Letter by Sposato et al Regarding Article, “Stroke as the Initial Manifestation of Atrial Fibrillation: The Framingham Heart Study”
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To the Editor:
We read with interest the study by Lubitz et al1 on stroke as the initial manifestation of atrial fibrillation (AF) in the Framingham Heart Study. Stroke occurred as the initial clinical expression of AF among 1.7% of patients on the same day, in 3.4% within 30 days before, in 3.7% within 90 days before, and among 4.8% within the first year before AF detection.
There are 2 possible ways of understanding these results. First, as acknowledged by the authors, stroke occurring at different time points within a year before AF detection could be regarded as the first clinically evident consequence of AF. In contrast, AF could be the consequence of the index stroke among some participants. The inflammatory response and impairment of the autonomic regulation of …