Potential Augmentation of the Risk of Ischemic Cerebrovascular Accident by Chronic Obstructive Pulmonary Disease in Patients with Atrial Fibrillation

Abstract

Atrial fibrillation (AF) is a potent risk factor for ischemic cerebrovascular accident (ICVA). Inflammation is a potential pathogenic factor for atherosclerosis and ICVA. Chronic obstructive pulmonary disease (COPD) is associated with increased inflammatory markers. Subjects who frequently experience COPD and AF together may have higher risk of ICVA. The objective of the study is to compare the prevalence of ICVA in patients with atrial fibrillation and COPD together versus atrial fibrillation alone. Subjects diagnosed with COPD, AF, and ICVA were categorized into 3 groups: COPD, AF, and COPD plus AF. Prevalence of ICVA was compared. Confounding factors affecting ICVA risk were recorded: age, diabetes, hypertension, peripheral vascular disease, dyslipidemia, and congestive cardiac failure. Total charts reviewed were 500: COPD alone 244, AF alone 188, and both together 68. ICVA was documented in 132 (26.4%) subjects. Prevalence of ICVA was 11.8% (COPD alone), 29.8% (AF alone), and 39.7% (AF plus COPD). COPD plus AF group had ICVA 2.05 (95% confidence interval [CI], 1.203-3.94; P = .007) times compared with others. ICVA was also higher in patients with AF only versus COPD only (P < .001). Logistic regression showed AF plus COPD was a stronger predictor of ICVA (P = .001) than AF only (P = .07) or COPD only (P = .8). Odds ratio for ICVA was 2.85 (CI, 1.57-5.16; P = .001) for AF plus COPD versus 1.81 (CI, .94-3.47; P = .71) for AF only and 1.08 (CI, .58-2.10; P = .8) for COPD only. COPD may increase the risk of ischemic stroke in subjects with AF. Presence of COPD may increase the risk of ischemic stroke in subjects with AF.