title: Peripheral arterial disease and atrial fibrillation and risk of stroke, heart failure hospitalization and cardiovascular death: A nationwide cohort study.
abstract: BACKGROUND
  Peripheral arterial disease (PAD) and atrial fibrillation (AF) share several comorbidities and contribute to similar cardiovascular (CV) outcomes. Only few studies have evaluated the correlation between PAD, AF, and their interaction effects on CV outcomes.
  
  
  METHODS
  We included 597,164 adults from Taiwan's National Health Insurance Research Database to conduct a cohort study to assess whether PAD was an independent risk factor of AF and vice versa. We also examined if PAD and AF increased the incident stroke, heart failure hospitalization and CV death.
  
  
  RESULTS
  People with PAD had a significant higher risk of incident AF than those without PAD [adjusted hazard ratio (HR): 1.29, 95% confidence interval (CI): 1.17-1.42]. Meanwhile, people with AF did not have an increased risk of incident PAD compared to those without AF (adjusted HR: 1.00, 95% CI: 0.89-1.11). Both AF and PAD increased the risk of stroke [adjusted HR being 1.29 (95% CI: 1.17-1.43) and 1.41 (95% CI: 1.35-1.47), respectively], heart failure hospitalization [adjusted HR being 1.96 (95% CI: 1.77-2.17) and 1.35 (95% CI: 1.28-1.42), respectively], and CV death [adjusted HR being 3.33 (95% CI: 2.58-4.30) and 2.08 (95% CI: 1.80-2.41), respectively]. However, we found no interaction effects of AF and PAD on these outcomes.
  
  
  CONCLUSIONS
  PAD is an independent risk factor of incident AF but not vice versa. Both PAD and AF are independent risk factors for stroke, heart failure hospitalization, and CV death.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Centre for Evidence-Based Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Lin
authors.affiliation: Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan; Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan.
authors.forename: Tao-Hsin
authors.initials: TH
authors.lastname: Tung
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Jui
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Health, Taipei City Government, Taipei, Taiwan; Institute of Health and Welfare Policy, National Yang Ming University, Taipei, Taiwan; Department of Nursing, Kang-Ning Junior College of Medical Care and Management, Taipei, Taiwan.
authors.forename: Yu-Fen
authors.initials: YF
authors.lastname: Chen
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
authors.forename: Tien-Hsing
authors.initials: TH
authors.lastname: Chen
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Yulin, Taiwan.
authors.forename: Ming-Sheng
authors.initials: MS
authors.lastname: Lin
authors.affiliation: Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Centre for Evidence-Based Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Dermatology, Chang Gung Memorial Hospital, Chiayi, Taiwan. Electronic address: chingchi@cgmh.org.tw.
authors.forename: Ching-Chi
authors.initials: CC
authors.lastname: Chi
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. Electronic address: chenmien@ms76.hinet.net.
authors.forename: Mien-Cheng
authors.initials: MC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000209:etiology*; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*; D055815:Young Adult
keywords: Atrial fibrillation; Cardiovascular death; Heart failure; Peripheral arterial disease; Stroke