Related Experiment Videos
Left atrial size and the risk of stroke and death. The Framingham Heart Study
E J Benjamin1, R B D'Agostino, A J Belanger
1Framingham Heart Study, MA 01701, USA.
Insights
Left atrial enlargement predicts stroke in men and death in both sexes. This association is partly explained by left ventricular mass, highlighting its role in cardiovascular risk.
Area of Science:
- Cardiology
- Epidemiology
- Echocardiography
Background:
- Conflicting reports exist on left atrial (LA) enlargement and stroke risk.
- The relationship between LA size and stroke/death in the general population is understudied.
Purpose of the Study:
- To investigate the association between echocardiographic LA size and the risk of stroke and death.
- To explore the role of LA size in cardiovascular risk stratification.
Main Methods:
- Utilized data from the Framingham Heart Study, including 50+ year olds.
- Employed sex-specific Cox proportional-hazards models with multivariable adjustments.
- Assessed stroke and death events over an 8-year follow-up period.
Main Results:
- Increased LA size significantly predicted stroke in men (RR 2.4 per 10mm) and death in both sexes (men RR 1.3, women RR 1.4).
- The association between LA size and stroke/death risk was partially attenuated after adjusting for ECG left ventricular (LV) mass/height.
Conclusions:
- Left atrial enlargement is a significant predictor of stroke in men and all-cause mortality in both sexes.
- Left ventricular mass appears to partially mediate the relationship between LA enlargement and adverse cardiovascular outcomes.
Background:
The medical literature contains conflicting reports on the association of left atrial (LA) enlargement with risk of stroke. The relation of LA size to risk of stroke and death in the general population remains largely unexplored.
Methods And Results:
Subjects 50 years of age and older from the Framingham Heart Study were studied to assess the relations between echocardiographic LA size and risk of stroke and death. During 8 years of follow-up, 64 of 1371 (4.7%) men and 73 of 1728 (4.2%) women sustained a stroke, and 296 (21.6%) men and 271 (15.7%) women died. Sex-specific Cox proportional-hazards models were adjusted for age, hypertension, diabetes, atrial fibrillation, smoking, ECG left ventricular (LV) hypertrophy, and congestive heart failure or myocardial infarction. After multivariable adjustment, for every 10-mm increase in LA size, the relative risk of stroke was 2.4 in men (95% CI, 1.6 to 3.7) and 1.4 in women (95% CI, 0.9 to 2.1); the relative risk of death was 1.3 in men (95% CI, 1.0 to 1.5) and 1.4 in women (95% CI, 1.1 to 1.7). Adjusting for ECG LV mass/height attenuated the relation of LA size to stroke and death.
Conclusions:
After multivariable adjustment, LA enlargement remained a significant predictor of stroke in men and death in both sexes. The relation of LA enlargement to stroke and death appears to be partially mediated by LV mass.