Publications

PWH have a heightened risk for CVD and common CVD risk factors, reinforcing the importance for regular screening for such conditions.

Background: In the ENSURE-AF study (NCT 02072434), the oral factor Xa inhibitor edoxaban showed a similar efficacy and safety profile vs enoxaparin-warfarin (enox-warf) in patients undergoing elect...

People with atrial fibrillation are at an increased risk of stroke, cognitive decline and dementia. We recently identified that individuals with atrial fibrillation exhibit a reduced cerebrovascular reactivity to carbon dioxide, indicative of a diminished cerebral vasodilatory reserve. In this study we sought to determine whether neurovascular coupling (NVC) is blunted in atrial fibrillation in comparison with age‐matched, hypertensive and healthy control participants. Posterior (PCA) and middle cerebral artery (MCA) flow velocity (Vm), along with beat‐to‐beat mean arterial pressure (MAP), were measured during a NVC assessment consisting of five cycles of visual stimulation (reading) for 30 s followed by 30 s with both eyes‐closed in 12 patients with atrial fibrillation (69 [7] yr; mean [SD], 3 women), 13 patients with hypertension (67 [5] yr, 4 women) and 12 healthy control participants (63 [10] yr, 4 women). Cerebrovascular conductance indices (CVCi) were calculated as PCA Vm/MAP and MCA Vm/MAP. NVC was denoted by the peak response observed during visual stimulation and is expressed as a percentage change from the eyes‐closed period. Resting PCA Vm and MCA Vm were not different between the atrial fibrillation (31 [7] and 49 [12] cm/s), hypertension (33 [8] and 55 [12] cm/s), and healthy control (36 [8] and 55 [12] cm/s) groups (P>0.05). Visual stimulation evoked an increase in PCA CVCi in all groups, but the magnitude of the hyperemic response was blunted in patients with atrial fibrillation (18 [8] %) and hypertension (17 [8] %), in comparison with healthy controls (26 [9] %) (P<0.05). Visual stimulation evoked a greater increase in MCA CVCi in the atrial fibrillation group (17 [6] %), than patients with hypertension (10 [4] %) and healthy controls (13 [6] %) (P<0.05). Thus, when peak PCA CVCi responses were considered following subtraction of the peak MCA CVCi responses (i.e., the “non‐selective” effect of the NVC test), a significantly diminished response was observed in the atrial fibrillation group (1 [8] %) compared the hypertension (7 [9] %) and healthy control groups (13 [9] %) (P<0.01). In summary, individuals with atrial fibrillation exhibit a blunted NVC response to visual stimulation when compared to age‐matched, healthy control and hypertensive participants. Additional studies are required to identify the mechanisms for the attenuated cerebral perfusion response of the occipital lobe to visual stimulation in atrial fibrillation (e.g., attenuated neuronal activation, altered cerebrovascular vasodilatory signaling). Support or Funding Information Funded by BHF project grant PG/15/45/31579. This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .

Generalisability was an issue in Brazil and China, as was selection bias. Recruitment bias was highlighted in Sri Lanka. Additional or alternative recruitment methods may be required to ensure generalisability and reduce bias in future studies aimed at identifying NCD care pathways in LMICs.

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. Funding Acknowledgement Type of funding sources: None.

Background Previous studies have provided conflicting results as to whether women are at higher risk than men for thromboembolism in the setting of atrial fibrillation ( AF ). We investigated whether women with AF were at higher risk of ischemic stroke in the China-AF (China Atrial Fibrillation Registry) Study. Methods and Results A total of 19 515 patients were prospectively enrolled between August 2011 and December 2016 in the China- AF Study. After exclusion of patients receiving anticoagulation or ablation therapy, 6239 patients (2574 women) with results from at least 6 months of follow-up were used for the analysis. Cox proportional hazards models were performed to evaluate whether female sex was an independent risk factor for thromboembolism after multivariate adjustment. The primary outcome was the time to the first occurrence of ischemic stroke or systemic embolism. After a mean follow-up of 2.81±1.46 years, 152 female patients reached the primary outcome, as compared with 172 male patients. Crude incidence rates of thromboembolism between women and men were of borderline statistical significance (2.08 versus 1.68 per 100 patient-years, P=0.058). After multivariable analysis, female sex was not independently associated with an increased thromboembolism risk (hazard ratio 1.09, 95% confidence interval 0.86-1.39). There was no significant difference in thromboembolism risk by sex stratified by age and presence or absence of risk factors ( P for interaction all >0.1). Conclusions Although crude incidence rates of thromboembolism were higher in Chinese female patients with AF compared with male patients, female sex did not emerge as an independent risk factor for thromboembolism on multivariate analysis. Clinical Trial Registration URL : http://www.chictr.org.cn/ . Unique identifier: Chi CTR - OCH -13003729.

Comorbidities influence management and long-term prognosis of patients with AF. Patients with complex phenotypes may require comprehensive and holistic approaches to improve their prognosis.

Background: The Risk of Paradoxical Embolism (RoPE) score was developed to identify stroke-related patent foramen ovale (PFO) in patients with cryptogenic stroke. Methods: We conducted a retrospective analysis of the 2016 to 2020 National Inpatient Sample to determine the performance of modified RoPE score for PFO presence in patients with acute ischemic stroke (AIS). Results: A total of 3,338,805 hospital admissions for AIS were analysed and 3.0% had PFO. Patients with PFO were younger compared to those without PFO (median 63 years vs. 71 years, p<0.001) and fewer were female (46.1% vs. 49.7%, p<0.001). The patients with PFO had greater mean modified RoPE score (4.0 vs. 3.3, p<0.001). The area under the curve for the RoPE score in predicting PFO was 0.625 (95%CI 0.620-0.629). The best diagnostic power of the RoPE score was achieved with a cut point of ≥4 where the sensitivity was 55% and the specificity was 64.2%. A cut point of ≥5 increased specificity (83.1%) at the expense of sensitivity (35.8%). The strongest predictor of PFO was deep vein thrombosis (OR 3.97, 95%CI 3.76-4.20). Conclusions: The modified RoPE score had modest predictive value in identifying patients with PFO among patients admitted with AIS.