ReviewRecent Developments in Understanding Epidemiology and Risk Determinants of Atrial Fibrillation as a Cause of Stroke
Section snippets
Established risk factors for AF
There are numerous well-established and validated risk factors for the development of AF,17 as summarized in Figure 1.
These risk factors are well known and accepted, and it is likely that there is a cumulative effect in that an individual with multiple risk factors is more likely to develop AF than an individual with a single risk factor.18 For patients with concomitant cardiac diseases that increase their risk of AF, effective prevention and control of these disorders might protect patients
Stroke Risk Factors in AF
The risk of stroke in AF is not homogeneous and is dependent on the presence or absence of specific stroke risk factors.78, 79 There has been a concerted effort to identify novel risk factors for stroke and determine the extent to which they confer an additional risk for stroke in patients with AF. Historical landmark trials identified a collection of now accepted stroke risk factors and have been included in various schemata for determining stroke risk.
A recent systematic review of predictors
Stroke Risk Stratification Schemes
Traditional risk factor schemes for stroke in AF classified patients broadly into high-, intermediate-, and low-risk categories, in which patients deemed to be at high risk were recommended for treatment with OAC, and the intermediate risk group could be offered OAC or antiplatelet therapy at the discretion of the clinician, with low-risk patients treated with aspirin or no antithrombotic therapy. The best example of such a scheme is the CHADS2 score,16 which was adopted into international
Conclusions
AF is associated with a significant clinical and public health burden, and the management of this increasingly common arrhythmia is a key challenge facing modern cardiovascular medicine. Epidemiological data have identified many established risk factors for AF, but evidence suggests that a substantial proportion of incident AF cases might not be explained by these traditional factors. Renewed focus on this area has highlighted several emerging clinical and biochemical risk factors. These risk
Key Messages
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The prevalence of AF is increasing, primarily because of the aging population.
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Traditional AF risk factors explain only a portion of the AF risk.
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Novel risk factors for the development of AF are emerging and might yield potential new therapeutic options.
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Stroke risk in AF is heterogeneous and dependent on the presence of specific stroke risk factors.
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Newer stroke risk factors (such as female sex and vascular disease) have been identified and are now incorporated into a risk stratification scheme.
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Funding Sources
Publication of this article is supported by Bayer Canada and by Pfizer and Bristol-Myers Squibb.
Disclosures
G.Y.H.L. has served as a consultant for Bayer, Astellas, Merck, AstraZeneca, Sanofi, Bristol-Myers Squibb/Pfizer, Daiichi-Sankyo, Biotronik, Portola, and Boehringer Ingelheim, and has been on the speakers bureau for Bayer, Bristol-Myers Squibb/Pfizer, Boehringer Ingelheim, and Sanofi Aventis. D.A.L. is in receipt of an investigator-initiated educational grants from Bayer Healthcare and Boehringer Ingelheim and has been on the speakers bureau for Boehringer Ingelheim, Bristol-Myers
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