Recent hospital-based cohort studies found the CHA2DS2-VASc score to be associated with ischemic stroke in individuals without atrial fibrillation
(AF). Our aim was to determine the distribution of embolic and thrombotic strokes
and association with the CHA2DS2-VASc score, among community-dwelling individuals without AF. We included participants
from the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 4 (1996
to 1998) and had no previous AF, stroke, or anticoagulant use (n = 10,671). During
follow-up through 2008, incident AF cases (n = 760) and participants who started warfarin
were censored. Incident AF was ascertained from study electrocardiograms and hospital
discharge diagnosis codes, and stroke was physician-adjudicated. After 10 years of
follow-up, 280 ischemic strokes were identified, of which 146 were thrombotic and
57 embolic. The hazard ratios (95% confidence intervals [CI]) for thrombotic stroke
were 1 (reference), 1.71 (1.13 to 2.59), 2.92 (1.91 to 4.45), 3.22 (1.70 to 6.11),
and 1.25 (0.17 to 9.09), with CHA2DS2-VASc scores of 0 to 1, 2, 3, 4, and ≥5, respectively. The hazard ratios (95% CI)
for embolic stroke were 1 (ref), 4.91 (2.10 to 11.5), 7.07 (2.93 to 17.0), 14.8 (5.50
to 39.6), and 15.2 (3.16 to 73.3), with CHA2DS2-VASc scores of 0 to 1, 2, 3, 4, and ≥5, respectively. A receiver-operating characteristic
model had a C-statistic of 0.65 for ischemic stroke, 0.61 for thrombotic stroke, and
0.71 for embolic stroke. In conclusion, in community-dwelling individuals without
AF, the CHA2DS2-VASc score can assess ischemic stroke risk and has good discriminatory capacity for
embolic stroke.
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Article Info
Publication History
Published online: November 06, 2018
Received in revised form:
October 27,
2018
Received:
August 26,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
