Heart. 2023;110(2):101-107.
Metabolic syndrome and ischaemic stroke in non-anticoagulated atrial fibrillation with low CHA2DS2-VASc scores.
제1저자 안효정, 이소령 · 교신저자 최의근
소속 (6)
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea choiek417@gmail.com.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
- Department of Medical Statistics, Catholic University of Korea College of Medicine, Seoul, Korea.
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.
Abstract
OBJECTIVE Conflicting results have been reported on whether metabolic syndrome (MetS) confers an increased risk of ischaemic stroke in atrial fibrillation (AF). We investigated the risk of ischaemic stroke according to MetS in patients with AF who are not indicated for oral anticoagulants.
METHODS A total of 76 015 oral anticoagulant-naïve patients with AF with low Congestive Heart Failure, Hypertension, Age ≥75 years (Doubled), Diabetes Mellitus, Stroke (Doubled), Vascular Disease, Age 65-74 years, Sex Category (Female) (CHA2DS2-VASc) score (0 and 1) were included from the National Health Information Database. The risk of ischaemic stroke was evaluated according to MetS, the number of MetS components (metabolic burden), and individual metabolic components defined by health examination data within 2 years of AF diagnosis.
RESULTS MetS was prevalent among 21 570 (28.4%) of the entire study population (mean age 49.8±11.1 years, mean CHA2DS2-VASc score 0.7±0.5). During a mean follow-up of 5.1 years, ischaemic stroke occurred in 1395 (1.84%) patients. MetS was associated with a higher risk of ischaemic stroke (adjusted HR (aHR) 1.19, 95% CI 1.06 to 1.33, p=0.002). Patients with the highest number of MetS components (4 or 5) showed the greatest aHR of 1.38 (95% CI 1.13 to 1.69), whereas those with a single component had a marginal risk of ischaemic stroke (aHR 1.17, 95% CI 0.97 to 1.40). Elevated blood pressure and increased waist circumference were independent components associated with 1.48-fold and 1.15-fold higher risks of ischaemic stroke, respectively.
CONCLUSION Among AF patients with CHA2DS2-VASc scores of 0 and 1 with no anticoagulation, MetS is associated with an increased risk of ischaemic stroke. Given the linear incremental association between metabolic burden and ischaemic stroke, the integrated management of metabolic derangements in AF is required.
© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords
atrial fibrillationmetabolic syndromestroke
Conflict of interest statement
Competing interests: EKC: research grants or speaking fees from Abbott, Bayer, BMS/Pfizer, Biosense Webster, Chong Kun Dang, Daewoong Pharmaceutical Co., Daiichi-Sankyo, DeepQure, Dreamtech Co., Ltd., Jeil Pharmaceutical Co. Ltd, Medtronic, Samjinpharm, Seers Technology and Skylabs. GYHL: International advisory board member of BMJ Heart and consultant and speaker for BMS/Pfizer, Boehringer Ingelheim and Daiichi-Sankyo.
그 밖의 정보
- 출판 형태
- Journal Article, Research Support, Non-U.S. Gov't
- 저널
- Heart (British Cardiac Society) · eISSN 1468-201X
- 전자 출판
- 2023-12-20
- MeSH
- Adult · Aged · Female · Humans · Middle Aged · Anticoagulants / therapeutic use · Atrial Fibrillation* / complications / diagnosis / drug therapy · Brain Ischemia* / diagnosis / epidemiology / etiology · Hypertension* / complications / drug therapy / epidemiology · Ischemic Stroke* / diagnosis / epidemiology / etiology · Metabolic Syndrome* / complications / diagnosis / epidemiology · Risk Assessment · Risk Factors
- Substances
- Anticoagulants