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Risk of Nonstroke Events Underappreciated in Atrial Fibrillation 

 A meta-analysis finds that patients with atrial fibrillation (AF) are at higher risk for a range of cardiovascular and renal events—with the risk for heart failure far outstripping that for the long-recognized complication of stroke.

After examining 104 cohort studies involving 9.68 million participants, UK researchers found that AF was associated with a 64% higher risk of chronic kidney disease, 88% higher risk of sudden cardiac death, and 96% higher risk of a major CV event.

Among patients with AF vs those without, the risk was fivefold higher for congestive heart failure compared with a 2.3-fold risk for stroke, according to data published online September 6, 2016 in the BMJ.

Principal investigator DrAyodeleOdutayo (University of Oxford, UK) told heartwire from Medscape that the study is unable to prove causality based on the data, "but when you see associations across a range of diseases it suggests atrial fibrillation is acting as a marker for shared underlying risk factors for cardiovascular disease."

He noted, for instance, that hypertension is diagnosed in up to 90% of patients with AF but also contributes to chronic kidney disease, the development of heart failure, and MI.

Odutayo also pointed out that non–vitamin K antagonist oral anticoagulants (NOACs) have been the focus of clinical care in AF and have shown to be equivalent to warfarin with respect to stroke outcomes, "but they don"t provide any added benefit for nonstroke outcomes. So again, it raises the question of whether atrial fibrillation is causing these cardiovascular outcomes or whether it"s just an association."

The analysis included 587,867 participants with AF. The associations between AF and nonstroke outcomes were broadly consistent across subgroups and in sensitivity analyses.

AtrialFibrillationandNonstrokeOutcomes

Outcome

Relativerisk

95% CI

Heartfailure

4.99 3.04–8.22

Stroke

 2.42  2.17–2.71

CV mortality

 2.03  1.79–2.30

Major CV events

 1.96  1.53–2.51

Suddencardiacdeath

 1.88  1.36–2.60

Chronickidneydisease

 1.64  1.41–1.91

Ischemicheartdisease

 1.61  1.38–1.87

All-causemortality

 1.46  1.39–1.53

Peripheralarterialdisease

 1.31  1.19–1.45

 

http://www.medscape.com/viewarticle/868625