Abstract
BackgroundOnly a few population-based cohort studies have investigated the impact of atrial fibrillation (AF) on stroke in Japan.MethodsA total of 10 929 participants (4147 men and 6782 women) were included in this population-based prospective cohort study. Baseline data, including electrocardiograms (ECGs) to ascertain AF status, were obtained from April 1992 through July 1995 in 12 areas in Japan. Cox proportional hazards models were used to analyze the association of AF with stroke.ResultsA total of 54 participants had AF (0.49%). The mean follow-up period was 10.7 years, during which 405 strokes were identified; 12 of these occurred in participants with AF. The crude incidence of stroke in participants with and without AF was 14.9 and 4.5 per 1000 person-years in men, respectively, and 39.3 and 2.7 per 1000 person-years in women. After adjusting for geographical area, sex, age, smoking status, drinking status, obesity, hypertension, dyslipidemia, and diabetes mellitus, the hazard ratios (95% confidence interval) of AF in all participants and in male and female participants were 4.11 (2.28–7.41), 2.12 (0.77–5.84), and 10.6 (5.01–22.4), respectively. The population attributable fraction (PAF) of stroke caused by AF was 2.2%; the PAFs were 1.0% and 3.6% in men and women, respectively.ConclusionsThe present Japanese population-based prospective cohort study showed that AF is a major risk factor for stroke, especially in women.
Highlights
Mean age was significantly higher in participants with atrial fibrillation (AF) than in those without AF, there was no significant difference in mean age with respect to AF status in men or women
Body mass index (BMI) and high-density lipoprotein cholesterol were significantly higher in AF participants than in non-AF participants in men and women, respectively
In non-AF participants, systolic blood pressure, diastolic blood pressure, triglyceride, and blood sugar were significantly higher in men, whereas, BMI, total cholesterol, and high-density lipoprotein cholesterol were significantly higher in women
Summary
Atrial fibrillation (AF) is the most common sustained arrhythmia and is a major risk factor for stroke.[1,2] The prevalence of AF is rising with the increasing age of many populations,[1,2,3,4,5,6,7,8] and it is more frequent in men than in women.[2,5,6,7,8] Studies have shown that the risk of stroke is 2 to 7 times higher in people with AF as compared with those without AF.[3,4,9,10,11] It has been suggested that the risk of stroke due to AF is higher in women than in men.[11,12,13,14,15] AF contributes to a number of medical, social, and economic problems by increasing the burdens on outpatient clinics, the extent of pharmacological treatment, admissions to hospital, and the incidence of disability due to cardiovascular diseases.[13,16]. The estimated number of persons with AF is rising rapidly in Japan.[5] there have only been a few Japanese population-based studies of the effect of AF on stroke.[17,18,19,20] Tanaka et al[17] and Tanizaki et al[19] conducted an epidemiologic study of cerebral infarction as a stroke subtype. In the Shibata study, Nakayama et al[18] classified stroke into 4 subtypes: hemorrhagic stroke, ischemic stroke, subarachnoid hemorrhage (SAH), and undetermined strokes. None of these studies found an effect of AF on hemorrhagic stroke or SAH. To estimate the proportion of strokes due to AF in this population, we calculated population attributable fractions (PAFs) of AF for all strokes and for stroke subtypes
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