title: Increases in cerebral atherosclerosis according to CHADS2 scores in patients with stroke with nonvalvular atrial fibrillation.
abstract: OBJECTIVE
  The CHADS(2) score is used for risk stratification of ischemic stroke in patients with nonvalvular atrial fibrillation and high CHADS(2) scores are associated with increased risk of stroke. Most components of the CHADS(2) score are also risk factors for atherosclerosis. Therefore, high CHADS(2) scores can be associated with concomitant cerebral atherosclerosis and subsequently atherothrombotic stroke. The aim of this study was to determine whether there are differences in the presence and burden of concomitant cerebral atherosclerosis according to CHADS(2) scores in patients with stroke with nonvalvular atrial fibrillation.
  
  
  METHODS
  We included 780 consecutive patients with nonvalvular atrial fibrillation who had undergone angiographic studies at index stroke between August 1994 and March 2010 in the present study. We investigated the relationships between the CHADS(2) score and the presence, severity, and pattern of cerebral atherosclerosis and stroke mechanism.
  
  
  RESULTS
  Of the 780 patients, concomitant arterial stenosis (≥50%) was found in 231 patients (29.6%). The number of arteries with atherosclerosis increased as the CHADS(2) score increased (P<0.001) as did the proportion of combined extracranial and intracranial atherosclerosis (P<0.001). Multivariate analyses showed that high risk based on the CHADS(2) score was an independent predictor of concomitant cerebral atherosclerosis (OR, 3.121; 95% CI, 1.770 to 5.504) and the presence of proximal stenosis at the symptomatic artery (OR, 3.043; 95% CI, 1.458 to 6.350).
  
  
  CONCLUSIONS
  The CHADS(2) score can predict the presence of concomitant cerebral artery atherosclerosis. Increased risk of stroke in patients with high CHADS(2) scores may be partly explained by increased frequency and burden of cerebral atherosclerosis.
authors.affiliation: Department of Neurology, Yonsei University College of Medicine, 250 Seongsan-no, Seodaemoon-gu, Seoul, 120-752, Korea.
authors.forename: Young Dae
authors.initials: YD
authors.lastname: Kim
authors.forename: Myoung Jin
authors.initials: MJ
authors.lastname: Cha
authors.forename: Jinkwon
authors.initials: J
authors.lastname: Kim
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Lee
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Lee
authors.forename: Chung Mo
authors.initials: CM
authors.lastname: Nam
authors.forename: Hyo Suk
authors.initials: HS
authors.lastname: Nam
authors.forename: Ji Hoe
authors.initials: JH
authors.lastname: Heo
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000503:physiopathology; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D015897:Comorbidity / Q000639:trends; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000503:physiopathology; D004185:Disability Evaluation; D018450:Disease Progression; D006801:Humans; D015994:Incidence; D002537:Intracranial Arteriosclerosis / Q000453:epidemiology* / Q000503:physiopathology; D015999:Multivariate Analysis; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology* / Q000503:physiopathology