Temporal relations between atrial fibrillation and ischaemic stroke and their prognostic impact on mortality.

Autor:	Camen S; Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.; DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany., Ojeda FM; Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany., Niiranen T; Finnish Institute for Health and Welfare, Helsinki, Finland.; Department of Medicine, Turku University Hospital and University of Turku, Finland., Gianfagna F; Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.; Mediterranea Cardiocentro, Napoli, Italy., Vishram-Nielsen JK; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Denmark.; Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark., Costanzo S; Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy., Söderberg S; Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Umeå, Sweden., Vartiainen E; Finnish Institute for Health and Welfare, Helsinki, Finland., Donati MB; Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy., Løchen ML; Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway., Pasterkamp G; Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands., Magnussen C; Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.; DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany., Kee F; Centre for Public Health, Queens University Belfast, Belfast, UK., Jousilahti P; Finnish Institute for Health and Welfare, Helsinki, Finland., Hughes M; Centre for Public Health, Queens University Belfast, Belfast, UK., Kontto J; Finnish Institute for Health and Welfare, Helsinki, Finland., Mathiesen EB; Brain and Circulation Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway., Koenig W; German Heart Center Munich, Technical University of Munich, Munich, Germany.; German Centre for Cardiovascular Research (DZHK e.V.), partner site Munich Heart Alliance, Munich, Germany.; Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany., Palosaari T; Finnish Institute for Health and Welfare, Helsinki, Finland., Blankenberg S; Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.; DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany., de Gaetano G; Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy., Jørgensen T; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Denmark.; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.; Faculty of Medicine, Aalborg University, Aalborg, Denmark., Zeller T; Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.; DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany., Kuulasmaa K; Finnish Institute for Health and Welfare, Helsinki, Finland., Linneberg A; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Denmark.; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark., Salomaa V; Finnish Institute for Health and Welfare, Helsinki, Finland., Iacoviello L; Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.; Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy., Schnabel RB; Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.; DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.
Jazyk:	angličtina
Zdroj:	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2020 Apr 01; Vol. 22 (4), pp. 522-529.
DOI:	10.1093/europace/euz312
Abstrakt:	Aims: Limited evidence is available on the temporal relationship between atrial fibrillation (AF) and ischaemic stroke and their impact on mortality in the community. We sought to understand the temporal relationship of AF and ischaemic stroke and to determine the sequence of disease onset in relation to mortality. Methods and Results: Across five prospective community cohorts of the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project we assessed baseline cardiovascular risk factors in 100 132 individuals, median age 46.1 (25th-75th percentile 35.8-57.5) years, 48.4% men. We followed them for incident ischaemic stroke and AF and determined the relation of subsequent disease diagnosis with overall mortality. Over a median follow-up of 16.1 years, N = 4555 individuals were diagnosed solely with AF, N = 2269 had an ischaemic stroke but no AF diagnosed, and N = 898 developed both, ischaemic stroke and AF. Temporal relationships showed a clustering of diagnosis of both diseases within the years around the diagnosis of the other disease. In multivariable-adjusted Cox regression analyses with time-dependent covariates subsequent diagnosis of AF after ischaemic stroke was associated with increased mortality [hazard ratio (HR) 4.05, 95% confidence interval (CI) 2.17-7.54; P < 0.001] which was also apparent when ischaemic stroke followed after the diagnosis of AF (HR 3.08, 95% CI 1.90-5.00; P < 0.001). Conclusion: The temporal relations of ischaemic stroke and AF appear to be bidirectional. Ischaemic stroke may precede detection of AF by years. The subsequent diagnosis of both diseases significantly increases mortality risk. Future research needs to investigate the common underlying systemic disease processes. (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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