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Interaction between atrial fibrillation or flutter and the CHA2DS2-VASc score on the risk of ischemic stroke: A

Mohab Basem1, Kasper Bonnesen1, Péter Szentkúti1

  • 1Department of Clinical Epidemiology, Center for Population Medicine, Aarhus University Hospital and Aarhus University, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.

International Journal of Cardiology
|May 18, 2025
PubMed

Insights

Atrial fibrillation (AF/AFL) and the CHA2DS2-VASc score interact to elevate ischemic stroke risk. Female sex demonstrated the most significant interaction effect, highlighting its importance in stroke risk assessment.

Area of Science:

  • Cardiology
  • Neurology
  • Epidemiology

Background:

  • The CHA2DS2-VASc score is established for predicting ischemic stroke risk in patients with atrial fibrillation or flutter (AF/AFL).
  • The potential interaction between AF/AFL and the CHA2DS2-VASc score in increasing stroke risk remains largely unquantified.

Purpose of the Study:

  • To investigate the interaction effect between AF/AFL and the CHA2DS2-VASc score on ischemic stroke risk.
  • To determine if the combined effect of AF/AFL and CHA2DS2-VASc score exceeds the sum of their individual risks.

Main Methods:

  • A large Danish cohort study included 287,990 adult patients with AF/AFL and 1,404,705 matched controls from 1996-2021.
  • Ischemic stroke rates were analyzed across CHA2DS2-VASc score categories (0, 1, 2, ≥3) at various follow-up intervals (1, 1.5, 5-10 years).
  • Interaction effects between AF/AFL and individual CHA2DS2-VASc score components were assessed using interaction contrasts.

Main Results:

  • An 11% increase in ischemic stroke rate was attributed to the interaction between AF/AFL and a CHA2DS2-VASc score of 1 at 1-year follow-up.
  • A 6% interaction effect was observed between AF/AFL and a CHA2DS2-VASc score ≥3 during 5-10 year follow-up.
  • Female sex exhibited a significant interaction effect with AF/AFL across all follow-up periods.

Conclusions:

  • Atrial fibrillation/flutter and the CHA2DS2-VASc score exhibit a synergistic effect, increasing ischemic stroke risk beyond their additive contributions.
  • Female sex is a key factor in the interaction between AF/AFL and stroke risk, warranting specific clinical consideration.
Abstract

Keywords:
Atrial fibrillationAtrial flutterCHA(2)DS(2)-VASc scoreComorbidityIschemic stroke risk

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