) is defined as a glomerular filtration rate (GFR) of <15 mL/min/1.73 m 2 or requiring hemodialysis (HD). The unadjusted ESRD prevalence is 0.21% of the US population, affecting over 700 000 Americans in 2015, with over 40 000 having atrial fibrillation (AF).…”

Section: Introductionmentioning

confidence: 99%

“…There is increasing recognition that AF is a marker of disease in addition to its well-documented role as a prothromboembolic state, as reflected in studies showing higher mortality other than from ischemic stroke. 2 The reasons for the higher mortality in patients with ESRD and AF can be divided into thromboembolic and hemorrhagic. The thromboembolic risk of ESRD is almost double that of patients with AF without ESRD and approaches 7 events per 100 patient-years (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Oral Anticoagulants in Patients With Atrial Fibrillation and End-Stage Renal Disease

Zaman

Bhandari

2019

J Cardiovasc Pharmacol Ther

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The role of oral anticoagulants (OAC) in atrial fibrillation (AF) is well established. However, none of the randomized controlled trials included patients with end-stage renal disease (ESRD) leaving a lack of evidence in this large, challenging and unique patient group. Patients on hemodialysis (HD) with AF have additional risk factors for stroke due to vascular comorbidities, HD treatment, age, and diabetes. Conversely, they are also at increased risk of major bleeding due to uremic platelet impairment. Anticoagulants increase bleeding risk in patients with ESRD and HD up to 10-fold compared with non chronic kidney disease (CKD) patients on warfarin. There are conflicting data and recommendations regarding use of OACs in ESRD which will be reviewed in this article. We conclude by proposing a modified strategy for OAC use in ESRD based on the latest evidence.

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Although non-stroke outcomes are more common, stroke risk scores can be used for prediction in patients with atrial fibrillation

Abstract: Non-stroke cardiovascular outcomes are more common than stroke in all AF subgroups but current stroke risk scores exhibit similar (modest) ability to predict risk for NS-MACE as for stroke, allowing identification of high-risk individuals for intervention.

Cited by 5 publications

References 41 publications

Hypertension prevalence but not control varies across the spectrum of risk in patients with atrial fibrillation: A RE-LY atrial fibrillation registry sub-study

Hypertension prevalence but not control varies across the spectrum of risk in patients with atrial fibrillation: A RE-LY atrial fibrillation registry sub-study

Male childlessness as independent predictor of risk of cardiovascular and all-cause mortality: A population-based cohort study with more than 30 years follow-up

Oral Anticoagulants in Patients With Atrial Fibrillation and End-Stage Renal Disease

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