The co‐predictive value of a cardiovascular score for CV outcomes in diabetic patients with no atrial fibrillation

et al. 2019

Eur J Prev Cardiolog

Self Cite

Aims The CHA2DS2VASc score is used to evaluate the risk of thromboembolic events in patients with non-valvular atrial fibrillation. We assessed the prognostic yield of CHA2DS2VASc for new-onset atrial fibrillation, cardiovascular morbidity and mortality in a non-atrial fibrillation population. Methods We analysed a population-based cohort of 22,179 middle-aged individuals with ( n = 3542) and without ( n = 18,367) a history of atrial fibrillation; we grouped the population into five CHA2DS2VASc strata (0–1–2–3–≥4), and compared the risk of major adverse cerebro-cardiovascular events and mortality. Furthermore, we analysed the annual incidence of atrial fibrillation across different CHA2DS2VASc strata. Results Over a median follow-up of 15 years, 1572 patients (6.9%) had ischaemic strokes, 2162 (9.5%) coronary events and 5899 (26%) died. The cumulative incidence of ischaemic stroke in CHA2DS2VASc ≥ 4 subjects without atrial fibrillation was similar to patients with atrial fibrillation and CHA2DS2VASc 2, with a 10-year crude incidence rate of 0.91 (95% confidence interval (CI) 0.68–1.19) and 1.13 (95% CI 0.93–1.36) ischaemic strokes per 100 patient-years, respectively. CHA2DS2VASc in a non-atrial fibrillation population showed higher predictive accuracy for ischaemic stroke compared with an atrial fibrillation population (area under the curve 0.60 vs. 0.56; P = 0.001). In multivariable Cox regression analysis, CHA2DS2VASc ≥ 2 was an independent predictor of all-cause death (adjusted hazard ratio (aHR) 2.58; 95% CI 2.42–2.76), cardiovascular death (aHR 3.40; 95% CI 2.98–3.89), ischaemic stroke (aHR 2.20; 95% CI 1.92–2.53) and coronary events (aHR 1.83; 95% CI 1.63–2.04). The cumulative incidence of atrial fibrillation was greater with increasing CHA2DS2VASc strata, with an absolute annual incidence of more than 2% per year if CHA2DS2VASc ≥ 4. Conclusion The CHA2DS2VASc score is a sensitive tool for predicting new-onset atrial fibrillation and adverse outcomes in subjects both with and without atrial fibrillation.

“…11 Moreover, we recently found that the CHA 2 DS 2 VASc score was an independent predictor of ischaemic stroke, coronary events and overall mortality in diabetes patients without AF. 24…”

Section: Discussionmentioning

confidence: 99%

CHA₂DS₂VASc score and adverse outcomes in middle-aged individuals without atrial fibrillation

Renda

Ricci

et al. 2019

Eur J Prev Cardiolog

Self Cite

“…Strengths are as follows: the robustness of the data obtained from a large, real-life, adult general population, where severely ill individuals were comprised; the long follow-up duration, with large number of person-years; the reliability of prospectively collected data, with limited loss to follow-up; the stability of the health care and reporting system over time, where adverse events during follow-up were carefully counted through medical history and hospitalization records. 31,32 Limitations are the risk of inclusion bias and residual confounding, and the lack of adjustment for all potential confounders. Approximately 70% of all stroke cases were validated by review of hospital records, but no individual event adjudication was performed for MI.…”

Section: Discussionmentioning

confidence: 99%

Clustering of blood cell count abnormalities and future risk of death

Eur J Clin Investigation

Lio

et al. 2021

Self Cite

“…Strengths are: the robustness of the data related to a large, real-life, adult general population, in which severely ill subjects were not excluded; the long follow-up duration, with consequent high number of person-years; the reliability of the prospective data collection protocol, with limited loss to follow-up; and the consistency over time of the health care system for the included endpoints, where cardiovascular events cases were identified and registered according to careful medical history and hospitalization records. 50 Limitations are represented by a possible inclusion bias, the lack of events adjudication, the lack of adjustments for all potential confounders, and the risk of residual confounding. Moreover, in many cases we had no specific information on concomitant conditions or undiagnosed diseases potentially causing variations in platelet count at baseline.…”

Section: Discussionmentioning

confidence: 99%

Platelet Indices and Risk of Death and Cardiovascular Events: Results from a Large Population-Based Cohort Study

Ricci

et al. 2019

Thromb Haemost

Self Cite

Studies evaluating the relationship between platelet indices and cardiovascular (CV) outcomes yielded conflicting results. We assessed the incidence of adverse events according to baseline quintiles of platelet indices in the prospective cohort of the Malmö Diet and Cancer Study. A total of 30,314 individuals (age 57 ± 8 years) were followed for a median of 16 years (468,490 person-years). Outcome measures included all-cause death, CV death, myocardial infarction (MI), and ischemic stroke. The fifth quintile of platelet count (> 274.6 × 109/L) was associated with higher incidence of all-cause death (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.09–1.32, p < 0.001), CV death (HR 1.19, 95% CI 1.00–1.42; p = 0.044), MI (HR 1.32, 95% CI 1.12–1.54; p = 0.001), and ischemic stroke (HR 1.27, 95% CI 1.08–1.50, p = 0.004) compared with the first quintile (≤ 185 × 109/L), and also associated with a lower survival, regardless of previous history of MI (p for interaction = 0.58) or stroke (p for interaction = 0.42). In the highest quintile, history of stroke had a higher risk of CV death (HR 3.18, 95% CI 1.54–6.54) compared with no previous stroke (HR 1.12, 95% CI 0.96–1.31). The risk of MI and stroke was greatest in the fifth quintile, regardless of previous MI or previous stroke, respectively. The risk of all adverse events was similar across different quintiles of mean platelet volume. In conclusion, elevated platelet count is associated with higher mortality and risk of CV events, regardless of previous MI and stroke. Platelet count may thus be a useful marker for further stratification of CV risk, and especially of death.