Influenza vaccination might reduce the risk of ischemic stroke in patients with atrial fibrillation: A population-based cohort study

Objective Several studies have shown an increased risk for cardiovascular disease (CVD) in hyperthyroidism, but most studies have been too small to address the effect of hyperthyroidism on individual cardiovascular endpoints. Our main aim was to assess the association among hyperthyroidism, acute cardiovascular events and mortality. Design It is a nationwide population-based cohort study. Data were obtained from the Danish Civil Registration System and the Danish National Patient Registry, which covers all Danish hospitals. We compared the rate of all-cause mortality as well as venous thromboembolism (VTE), acute myocardial infarction (AMI), ischemic and non-ischemic stroke, arterial embolism, atrial fibrillation (AF) and percutaneous coronary intervention (PCI) in the two cohorts. Hazard ratios (HR) with 95% confidence intervals (95% CI) were estimated. Results The study included 85 856 hyperthyroid patients and 847 057 matched population-based controls. Mean follow-up time was 9.2 years. The HR for mortality was highest in the first 3 months after diagnosis of hyperthyroidism: 4.62, 95% CI: 4.40–4.85, and remained elevated during long-term follow-up (>3 years) (HR: 1.35, 95% CI: 1.33–1.37). The risk for all examined cardiovascular events was increased, with the highest risk in the first 3 months after hyperthyroidism diagnosis. The 3-month post-diagnosis risk was highest for atrial fibrillation (HR: 7.32, 95% CI: 6.58–8.14) and arterial embolism (HR: 6.08, 95% CI: 4.30–8.61), but the risks of VTE, AMI, ischemic and non-ischemic stroke and PCI were increased also 2- to 3-fold. Conclusions We found an increased risk for all-cause mortality and acute cardiovascular events in patients with hyperthyroidism.

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Association between exercise habits and stroke, heart failure, and mortality in Korean patients with incident atrial fibrillation: A nationwide population-based cohort study

PLoS Medicine ◽

10.1371/journal.pmed.1003659 ◽

2021 ◽

Vol 18 (6) ◽

pp. e1003659

Author(s):

Hyo-Jeong Ahn ◽

So-Ryoung Lee ◽

Eue-Keun Choi ◽

Kyung-Do Han ◽

Jin-Hyung Jung ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Cohort Study ◽

Ischemic Stroke ◽

Lower Risk ◽

Population Based ◽

Health Examination ◽

Regular Exercise ◽

Exercise Habits ◽

Before And After

Background There is a paucity of information about cardiovascular outcomes related to exercise habit change after a new diagnosis of atrial fibrillation (AF). We investigated the association between exercise habits after a new AF diagnosis and ischemic stroke, heart failure (HF), and all-cause death. Methods and findings This is a nationwide population-based cohort study using data from the Korea National Health Insurance Service. A retrospective analysis was performed for 66,692 patients with newly diagnosed AF between 2010 and 2016 who underwent 2 serial health examinations within 2 years before and after their AF diagnosis. Individuals were divided into 4 categories according to performance of regular exercise, which was investigated by a self-reported questionnaire in each health examination, before and after their AF diagnosis: persistent non-exercisers (30.5%), new exercisers (17.8%), exercise dropouts (17.4%), and exercise maintainers (34.2%). The primary outcomes were incidence of ischemic stroke, HF, and all-cause death. Differences in baseline characteristics among groups were balanced considering demographics, comorbidities, medications, lifestyle behaviors, and income status. The risks of the outcomes were computed by weighted Cox proportional hazards models with inverse probability of treatment weighting (IPTW) during a mean follow-up of 3.4 ± 2.0 years. The new exerciser and exercise maintainer groups were associated with a lower risk of HF compared to the persistent non-exerciser group: the hazard ratios (HRs) (95% CIs) were 0.95 (0.90–0.99) and 0.92 (0.88–0.96), respectively (p < 0.001). Also, performing exercise any time before or after AF diagnosis was associated with a lower risk of mortality compared to persistent non-exercising: the HR (95% CI) was 0.82 (0.73–0.91) for new exercisers, 0.83 (0.74–0.93) for exercise dropouts, and 0.61 (0.55–0.67) for exercise maintainers (p < 0.001). For ischemic stroke, the estimates of HRs were 10%–14% lower in patients of the exercise groups, yet differences were statistically insignificant (p = 0.057). Energy expenditure of 1,000–1,499 MET-min/wk (regular moderate exercise 170–240 min/wk) was consistently associated with a lower risk of each outcome based on a subgroup analysis of the new exerciser group. Study limitations include recall bias introduced due to the nature of the self-reported questionnaire and restricted external generalizability to other ethnic groups. Conclusions Initiating or continuing regular exercise after AF diagnosis was associated with lower risks of HF and mortality. The promotion of exercise might reduce the future risk of adverse outcomes in patients with AF.

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The risk and timing of acute ischemic stroke after electrical cardioversion for atrial fibrillation in Taiwan: A nationwide population-based cohort study

International Journal of Cardiology ◽

10.1016/j.ijcard.2021.12.035 ◽

2021 ◽

Author(s):

Chih-Kang Huang ◽

Jen-Chun Wang ◽

Chi-Hsiang Chung ◽

Sy-Jou Chen ◽

Wen-I Liao ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Population Based ◽

Electrical Cardioversion

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Bleeding Complications Associated with Warfarin Treatment in Ischemic Stroke Patients with Atrial Fibrillation: A Population-Based Cohort Study

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2013.01.019 ◽

2013 ◽

Vol 22 (4) ◽

pp. 561-569 ◽

Cited By ~ 15

Author(s):

Raymond C.S. Seet ◽

Alejandro A. Rabinstein ◽

Teresa J.H. Christianson ◽

George W. Petty ◽

Robert D. Brown

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Ischemic Stroke ◽

Population Based ◽

Bleeding Complications ◽

Stroke Patients ◽

Warfarin Treatment

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Influenza vaccination reduces hemorrhagic stroke risk in patients with atrial fibrillation: A population-based cohort study

International Journal of Cardiology ◽

10.1016/j.ijcard.2016.12.074 ◽

2017 ◽

Vol 232 ◽

pp. 315-323 ◽

Cited By ~ 8

Author(s):

Ju-Chi Liu ◽

Ta-Jung Wang ◽

Li-Chin Sung ◽

Pai-Feng Kao ◽

Tsung-Yeh Yang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Influenza Vaccination ◽

Hemorrhagic Stroke ◽

Stroke Risk ◽

Population Based

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Association between body mass index and the risk of atrial fibrillation and ischemic stroke according to age: a nationwide population-based cohort study

European Heart Journal ◽

10.1093/eurheartj/ehab724.2411 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

H J Ahn ◽

S R Lee ◽

E K Choi ◽

K D Han ◽

S I Kwon ◽

...

Keyword(s):

Atrial Fibrillation ◽

Body Mass Index ◽

Cohort Study ◽

Ischemic Stroke ◽

Body Mass ◽

Age Groups ◽

The Elderly ◽

Population Based ◽

Age Group ◽

Increased Risk

Abstract Background Atrial fibrillation (AF) and ischemic stroke (IS) are two significant cardiovascular diseases that confer an enormous healthcare burden. A limited study comprehensively evaluated the association between full ranges of body mass index (BMI), including underweight, and AF or IS risks, especially in the different age subgroups. Purpose We investigated the association between BMI and AF and IS incidence according to the Korean population's age groups. Methods This was a nationwide population-based cohort study using data from the Korea National Health Insurance Service, including 9 194 477 healthy adults who underwent a medical examination in 2009. We stratified the study population into three age subgroups: age 20–39 (young, 33.1%), age 40–64 (middle-aged, 56.3%), and age over 65 years (elderly, 10.6%). In each age group, the individuals were categorized based on BMI (kg/m2) into underweight (<18.5), normal (18.5 to <23), overweight (23 to <25), obese I (25 to <30), and obese II (≥30). The first occurrences of AF and IS were followed up until December 31, 2018. According to BMI in each age group, the risks of AF and IS were analyzed by Cox proportional hazards regression with 95% confidence intervals (CI) by adjusting age, sex, lifestyle behaviors, and comorbidities. Results Overall, both underweight and higher BMI were associated with an increased risk of AF and stroke across all age groups. The increased risk of AF for patients with obese II was slightly accentuated compared to patients with normal BMI in the young population than elderly population (hazard ratio [HR] 1.78, 95% CI 1.63–1.94 for age 20–39 years; HR 1.55, 95% CI 1.48–1.61 for age ≥65 years, respectively). For underweight individuals, however, the increased risk of AF became more prominent in the elderly: HR and 95% CI was 1.12 (1.07–1.17) in the age over 65 years old, and 1.05 (0.94–1.16) in the age 20–39. Regarding IS, the young group presented a considerable increment in the magnitude of HRs in both underweight and higher BMI groups. However, the association between the BMI and stroke risk became attenuated in the elderly: HRs and 95% CI in underweight and obese II individuals were 1.10 (0.93–1.30) and 2.223 (1.99–2.49) in the age 20–39 group, whereas 0.97 (0.93–1.01) and 1.03 (0.98–1.08) in the age over 65 years old. Conclusions Underweight as well as obesity was associated with increased risks of AF and IS in the general population. In both AF and IS, the gradient of risks according to BMI was apparent at young ages; thus, maintaining normal body weight should be warranted in early life. An interplay of several factors other than BMI may contribute to ischemic stroke in the old ages, requiring integrated risk management in older patients. FUNDunding Acknowledgement Type of funding sources: None.

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Does Digoxin Increase the Risk of Ischemic Stroke and Mortality in Atrial Fibrillation? A Nationwide Population-Based Cohort Study

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2014.05.009 ◽

2014 ◽

Vol 30 (10) ◽

pp. 1190-1195 ◽

Cited By ~ 26

Author(s):

Tze-Fan Chao ◽

Chia-Jen Liu ◽

Su-Jung Chen ◽

Kang-Ling Wang ◽

Yenn-Jiang Lin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Ischemic Stroke ◽

Population Based

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SP372INCREASED RISK OF ISCHEMIC STROKE IN PATIENTS WITH CHRONIC KIDNEY DISEASE AFTER RECURRENT DYSNATREMIA: A NATIONWIDE POPULATION BASED COHORT STUDY IN TAIWAN

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfv192.38 ◽

2015 ◽

Vol 30 (suppl_3) ◽

pp. iii502-iii502

Author(s):

Mu-Chi Chung ◽

Tung-Min Yu ◽

Ming-Ju Wu ◽

Chao-Hsiang Chang ◽

Chih-Hsin Muo ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Cohort Study ◽

Ischemic Stroke ◽

Kidney Disease ◽

Population Based

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Women With Osteoarthritis Are at Increased Risk of Ischemic Stroke: A Population-Based Cohort Study

Journal of Epidemiology ◽

10.2188/jea.je20200042 ◽

2021 ◽

Author(s):

Chung-Hsin Yeh ◽

Wei-Lun Chang ◽

Po-Chi Chan ◽

Chih-Hsin Mou ◽

Ko-Shih Chang ◽

...

Keyword(s):

Cohort Study ◽

Ischemic Stroke ◽

Population Based ◽

Increased Risk

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Edoxaban versus warfarin on stroke risk in patients with atrial fibrillation: a territory-wide cohort study

10.1101/2021.01.04.21249209 ◽

2021 ◽

Author(s):

Dicken Kong ◽

Jiandong Zhou ◽

Sharen Lee ◽

Keith Sai Kit Leung ◽

Tong Liu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Ischemic Stroke ◽

Propensity Score ◽

Ischaemic Stroke ◽

Propensity Score Matching ◽

Lower Risk ◽

Cox Regression ◽

Significant Risk ◽

Risk Predictors

AbstractBackgroundIn this territory-wide, observational, propensity score-matched cohort study, we evaluate the development of transient ischaemic attack and ischaemic stroke (TIA/Ischaemic stroke) in patients with AF treated with edoxaban or warfarin.MethodsThis was an observational, territory-wide cohort study of patients between January 1st, 2016 and December 31st, 2019, in Hong Kong. The inclusion were patients with i) atrial fibrillation, and ii) edoxaban or warfarin prescription. 1:2 propensity score matching was performed between edoxaban and warfarin users. Univariate Cox regression identifies significant risk predictors of the primary, secondary and safety outcomes. Hazard ratios (HRs) with corresponding 95% confidence interval [CI] and p values were reported.ResultsThis cohort included 3464 patients (54.18% males, median baseline age: 72 years old, IQR: 63-80, max: 100 years old), 664 (19.17%) with edoxaban use and 2800 (80.83%) with warfarin use. After a median follow-up of 606 days (IQR: 306-1044, max: 1520 days), 91(incidence rate: 2.62%) developed TIA/ischaemic stroke: 1.51% (10/664) in the edoxaban group and 2.89% (81/2800) in the warfarin group. Edoxaban was associated with a lower risk of TIA or ischemic stroke when compared to warfarin.ConclusionsEdoxaban use was associated with a lower risk of TIA or ischemic stroke after propensity score matching for demographics, comorbidities and medication use.

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