Relation of the CHA(2)DS(2)-VASc Score to Risk of Thrombotic and Embolic Stroke in Community-Dwelling Individuals Without Atrial Fibrillation (From The Atherosclerosis Risk in Communities [ARIC] Study)

• Type of Material: Article
• Authors: Ryan J. Koene, University of Minnesota; M. Chadi Alraies, University of Minnesota; Faye L. Norby, University of Minnesota; Elsayed Z. Soliman, Wake Forest University; Ankit Maheshwari, University of Minnesota; Gregory Y. H. Lip, University of Birmingham; Alvaro Alonso, Emory University; Lin Y. Chen, University Minnesota
• Language: English
• Date: 2019-02-01
• Publisher: Elsevier Science Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amjcard.2018.10.037
• Title of Journal or Parent Work: American Journal of Cardiology
• Volume: 123
• Issue: 3
• Start Page: 402
• End Page: 408
• Grant/Funding Information: Dr. Chen receives grant funding from the National Heart, Lung, and Blood Institute as PI of R01HL126637 and R01HL141288.; The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C).; This work was additionally supported by American Heart Association grant 16EIA26410001 (Alonso).
• Keywords: Thromboembolism; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; Predicting stroke; Population; Ischemic stroke; Life Sciences & Biomedicine; Temporal relationship; CHADS(2); Science & Technology; Stratification
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology; Biology, Neuroscience

Abstract

Recent hospital-based cohort studies found the CHA2DS2-VASc score to be associated with ischemic stroke in individuals without atrial fibrillation (AF). Our aim was to determine the distribution of embolic and thrombotic strokes and association with the CHA2DS2-VASc score, among community-dwelling individuals without AF. We included participants from the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 4 (1996 to 1998) and had no previous AF, stroke, or anticoagulant use (n = 10,671). During follow-up through 2008, incident AF cases (n = 760) and participants who started warfarin were censored. Incident AF was ascertained from study electrocardiograms and hospital discharge diagnosis codes, and stroke was physician-adjudicated. After 10 years of follow-up, 280 ischemic strokes were identified, of which 146 were thrombotic and 57 embolic. The hazard ratios (95% confidence intervals [CI]) for thrombotic stroke were 1 (reference), 1.71 (1.13 to 2.59), 2.92 (1.91 to 4.45), 3.22 (1.70 to 6.11), and 1.25 (0.17 to 9.09), with CHA2DS2-VASc scores of 0 to 1, 2, 3, 4, and ≥5, respectively. The hazard ratios (95% CI) for embolic stroke were 1 (ref), 4.91 (2.10 to 11.5), 7.07 (2.93 to 17.0), 14.8 (5.50 to 39.6), and 15.2 (3.16 to 73.3), with CHA2DS2-VASc scores of 0 to 1, 2, 3, 4, and ≥5, respectively. A receiver-operating characteristic model had a C-statistic of 0.65 for ischemic stroke, 0.61 for thrombotic stroke, and 0.71 for embolic stroke. In conclusion, in community-dwelling individuals without AF, the CHA2DS2-VASc score can assess ischemic stroke risk and has good discriminatory capacity for embolic stroke.