Related Experiment Video
Updated: Mar 20, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Carotid Atherosclerosis and Stroke in Atrial Fibrillation: The Atherosclerosis Risk in Communities Study
Wobo Bekwelem1, Paul N Jensen2, Faye L Norby2
1From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.). bekwe001@umn.edu.
Insights
Carotid intima-media thickness and plaque improve ischemic stroke risk prediction in atrial fibrillation (AF) patients. Adding these measures to the CHA2DS2-VASc score enhances stroke risk assessment for better patient management.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Atrial fibrillation (AF) increases ischemic stroke risk.
- Current risk prediction scores may not fully capture stroke risk in AF patients.
- Carotid intima-media thickness (cIMT) and carotid plaque are indicators of atherosclerosis.
Purpose of the Study:
- To evaluate if adding cIMT and carotid plaque improves ischemic stroke risk prediction in individuals with AF.
- To assess the incremental predictive value of carotid measures beyond the CHA2DS2-VASc score.
Main Methods:
- Analysis of participants from the Atherosclerosis Risk in Communities (ARIC) study.
- Inclusion of AF patients without prior stroke and not on warfarin.
- Utilized multivariable Cox models and assessed risk prediction improvement using C-statistic, net reclassification improvement, and integrated discrimination improvement.
Main Results:
- Increased cIMT and presence of carotid plaque were significantly associated with higher stroke risk.
- Adding cIMT and plaque to the CHA2DS2-VASc score showed marginal improvement in the C-statistic.
- Net reclassification improvement and integrated discrimination improvement indicated enhanced risk prediction.
Conclusions:
- Increased cIMT and carotid plaque presence are linked to elevated ischemic stroke risk in AF patients.
- These carotid measures may enhance stroke risk prediction beyond the established CHA2DS2-VASc score.
- Consideration of cIMT and plaque could refine stroke risk stratification in AF management.
Background And Purpose:
Whether consideration of carotid intima-media thickness (cIMT) and carotid plaque would improve risk prediction of ischemic stroke in persons with atrial fibrillation (AF) is unknown. The purpose of this study was to assess the improvement in risk prediction of stroke by adding cIMT and carotid plaque to the CHA2DS2-VASc (variables age, heart failure, hypertension, diabetes mellitus, myocardial infarction, and peripheral arterial disease) score.
Methods:
We included participants from the Atherosclerosis Risk in Communities (ARIC) study (mean age, 63 years) who developed AF within 5 years after carotid measurement, were not on warfarin, and had no prior stroke at AF diagnosis. AF was ascertained from study ECGs and diagnosis codes, and stroke was physician adjudicated. Multivariable Cox models were used to assess association between carotid indices and ischemic stroke. Improvement in 10-year risk prediction of stroke was assessed by the C-statistic, net reclassification improvement, and relative integrated discrimination improvement.
Results:
There were 81 (11.2%) stroke events that occurred among 724 participants with AF during a mean follow-up of 8.5 years. Increased cIMT and presence of carotid plaque were significantly associated with increased stroke risk. The addition of cIMT+plaque to the CHA2DS2-VASc score marginally increased the C-statistic (95% confidence interval) from 0.685 (0.623-0.747) to 0.698 (0.638-0.759). The net reclassification improvement and integrated discrimination improvement for cIMT+plaque were 0.091 (95% confidence interval, 0.012-0.170) and 0.101 (95% confidence interval, 0.002-0.226), respectively.
Conclusions:
Increased cIMT and presence of carotid plaque are associated with increased risk of ischemic stroke in individuals with AF. Furthermore, they may improve risk prediction of stroke, over and above the CHA2DS2-VASc score.
More Related Videos
23:33The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
09:36A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
Published on: August 12, 2025
Related Concept Videos
01:23Atherosclerosis IV: Nursing Management
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
01:30Atherosclerosis I: Introduction
01:26Arteries of the Head and Neck
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...
01:26Atherosclerosis III: Management
01:30Coronary Artery Disease I: Introduction