Abstract
ObjectiveTo determine the impact of smoking status in the prediction of stroke using CHADS2 and CHA2DS2-VASc schemes.MethodsFive hundred twenty-eight consecutive patients with arrhythmic symptoms and without any documented arrhythmia from Queen Mary Hospital, Hong Kong, were followed up to determine the incidence of ischemic stroke, new-onset atrial fibrillation (AF), or all-cause mortality. Smoking status was classified into nonsmokers and smokers. The pairwise comparisons of C-statistics for outcomes were performed.ResultsDuring a median follow-up period of 6.2 years, 65 (12.3%) individuals developed ischemic stroke. Smokers experienced higher annual incidence of stroke, a new-onset AF, and all-cause death compare to nonsmokers, with corresponding hazard ratio (HR) of stroke, AF, and all-cause death being 2.51 (95% confidence intervals, CI 1.36als, CIse death bein 1.15a3.24), and 1.95 (95% CI 1.161.95 (95% CIath being 2.51 (95% confidence corr2 and CHA2DS2-VASc for stroke were 0.60 (95% CI 0.51 for stp = 0.09) and 0.59 (95% CI 0.50 (95%, p = 0.15) respectively, whereas the C-statistics of CHADS2 and CHA2DS2-VASc were 0.66 (95% CI 0.61 were 0p = 0.005), 0.75 (95% CI 0.7 CI 0.7p < 0.0001), respectively among nonsmokers. After incorporating smoking, both the CHADS2-smoking and CHA2DS2-VASc-smoking achieved better C-statistics for new-onset ischemic stroke prediction superior to baseline score systems in male groups.ConclusionCigarette smoking status has impact on stroke stratification using CHADS2 and CHA2DS2-VASc scheme. The discrimination of the CHADS2 and CHA2DS2-VASc scheme for stroke can be significantly improved if smoking status is additionally considered.
Highlights
Stroke that often shows up unnoticed in our life remains a major healthcare problem
Current stroke risk stratification schemas such as CHADS2, CHA2DS2-VASc, and NICE are validated stratification tools to estimate the risk factor of stroke occurrence used as guideline for oral anticoagulation therapy among non-valvular atrial fibrillation (NVAF) patients [2, 3], though Trousseau score recently appeared for differentiating cancerassociated stroke in patients with cancer [4]
Compared to the CHADS2 score, the CHA2DS2-VASc score includes three additional risk factors: female, age 64–75, and vascular disease for ischemic stroke, whereas cigarette smoking status is not considered during risk assessment in all those validation cohorts mentioned above
Summary
Howard et al forecasted that the number of stroke events will dramatically increase (more than double) from 2010 to 2050, and the increased burden of care of stroke patients on an already stressed healthcare system could be overwhelming [1]. Will this burden fall on physicians and hospitals, rather enhance the demand for rehabilitation services and increased nursing home. Compared to the CHADS2 score, the CHA2DS2-VASc score includes three additional risk factors: female, age 64–75, and vascular disease for ischemic stroke, whereas cigarette smoking status is not considered during risk assessment in all those validation cohorts mentioned above. Smoking status relates to atherosclerosis, vascular damage (e.g., endothelial dysfunction), AF incidence (e.g., increased atrial fibrosis), and the incidence of mild cognitive impairment as well [7, 8]
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