Clinical epidemiology of atrial fibrillation and related cerebrovascular events in the United States.
BACKGROUND
Atrial fibrillation (AF) is an important, independent risk factor for stroke and is estimated to cause a 5-fold increase in ischemic stroke risk. The aim of this article is to describe the changing epidemiology of AF in the United States and to assess the implications for stroke prevention and treatment.


RESULTS
AF prevalence is increasing in the general population. This is likely due to the aging of the population, the improvements in coronary care and the rising prevalence of AF risk factors such as diabetes. Risk factors such as rheumatic heart disease and hypertension have decreased in prevalence over the past few decades. However, novel risk factors such as obesity and possibly the metabolic syndrome have been identified and these have the potential to further increase AF prevalence. The utilization of warfarin has improved and this is reflected in falling ischemic stroke rates in the AF population. There is evidence for an increased incidence of anticoagulant associated intraparenchymal hemorrhages during the 1990s.


CONCLUSIONS
Although the decline in stroke rates in AF is laudable, the rising prevalence of AF, the changing profile of risk factors, and the recent plateauing of warfarin use indicate that stroke in AF patients will continue to be a significant public health problem.
Lakshminarayan
Kamakshi
K
Department of Neurology and Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota, USA. laksh004@umn.edu
Anderson
David C
DC
Herzog
Charles A
CA
Qureshi
Adnan I
AI
D000375:Aging / Q000502:physiology; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology*; D002545:Brain Ischemia / Q000453:epidemiology* / Q000517:prevention & control; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D015897:Comorbidity; D006801:Humans; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000517:prevention & control; D014481:United States / Q000453:epidemiology
D000925:Anticoagulants