Individual and Combined Risk Factors for Incident Atrial Fibrillation and Incident Stroke: An Analysis of 3 Million At-Risk US Patients.

Chyou JY, Hunter TD, Mollenkopf SA, Turakhia MP, Reynolds MR. Individual and Combined Risk Factors for Incident Atrial Fibrillation and Incident Stroke: An Analysis of 3 Million At-Risk US Patients. Journal of the American Heart Association. 2015 Jul 23; 4(7).

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Abstract:

BACKGROUND: The incremental effects of risk factor combinations for atrial fibrillation (AF) and stroke are incompletely understood. We sought to quantify the risks of incident AF and stroke for combinations of established risk factors in a large US sample. METHODS AND RESULTS: Patients with no evidence of AF or stroke in 2007 were stratified by combinations of the following risk factors: heart failure, hypertension, diabetes, age 65 to 74, age 75, coronary artery disease, and chronic kidney disease. Patients with 2 of the first 5 or 3 of the first 7, classified as "high-risk," and an age-matched sample of patients with fewer risk factors, classified as "low-risk," were followed over 2008-2010 for incident AF and stroke. Annualized incidence rates and risks were quantified for each combination of factors by using Cox regression. Annualized incidence rates for AF, stroke, and both were 3.59%, 3.27%, and 0.62% in 1 851 653 high-risk patients and 1.32%, 1.48%, and 0.18% in 1 156 221 low-risk patients, respectively. Among patients with 1 risk factor, those with age 75 had the highest hazards of incident AF and stroke (HR 9.2, 6.9). Among patients with 2 risk factors, those with age 75 and heart failure had the highest annualized incidence rates of AF and stroke (10.2%, 5.9%). The combination of age 75 and hypertension was prevalent and had the highest incidences of AF and stroke. CONCLUSIONS: Adults with combinations of known risk factors are at increased risk of incident AF and stroke, but combinations of risk factors are not always additive.