ATRIAL-FIBRILLATION AS AN INDEPENDENT RISK FACTOR FOR STROKE - THE FRAMINGHAM-STUDY
ATRIAL-FIBRILLATION AS AN INDEPENDENT RISK FACTOR FOR STROKE - THE FRAMINGHAM-STUDY
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DOI：
10.1161/01.str.22.8.983
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发表时间：
1991-08-01
期刊：
影响因子：
8.3
通讯作者：
KANNEL, WB
中科院分区：
文献类型：
--
作者：
WOLF, PA;ABBOTT, RD;KANNEL, WB
Fracket研究在随访34年后，对5,070名参与者进行了非风湿性房颤、高血压、冠心病和心力衰竭对卒中发生率的影响的研究。与无这些疾病的受试者相比，有冠心病的受试者的年龄校正卒中发病率增加一倍以上（p < 0.001），有高血压的受试者的年龄校正卒中发病率增加两倍以上（p < 0.001）。心力衰竭受试者的卒中发生率高出4倍以上（p < 0.001），房颤受试者的卒中发生率高出近5倍（p < 0.001）。在患有冠心病或心力衰竭的人中，房颤使男性中风风险增加一倍，使女性中风风险增加两倍。随着年龄的增长，高血压、冠心病和心力衰竭对卒中风险的影响逐渐减弱（p < 0.05）。然而，年龄的增长并没有减少房颤的显著影响。对于80-89岁的人群，房颤是对卒中发生率产生独立影响的唯一心血管疾病（p < 0.001）。除房颤外，所有心血管因素的卒中归因风险均随年龄增长而降低，房颤的归因风险显著增加（p < 0.01），从50-59岁的1.5%上升至80-89岁的23.5%。虽然这些研究结果强调了每种心血管疾病对中风风险的影响，但数据表明，当存在房颤时，老年人特别容易中风。本文报道的房颤强大的独立作用与近期随机临床试验的结果雅阁，在这些试验中，华法林抗凝治疗可预防> 50%的卒中事件。
The impact of nonrheumatic atrial fibrillation, hypertension, coronary heart disease, and cardiac failure on stroke incidence was examined in 5,070 participants in the Framingham Study after 34 years of follow-up. Compared with subjects free of these conditions, the age-adjusted incidence of stroke was more than doubled in the presence of coronary heart disease (p < 0.001) and more than trebled in the presence of hypertension (p < 0.001). There was a more than fourfold excess of stroke in subjects with cardiac failure (p < 0.001) and a near fivefold excess when atrial fibrillation was present (p < 0.001). In persons with coronary heart disease or cardiac failure, atrial fibrillation doubled the stroke risk in men and trebled the risk in women. With increasing age the effects of hypertension, coronary heart disease, and cardiac failure on the risk of stroke became progressively weaker (p < 0.05). Advancing age, however, did not reduce the significant impact of atrial fibrillation. For persons aged 80-89 years, atrial fibrillation was the sole cardiovascular condition to exert an independent effect on stroke incidence (p < 0.001). The attributable risk of stroke for all cardiovascular contributors decreased with age except for atrial fibrillation, for which the attributable risk increased significantly (p < 0.01), rising from 1.5% for those aged 50-59 years to 23.5% for those aged 80-89 years. While these findings highlight the impact of each cardiovascular condition on the risk of stroke, the data suggest that the elderly are particularly vulnerable to stroke when atrial fibrillation is present. The powerful independent effect of atrial fibrillation reported here is in accord with the findings of recent randomized clinical trials in which > 50% of stroke events were prevented by warfarin anticoagulation.