Cited by 7,388Atrial Fibrillation Management and OutcomesAcute Ischemic Stroke ManagementCardiovascular and Diving-Related Complications

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Atrial fibrillation as an independent risk factor for stroke: the Framingham study

Wolf, P A, Abbott, R D, Kannel, W B·1991·Stroke

DOI 10.1161/01.str.22.8.983

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Abstract

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 less than 0.001) and more than trebled in the presence of hypertension (p less than 0.001). There was a more than fourfold excess of stroke in subjects with cardiac failure (p less than 0.001) and a near fivefold excess when atrial fibrillation was present (p less than 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 less than 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 less than 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 less than 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.(ABSTRACT TRUNCATED AT 250 WORDS)

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Authors: Wolf, P. A., Abbott, R. D., & Kannel, W. B.
Affiliations: Department of Neurology, Evans Memorial Department of Clinical Research, Boston, Mass.
ORCID: Wolf, P A
Abbott, R D
Venue: Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1991-08
Volume: 22
Issue: 8
Pages: 983-988
ISSN: 0039-2499 (ISSN-L)
1524-4628
DOI: 10.1161/01.str.22.8.983
OpenAlex: W2114775432
Cited by: 7,388
References: 31
Citations by year: 2026: 184 · 2025: 232 · 2024: 306 · 2023: 299 · 2022: 349 · 2021: 419 · 2020: 414 · 2019: 381 · 2018: 413 · 2017: 360 · 2016: 434 · 2015: 396 · 2014: 381 · 2013: 406 · 2012: 368
FWCI: 16.82
Type: journal article
Language: en
Open access: closed
Locations: Stroke (publishedVersion)
PubMed (publishedVersion)
Stroke
Funders: National Institutes of Health (n01hc038038-022)
National Heart, Lung, and Blood Institute (N01-HC-38038)
National Institute of Neurological Disorders and Stroke (2-RO1-NS-17950, R01NS017950)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
Keywords: atrial fibrillation, stroke risk, stroke incidence, hypertension, coronary artery disease, heart failure, cardiovascular risk factors, attributable risk, aging, sex differences, Framingham Heart Study
MeSH terms: Aged, Atrial Fibrillation, Cardiovascular Diseases, Cerebrovascular Disorders, Female, Humans, Male, Middle Aged, Risk Factors, Sex Factors, Incidence, Prevalence

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Atrial fibrillation as an independent risk factor for stroke: the Framingham study

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