Risk factors and incidence of ischemic stroke in Taiwanese with nonvalvular atrial fibrillation-A nation wide database analysis

Lian Yu Lin, Chang Hsing Lee, Chih Chieh Yu, Chia Ti Tsai, Ling Pin Lai, Juey Jen Hwang, Pau Chung Chen, Jiunn Lee Lin

Research output: Contribution to journalArticle

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Abstract

Background:: Atrial fibrillation (AF) is a risk factor for ischemic stroke. Stroke-prevention strategies based on risk schemes have been developed but most of the data are from western people. Our goal is to investigate the risk factors of ischemic stroke in Taiwanese with AF in a nation-wide database. Methods:: A universal national health insurance (NHI) program has been implemented in Taiwan since 1995. We used system sampling database from 1997 to 2008 with a total of 1,000,000 subjects. By using ambulatory and inpatient claim data, we included subjects with AF and were above 20 years old. We excluded those who had ever taken warfarin or aspirin or had valvular heart diseases. Result:: A total of 7920 patients (3633 women, 4287 men) were included in the final analyses. Cox regression analysis showed that the risk factors for ischemic stroke were age (OR=1.338 for age 65-74 years vs. age 20-64 years, P=0.014; OR=1.652 for age over 75 years vs. age 20-64years, P<0.001), hypertension (HTN) (OR=2.656, P<0.001), diabetes mellitus (DM) (OR=1.341, P=0.005), heart failure (OR=1.611, P<0.001), previous ischemic stroke or transient ischemic accident (TIA) (OR=2.752, P<0.001) and peripheral arterial disease (PAD) (OR=1.814, P=0.006). The gender, coronary artery disease, history of myocardial infarction and chronic renal insufficiency were not associated with ischemic stroke. The rate of ischemic stroke was much lower in current cohort as compared with that in whites. Frequent used risk schemes including CHADS 2 and CHA 2DS 2-VASC had comparable but only limited ability to predict ischemic stroke in subjects with AF. Conclusion:: Compare with western people, hypertension plays a more important role in ischemic stroke in Taiwanese with AF and the incidence is lower. A substantial number of ischemic strokes cannot be accurately predicted by current risk schemes.

Original languageEnglish
Pages (from-to)292-295
Number of pages4
JournalAtherosclerosis
Volume217
Issue number1
DOIs
Publication statusPublished - Jul 1 2011
Externally publishedYes

Fingerprint

Atrial Fibrillation
Stroke
Databases
Incidence
National Health Programs
Hypertension
Heart Valve Diseases
Peripheral Arterial Disease
Warfarin
Taiwan
Chronic Renal Insufficiency
Aspirin
Accidents
Inpatients
Coronary Artery Disease
Diabetes Mellitus
Heart Failure
Myocardial Infarction
Regression Analysis

Keywords

  • Atrial fibrillation
  • Hypertension
  • Ischemic stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Risk factors and incidence of ischemic stroke in Taiwanese with nonvalvular atrial fibrillation-A nation wide database analysis. / Lin, Lian Yu; Lee, Chang Hsing; Yu, Chih Chieh; Tsai, Chia Ti; Lai, Ling Pin; Hwang, Juey Jen; Chen, Pau Chung; Lin, Jiunn Lee.

In: Atherosclerosis, Vol. 217, No. 1, 01.07.2011, p. 292-295.

Research output: Contribution to journalArticle

Lin, Lian Yu ; Lee, Chang Hsing ; Yu, Chih Chieh ; Tsai, Chia Ti ; Lai, Ling Pin ; Hwang, Juey Jen ; Chen, Pau Chung ; Lin, Jiunn Lee. / Risk factors and incidence of ischemic stroke in Taiwanese with nonvalvular atrial fibrillation-A nation wide database analysis. In: Atherosclerosis. 2011 ; Vol. 217, No. 1. pp. 292-295.
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abstract = "Background:: Atrial fibrillation (AF) is a risk factor for ischemic stroke. Stroke-prevention strategies based on risk schemes have been developed but most of the data are from western people. Our goal is to investigate the risk factors of ischemic stroke in Taiwanese with AF in a nation-wide database. Methods:: A universal national health insurance (NHI) program has been implemented in Taiwan since 1995. We used system sampling database from 1997 to 2008 with a total of 1,000,000 subjects. By using ambulatory and inpatient claim data, we included subjects with AF and were above 20 years old. We excluded those who had ever taken warfarin or aspirin or had valvular heart diseases. Result:: A total of 7920 patients (3633 women, 4287 men) were included in the final analyses. Cox regression analysis showed that the risk factors for ischemic stroke were age (OR=1.338 for age 65-74 years vs. age 20-64 years, P=0.014; OR=1.652 for age over 75 years vs. age 20-64years, P<0.001), hypertension (HTN) (OR=2.656, P<0.001), diabetes mellitus (DM) (OR=1.341, P=0.005), heart failure (OR=1.611, P<0.001), previous ischemic stroke or transient ischemic accident (TIA) (OR=2.752, P<0.001) and peripheral arterial disease (PAD) (OR=1.814, P=0.006). The gender, coronary artery disease, history of myocardial infarction and chronic renal insufficiency were not associated with ischemic stroke. The rate of ischemic stroke was much lower in current cohort as compared with that in whites. Frequent used risk schemes including CHADS 2 and CHA 2DS 2-VASC had comparable but only limited ability to predict ischemic stroke in subjects with AF. Conclusion:: Compare with western people, hypertension plays a more important role in ischemic stroke in Taiwanese with AF and the incidence is lower. A substantial number of ischemic strokes cannot be accurately predicted by current risk schemes.",
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AU - Lin, Lian Yu

AU - Lee, Chang Hsing

AU - Yu, Chih Chieh

AU - Tsai, Chia Ti

AU - Lai, Ling Pin

AU - Hwang, Juey Jen

AU - Chen, Pau Chung

AU - Lin, Jiunn Lee

PY - 2011/7/1

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N2 - Background:: Atrial fibrillation (AF) is a risk factor for ischemic stroke. Stroke-prevention strategies based on risk schemes have been developed but most of the data are from western people. Our goal is to investigate the risk factors of ischemic stroke in Taiwanese with AF in a nation-wide database. Methods:: A universal national health insurance (NHI) program has been implemented in Taiwan since 1995. We used system sampling database from 1997 to 2008 with a total of 1,000,000 subjects. By using ambulatory and inpatient claim data, we included subjects with AF and were above 20 years old. We excluded those who had ever taken warfarin or aspirin or had valvular heart diseases. Result:: A total of 7920 patients (3633 women, 4287 men) were included in the final analyses. Cox regression analysis showed that the risk factors for ischemic stroke were age (OR=1.338 for age 65-74 years vs. age 20-64 years, P=0.014; OR=1.652 for age over 75 years vs. age 20-64years, P<0.001), hypertension (HTN) (OR=2.656, P<0.001), diabetes mellitus (DM) (OR=1.341, P=0.005), heart failure (OR=1.611, P<0.001), previous ischemic stroke or transient ischemic accident (TIA) (OR=2.752, P<0.001) and peripheral arterial disease (PAD) (OR=1.814, P=0.006). The gender, coronary artery disease, history of myocardial infarction and chronic renal insufficiency were not associated with ischemic stroke. The rate of ischemic stroke was much lower in current cohort as compared with that in whites. Frequent used risk schemes including CHADS 2 and CHA 2DS 2-VASC had comparable but only limited ability to predict ischemic stroke in subjects with AF. Conclusion:: Compare with western people, hypertension plays a more important role in ischemic stroke in Taiwanese with AF and the incidence is lower. A substantial number of ischemic strokes cannot be accurately predicted by current risk schemes.

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KW - Hypertension

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KW - Atrial fibrillation

KW - Hypertension

KW - Ischemic stroke

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