Christiansen Christine Benn, Gerds Thomas A, Olesen Jonas Bjerring, Kristensen Søren Lund, Lamberts Morten, Lip Gregory Y H, Gislason Gunnar H, Køber Lars, Torp-Pedersen Christian
Aalborg University Hospital, Forskningens Hus, Sdr. Skovvej 15, Aalborg 9000, Denmark
Department of Public Health, Section of Biostatistics, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark.
Europace. 2016 Nov;18(11):1689-1697. doi: 10.1093/europace/euv401. Epub 2016 Feb 2.
Although the relation between stroke risk factors and stroke in patients with atrial fibrillation (AF) has been extensively examined, only few studies have explored the association of AF and the risk of ischaemic stroke/systemic thromboembolism/transient ischaemic attack (stroke/TE/TIA) in the presence of concomitant stroke risk factors.
From nationwide registries, all persons who turned 50, 60, 70, or 80 from 1997 to 2011 were identified. Persons receiving warfarin were excluded. The absolute risk of stroke/TE/TIA was reported for a 5-year period, as was the absolute risk ratios for AF vs. no AF according to prior stroke and the number of additional risk factors. The study cohort comprised of 3 076 355 persons without AF and 48 189 with AF. For men aged 50 years, with no risk factors, the 5-year risk of stroke was 1.1% (95% confidence interval 1.1-1.1); with AF alone 2.5% (1.8-3.2); with one risk factor and no prior stroke or AF 2.5% (2.3-2.7); and with one factor, no prior stroke and AF 2.9% (1.4-4.3). In men aged 50 years with prior stroke as the only risk factor, 5-year risk was 10.2% (9.1-11.3). In men aged 70 years, the corresponding risks were 4.8% (4.7-4.9), 6.8% (5.7-7.9), 6.6% (6.3-6.8), 8.7 (7.4-9.9), and 19.1% (18.1-20.1), respectively. In women aged 50 years, the risk was of 0.7% (0.7-0.7), 2.1% (0.9-3.2), 1.6% (1.4-1.8), 4.1% (0.6-7.6), and 7.2% (6.3-8.2), respectively, and in women aged 70 years 3.4% (3.3-3.5), 8.2% (7.0-9.5), 4.6% (4.4-4.8), 9.1% (7.5-10.6), and 15.4% (14.5-16.4), respectively.
Stroke/TE/TIA risk was particularly increased when prior stroke/TE/TIA was present. Atrial fibrillation is associated with an increase in risk of stroke/TE/TIA in the absence of other risk factors but only a moderate increase in risk when other risk factors are present.
尽管房颤（AF）患者中风危险因素与中风之间的关系已得到广泛研究，但仅有少数研究探讨了在存在合并中风危险因素的情况下，AF与缺血性中风/全身性血栓栓塞/短暂性脑缺血发作（中风/TE/TIA）风险之间的关联。
从全国性登记处识别出1997年至2011年期间年满50、60、70或80岁的所有人。排除接受华法林治疗的人。报告了5年期间中风/TE/TIA的绝对风险，以及根据既往中风和其他危险因素数量得出的AF与无AF的绝对风险比。研究队列包括3076355名无AF者和48189名有AF者。对于50岁无危险因素的男性，5年中风风险为1.1%（95%置信区间1.1 - 1.1）；仅患有AF时为2.5%（1.8 - 3.2）；有一个危险因素且无既往中风或AF时为2.5%（2.3 - 2.7）；有一个因素、无既往中风且患有AF时为2.9%（1.4 - 4.3）。对于50岁既往中风为唯一危险因素的男性，5年风险为10.2%（9.1 - 11.3）。对于70岁男性，相应风险分别为4.8%（4.7 - 4.9）、6.8%（5.7 - 7.9）、6.6%（6.3 - 6.8）、8.7（7.4 - 9.9）和19.1%（18.1 - 20.1）。对于50岁女性，风险分别为0.7%（0.7 - 0.7）、2.1%（0.9 - 3.2）、1.6%（1.4 - 1.8）、4.1%（0.6 - 7.6）和7.2%（6.3 - 8.2），对于70岁女性分别为3.4%（3.3 - 3.5）、8.2%（7.0 - 9.5）、4.6%（4.4 - 4.8）、9.1%（7.5 - 10.6）和15.4%（14.5 - 16.4）。
当存在既往中风/TE/TIA时，中风/TE/TIA风险尤其增加。在无其他危险因素时，房颤与中风/TE/TIA风险增加相关，但在存在其他危险因素时，风险仅适度增加。
