| アブストラクト | The prevention of thromboembolism in atrial fibrillation (AF) is typically restricted to patients with specific risk factors and ignores outcomes such as vascular dementia. This population-based cohort study used electronic healthcare records from 5,199,994 primary care patients (UK; 2005-2020). A total of 290,525 (5.6%) had a diagnosis of AF and were aged 40-75 years, of which 36,340 had no history of stroke, a low perceived risk of stroke based on clinical risk factors and no oral anticoagulant prescription. Matching was performed for age, sex and region to 117,298 controls without AF. During 5 years median follow-up (831,005 person-years), incident stroke occurred in 3.8% with AF versus 1.5% control (adjusted hazard ratio (HR) 2.06, 95% confidence interval (CI) 1.91-2.21; P < 0.001), arterial thromboembolism 0.3% versus 0.1% (HR 2.39, 95% CI 1.83-3.11; P < 0.001), and all-cause mortality 8.9% versus 5.0% (HR 1.44, 95% CI 1.38-1.50; P < 0.001). AF was associated with all-cause dementia (HR 1.17, 95% CI 1.04-1.32; P = 0.010), driven by vascular dementia (HR 1.68, 95% CI 1.33-2.12; P < 0.001) rather than Alzheimer's disease (HR 0.85, 95% CI 0.70-1.03; P = 0.09). Death and thromboembolic outcomes, including vascular dementia, are substantially increased in patients with AF despite a lack of conventional stroke risk factors. |
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| ジャーナル名 | Nature medicine |
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| 投稿日 | 2024/6/6 |
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| 投稿者 | Mobley, Alastair R; Subramanian, Anuradhaa; Champsi, Asgher; Wang, Xiaoxia; Myles, Puja; McGreavy, Paul; Bunting, Karina V; Shukla, David; Nirantharakumar, Krishnarajah; Kotecha, Dipak |
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| 組織名 | Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.;NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS;Foundation Trust, Birmingham, UK.;West Midlands NHS Secure Data Environment, University Hospitals Birmingham NHS;Institute of Applied Health Research, University of Birmingham, Birmingham, UK.;Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory;Agency, London, UK.;Patient and Public Involvement Team, Birmingham, UK.;Primary Care Clinical Research, NIHR Clinical Research Network West Midlands,;Birmingham, UK.;d.kotecha@bham.ac.uk.;Foundation Trust, Birmingham, UK. d.kotecha@bham.ac.uk. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/38839900/ |
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