Abstract
BackgroundAtrial fibrillation (AF) is an important risk factor for acute ischemic stroke.MethodsA nested case–control study was conducted among patients diagnosed with AF, whose information was acquired from the prospective China Atrial Fibrillation Registry (China-AF), from August 2011 to December 2018.ResultsThis study compared patients with stroke group (n = 145) with a matched control group (n = 577). Demographic data were similar except for body mass index (BMI), diastolic blood pressure (DBP) which were higher, and new oral anticoagulant (NOAC) treatment rate which was lower in the stroke group (all P < 0.05). Baseline median [IQR] levels of including triglyceride (TG) were higher in the stroke group (21.96 [16.74, 21.52], mg/dL) than the control group (19.62 [14.76, 27.36], mg/dL) (P = 0.012), while the total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were similar between the two groups. Elevated TG and HDL-C were positively associated with ischemic stroke (OR 1.01, 95% CI 1.00–1.02, P = 0.032; OR 1.03, 95% CI 1.00–1.05, P = 0.025), after adjustment for BMI, systolic blood pressure, DBP, CHA2DS2-VASc score, HAS-BLED score, NOAC, LDL-C and HDL-C. However, NOAC (OR 0.20, 95% CI 0.05–0.84, P = 0.029) could decrease the likelihood of ischemic stroke in patients with AF. In subgroup analysis, higher TG level remained significantly associated with ischemic stroke for AF patients without a history of smoking (OR 1.26, 95% CI 1.02–1.55, P = 0.028).ConclusionHigher level of TG and HDL-C were positively associated with ischemic stroke in patients with AF.
Highlights
Atrial fibrillation (AF) is an important risk factor for acute ischemic stroke
Apart from the differences in the body mass index (BMI), diastolic blood pressure (DBP), and new oral anticoagulant (NOAC) utilization rate between the two groups, the other demographic baseline data were similar between the two groups
The results suggested that the elevation of TG and high-density lipoprotein cholesterol (HDL-C) increased the possibility of the occurrence of ischemic stroke in patients with AF, indicating that it was an independent risk factor
Summary
Around 16.9 million people suffer a stroke each year and the global burden of stroke is increasing dramatically [1]. China has the biggest stroke burden in the world and about 70% of cases are due to ischemic stroke, when a blood vessel supplying the brain becomes obstructed [2]. Ischemic stroke is a major cause of morbidity and mortality for Chinese adults. Atrial fibrillation (AF) is an important risk factor for an acute ischemic stroke [3]. Strokes related to AF are associated with higher mortality and more severe neurologic disability [4]. Patients with AF are encouraged to consider prevention measures such as oral anticoagulation therapy and modifying their diet and behavior [5]
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