Physicians' Academy for Cardiovascular Education

No increased risk of stroke in AF patients without CV comorbidities

Association of Atrial Fibrillation Without Cardiovascular Comorbidities and Stroke Risk: From the REGARDS Study

Literature - Singleton MJ, Imtiaz-Ahmad M, Kamel H et al., - J Am Heart Assoc. 2020. doi: 10.1161/JAHA.120.016380.

Introduction and methods

Atrial fibrillation (AF) is associated with a 2-fold increased risk of all-cause mortality and a 5-fold increased risk of stroke [1-3]. Anticoagulant therapy is indicated for the majority of nonvalvular AF patients with a CHA2DS2VASc score of ≥2 [4,5]. However, the risk/benefit profile of anticoagulation among AF patients without CV comorbidities remains unclear. There is no consensus in the literature about the risk of stroke among AF patients without CV comorbidities. Some studies have found an elevated stroke risk in these patients [6-8], while other studies report that the risk of stroke is indistinguishable from the general population [9,10]. This study evaluated the risk of stroke in patients with and without AF and with and without comorbidities in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study [11].

The REGARDS study was a longitudinal population-based cohort study which enrolled 30239 black and white participants, ≥45 years old. The study was designed to understand regional and racial disparities in stroke risk. For the current study, a total of 28,253 eligible participants from the REGARDS study were divided into 4 groups: 1: Participants without AF or CV comorbidities (reference group, n=7837, 27.7%), 2: Participants with no AF but with CV comorbidities (n=18103, 64.1%), 3: Participants with AF but no CV comorbidities (n=386, 1.4%), and 4: Participants with AF and CV comorbidities (n=1927, 6.8%).

The primary aim was to evaluate the risk of stoke in patients with AF but without CV comorbidities (group 3), compared with those without AF or CV comorbidities (group 1). The median follow-up was 8.7 years (IQR 5.8-11.6).

Main results


This analysis of the REGARDS study showed that AF patients without CV comorbidities had no increased risk of stroke compared to those without AF or CV comorbidities. Individuals with CV comorbidities, with and without AF, had an elevated risk of both stroke of any type and cardioembolic stroke.


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Find this article online at J Am Heart Assoc.

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