Multiple risk factors and ischaemic stroke in the elderly Asian population with and without atrial fibrillation. An analysis of 425,600 Chinese individuals without prior stroke
Ischaemic stroke risk rises with the increasing cardiovascular risk factors. How atrial fibrillation (AF) incrementally contributes to the risk for ischaemic stroke with increasing age and multiple cardiovascular risk factors is unclear. In an individual patient with AF the mechanism of ischaemic st...
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| Veröffentlicht in: | Thrombosis and haemostasis 2016-01, Vol.115 (1), p.184-192 |
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| creator | Guo, Yutao Wang, Hao Tian, Yingchun Wang, Yutang Lip, Gregory Y H |
| description | Ischaemic stroke risk rises with the increasing cardiovascular risk factors. How atrial fibrillation (AF) incrementally contributes to the risk for ischaemic stroke with increasing age and multiple cardiovascular risk factors is unclear. In an individual patient with AF the mechanism of ischaemic stroke may be related directly to AF itself or to risk factors associated with AF. It was this study's objective to investigate incident ischaemic stroke in relation to age and increasing cardiovascular risk factor(s), and the incremental impact of AF on stroke rates. We studied a 5% random sampling from Chinese medical insurance data covering more than 10 million individuals, for the years 2001 to 2012. The rate of ischaemic stroke was calculated amongst the individuals with no prior history of ischaemic stroke, in relation to age groups (aged |
| doi_str_mv | 10.1160/TH15-07-0577 |
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An analysis of 425,600 Chinese individuals without prior stroke</title><source>MEDLINE</source><source>Thieme Connect Journals</source><creator>Guo, Yutao ; Wang, Hao ; Tian, Yingchun ; Wang, Yutang ; Lip, Gregory Y H</creator><creatorcontrib>Guo, Yutao ; Wang, Hao ; Tian, Yingchun ; Wang, Yutang ; Lip, Gregory Y H</creatorcontrib><description>Ischaemic stroke risk rises with the increasing cardiovascular risk factors. How atrial fibrillation (AF) incrementally contributes to the risk for ischaemic stroke with increasing age and multiple cardiovascular risk factors is unclear. In an individual patient with AF the mechanism of ischaemic stroke may be related directly to AF itself or to risk factors associated with AF. It was this study's objective to investigate incident ischaemic stroke in relation to age and increasing cardiovascular risk factor(s), and the incremental impact of AF on stroke rates. We studied a 5% random sampling from Chinese medical insurance data covering more than 10 million individuals, for the years 2001 to 2012. The rate of ischaemic stroke was calculated amongst the individuals with no prior history of ischaemic stroke, in relation to age groups (aged < 65, 65-74, ≥ 75 years old; n = 348,431, n = 56,952, n = 20,217, respectively), and increasing risk factors using the CHA2DS2-VASc score. Among the randomly sampled 425,600 individuals with total follow-up of 1,864,232 patient-years [63.8% male, mean age 60 years; 880 with AF, vs 424,720 non-AF], there were 13,242 (3.1%) ischaemic strokes after 64,834 person-years follow-up. Overall, ischaemic stroke incidence (per 100 person-years) was 0.35 (95%CI 0.34-0.35) in the non-AF population and 1.11 (0.84-1.45) with AF. The AF population age < 65 and 65-74 had higher CHA2DS2-VASc scores than the non-AF population (p< 0.001), but this was non-significant between the non-AF and AF population age ≥ 75 (p=0.086). For the population age ≥ 75 years, incident stroke rates were 2.07 (0.86-4.76) and 4.29 (4.08-4.51) in non-AF and AF populations, respectively. The non-AF population age ≥ 65 years with ≥ 2 additional comorbidities (hypertension, vascular disease, diabetic, or heart failure) had ischaemic stroke rates similar to an AF population with CHA2DS2-VASc ≥ 4. In both non-AF and AF populations, those with CHA2DS2-VASc =1 had a 1.9 fold increase in stroke risk, and those with CHA2DS2-VASc ≥ 2 had more than four-fold increased risk for stroke, compared with those with CHA2DS2-VASc=0. In conclusion, an increasing cluster of multiple cardiovascular risk factors (besides AF) contributes to a greater risk for ischaemic stroke, especially in the elderly population. If elderly and with multiple risk factors, non-AF patients may have a risk of incident ischaemic stroke that is comparable or even higher than patients with AF, suggesting that the incremental stroke risk attributable to AF is marginal in such 'high risk' patients.</description><identifier>ISSN: 0340-6245</identifier><identifier>EISSN: 2567-689X</identifier><identifier>DOI: 10.1160/TH15-07-0577</identifier><identifier>PMID: 26322338</identifier><language>eng</language><publisher>Germany</publisher><subject>Adult ; Age Factors ; Aged ; Asian Continental Ancestry Group ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - ethnology ; Brain Ischemia - diagnosis ; Brain Ischemia - ethnology ; Case-Control Studies ; China - epidemiology ; Comorbidity ; Databases, Factual ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Multivariate Analysis ; Proportional Hazards Models ; Risk Assessment ; Risk Factors ; Stroke - diagnosis ; Stroke - ethnology ; Time Factors</subject><ispartof>Thrombosis and haemostasis, 2016-01, Vol.115 (1), p.184-192</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c178t-a5f010e7e8474d4cf82520d0b1c4259300e8331ff2edf34ebc130fafc9d527503</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26322338$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Guo, Yutao</creatorcontrib><creatorcontrib>Wang, Hao</creatorcontrib><creatorcontrib>Tian, Yingchun</creatorcontrib><creatorcontrib>Wang, Yutang</creatorcontrib><creatorcontrib>Lip, Gregory Y H</creatorcontrib><title>Multiple risk factors and ischaemic stroke in the elderly Asian population with and without atrial fibrillation. An analysis of 425,600 Chinese individuals without prior stroke</title><title>Thrombosis and haemostasis</title><addtitle>Thromb Haemost</addtitle><description>Ischaemic stroke risk rises with the increasing cardiovascular risk factors. How atrial fibrillation (AF) incrementally contributes to the risk for ischaemic stroke with increasing age and multiple cardiovascular risk factors is unclear. In an individual patient with AF the mechanism of ischaemic stroke may be related directly to AF itself or to risk factors associated with AF. It was this study's objective to investigate incident ischaemic stroke in relation to age and increasing cardiovascular risk factor(s), and the incremental impact of AF on stroke rates. We studied a 5% random sampling from Chinese medical insurance data covering more than 10 million individuals, for the years 2001 to 2012. The rate of ischaemic stroke was calculated amongst the individuals with no prior history of ischaemic stroke, in relation to age groups (aged < 65, 65-74, ≥ 75 years old; n = 348,431, n = 56,952, n = 20,217, respectively), and increasing risk factors using the CHA2DS2-VASc score. Among the randomly sampled 425,600 individuals with total follow-up of 1,864,232 patient-years [63.8% male, mean age 60 years; 880 with AF, vs 424,720 non-AF], there were 13,242 (3.1%) ischaemic strokes after 64,834 person-years follow-up. Overall, ischaemic stroke incidence (per 100 person-years) was 0.35 (95%CI 0.34-0.35) in the non-AF population and 1.11 (0.84-1.45) with AF. The AF population age < 65 and 65-74 had higher CHA2DS2-VASc scores than the non-AF population (p< 0.001), but this was non-significant between the non-AF and AF population age ≥ 75 (p=0.086). For the population age ≥ 75 years, incident stroke rates were 2.07 (0.86-4.76) and 4.29 (4.08-4.51) in non-AF and AF populations, respectively. The non-AF population age ≥ 65 years with ≥ 2 additional comorbidities (hypertension, vascular disease, diabetic, or heart failure) had ischaemic stroke rates similar to an AF population with CHA2DS2-VASc ≥ 4. In both non-AF and AF populations, those with CHA2DS2-VASc =1 had a 1.9 fold increase in stroke risk, and those with CHA2DS2-VASc ≥ 2 had more than four-fold increased risk for stroke, compared with those with CHA2DS2-VASc=0. In conclusion, an increasing cluster of multiple cardiovascular risk factors (besides AF) contributes to a greater risk for ischaemic stroke, especially in the elderly population. If elderly and with multiple risk factors, non-AF patients may have a risk of incident ischaemic stroke that is comparable or even higher than patients with AF, suggesting that the incremental stroke risk attributable to AF is marginal in such 'high risk' patients.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Asian Continental Ancestry Group</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - ethnology</subject><subject>Brain Ischemia - diagnosis</subject><subject>Brain Ischemia - ethnology</subject><subject>Case-Control Studies</subject><subject>China - epidemiology</subject><subject>Comorbidity</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Proportional Hazards Models</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Stroke - diagnosis</subject><subject>Stroke - ethnology</subject><subject>Time Factors</subject><issn>0340-6245</issn><issn>2567-689X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kMtu2zAQRYmgQew8dl0X8wFROiRFUV4aRvMAUnSTANkJFB8wY1oSSKqF_6qfGClOspoB5sy9F5eQ7xRvKK3w59M9FQXKAoWUJ2TJRCWLql69fCNL5CUWFSvFgpyn9IpIq3IlzsiCVZwxzusl-f97DNkPwUL0aQdO6dzHBKoz4JPeKrv3GlKO_c6C7yBvLdhgbAwHWCevOhj6YQwq-76Dfz5v3z_npR8zqBy9CuB8G304Qjew7iZGhUPyCXoHJRPXFSJstr6zaTYx_q83owrpS2eIvo8fKS7JqZtu9upjXpDn219Pm_vi8c_dw2b9WGgq61wo4ZCilbYuZWlK7WomGBpsqZ4cVxzR1pxT55g1jpe21ZSjU06vjGBSIL8g10ddHfuUonXNlGKv4qGh2MzFN3PxDcpmLn7CfxzxYWz31nzBn03zN5ZNgYI</recordid><startdate>201601</startdate><enddate>201601</enddate><creator>Guo, Yutao</creator><creator>Wang, Hao</creator><creator>Tian, Yingchun</creator><creator>Wang, Yutang</creator><creator>Lip, Gregory Y H</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>201601</creationdate><title>Multiple risk factors and ischaemic stroke in the elderly Asian population with and without atrial fibrillation. An analysis of 425,600 Chinese individuals without prior stroke</title><author>Guo, Yutao ; Wang, Hao ; Tian, Yingchun ; Wang, Yutang ; Lip, Gregory Y H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c178t-a5f010e7e8474d4cf82520d0b1c4259300e8331ff2edf34ebc130fafc9d527503</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Asian Continental Ancestry Group</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - ethnology</topic><topic>Brain Ischemia - diagnosis</topic><topic>Brain Ischemia - ethnology</topic><topic>Case-Control Studies</topic><topic>China - epidemiology</topic><topic>Comorbidity</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Proportional Hazards Models</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Stroke - diagnosis</topic><topic>Stroke - ethnology</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Guo, Yutao</creatorcontrib><creatorcontrib>Wang, Hao</creatorcontrib><creatorcontrib>Tian, Yingchun</creatorcontrib><creatorcontrib>Wang, Yutang</creatorcontrib><creatorcontrib>Lip, Gregory Y H</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Thrombosis and haemostasis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Guo, Yutao</au><au>Wang, Hao</au><au>Tian, Yingchun</au><au>Wang, Yutang</au><au>Lip, Gregory Y H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multiple risk factors and ischaemic stroke in the elderly Asian population with and without atrial fibrillation. An analysis of 425,600 Chinese individuals without prior stroke</atitle><jtitle>Thrombosis and haemostasis</jtitle><addtitle>Thromb Haemost</addtitle><date>2016-01</date><risdate>2016</risdate><volume>115</volume><issue>1</issue><spage>184</spage><epage>192</epage><pages>184-192</pages><issn>0340-6245</issn><eissn>2567-689X</eissn><abstract>Ischaemic stroke risk rises with the increasing cardiovascular risk factors. How atrial fibrillation (AF) incrementally contributes to the risk for ischaemic stroke with increasing age and multiple cardiovascular risk factors is unclear. In an individual patient with AF the mechanism of ischaemic stroke may be related directly to AF itself or to risk factors associated with AF. It was this study's objective to investigate incident ischaemic stroke in relation to age and increasing cardiovascular risk factor(s), and the incremental impact of AF on stroke rates. We studied a 5% random sampling from Chinese medical insurance data covering more than 10 million individuals, for the years 2001 to 2012. The rate of ischaemic stroke was calculated amongst the individuals with no prior history of ischaemic stroke, in relation to age groups (aged < 65, 65-74, ≥ 75 years old; n = 348,431, n = 56,952, n = 20,217, respectively), and increasing risk factors using the CHA2DS2-VASc score. Among the randomly sampled 425,600 individuals with total follow-up of 1,864,232 patient-years [63.8% male, mean age 60 years; 880 with AF, vs 424,720 non-AF], there were 13,242 (3.1%) ischaemic strokes after 64,834 person-years follow-up. Overall, ischaemic stroke incidence (per 100 person-years) was 0.35 (95%CI 0.34-0.35) in the non-AF population and 1.11 (0.84-1.45) with AF. The AF population age < 65 and 65-74 had higher CHA2DS2-VASc scores than the non-AF population (p< 0.001), but this was non-significant between the non-AF and AF population age ≥ 75 (p=0.086). For the population age ≥ 75 years, incident stroke rates were 2.07 (0.86-4.76) and 4.29 (4.08-4.51) in non-AF and AF populations, respectively. The non-AF population age ≥ 65 years with ≥ 2 additional comorbidities (hypertension, vascular disease, diabetic, or heart failure) had ischaemic stroke rates similar to an AF population with CHA2DS2-VASc ≥ 4. In both non-AF and AF populations, those with CHA2DS2-VASc =1 had a 1.9 fold increase in stroke risk, and those with CHA2DS2-VASc ≥ 2 had more than four-fold increased risk for stroke, compared with those with CHA2DS2-VASc=0. In conclusion, an increasing cluster of multiple cardiovascular risk factors (besides AF) contributes to a greater risk for ischaemic stroke, especially in the elderly population. If elderly and with multiple risk factors, non-AF patients may have a risk of incident ischaemic stroke that is comparable or even higher than patients with AF, suggesting that the incremental stroke risk attributable to AF is marginal in such 'high risk' patients.</abstract><cop>Germany</cop><pmid>26322338</pmid><doi>10.1160/TH15-07-0577</doi><tpages>9</tpages></addata></record> |
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| source | MEDLINE; Thieme Connect Journals |
| subjects | Adult Age Factors Aged Asian Continental Ancestry Group Atrial Fibrillation - diagnosis Atrial Fibrillation - ethnology Brain Ischemia - diagnosis Brain Ischemia - ethnology Case-Control Studies China - epidemiology Comorbidity Databases, Factual Female Humans Incidence Male Middle Aged Multivariate Analysis Proportional Hazards Models Risk Assessment Risk Factors Stroke - diagnosis Stroke - ethnology Time Factors |
| title | Multiple risk factors and ischaemic stroke in the elderly Asian population with and without atrial fibrillation. An analysis of 425,600 Chinese individuals without prior stroke |
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