Stroke, Vol 22, 983-988, Copyright © 1991 by American Heart Association
PA Wolf, RD Abbott and WB Kannel
The impact of nonrheumatic atrial fibrillation, hypertension, coronary
heart disease, and cardiac failure on stroke incidence was examined in
5,070 participants in the Framingham Study after 34 years of follow-up.
Compared with subjects free of these conditions, the age-adjusted incidence
of stroke was more than doubled in the presence of coronary heart disease
(p less than 0.001) and more than trebled in the presence of hypertension
(p less than 0.001). There was a more than fourfold excess of stroke in
subjects with cardiac failure (p less than 0.001) and a near fivefold
excess when atrial fibrillation was present (p less than 0.001). In persons
with coronary heart disease or cardiac failure, atrial fibrillation doubled
the stroke risk in men and trebled the risk in women. With increasing age
the effects of hypertension, coronary heart disease, and cardiac failure on
the risk of stroke became progressively weaker (p less than 0.05).
Advancing age, however, did not reduce the significant impact of atrial
fibrillation. For persons aged 80-89 years, atrial fibrillation was the
sole cardiovascular condition to exert an independent effect on stroke
incidence (p less than 0.001). The attributable risk of stroke for all
cardiovascular contributors decreased with age except for atrial
fibrillation, for which the attributable risk increased significantly (p
less than 0.01), rising from 1.5% for those aged 50-59 years to 23.5% for
those aged 80- 89 years. While these findings highlight the impact of each
cardiovascular condition on the risk of stroke, the data suggest that the
elderly are particularly vulnerable to stroke when atrial fibrillation is
present.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Atrial fibrillation as an independent risk factor for stroke: the Framingham Study
Department of Neurology, Evans Memorial Department of Clinical Research, Boston, Mass.
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