title: Advanced interatrial block and ischemic stroke: The Atherosclerosis Risk in Communities Study.
abstract: Given that recent reports have suggested left atrial disease to be an independent risk factor for ischemic stroke, we sought to examine if advanced interatrial block (aIAB) is an independent stroke risk factor.
  
  
  
  We examined the association between aIAB and incident ischemic stroke in 14,716 participants (mean age 54 ± 5.8 years; 55% female; 26% black) from the Atherosclerosis Risk in Communities Study (ARIC). Cases of aIAB were identified from digital ECGs recorded during the baseline ARIC visit (1987-1989) and the first 3 follow-up study visits (1990-1992, 1993-1995, and 1996-1998). Adjudicated ischemic stroke events were ascertained through December 31, 2010.
  
  
  
  There were 266 (1.8%) participants who had evidence of aIAB. Over a median follow-up of 22 years, 916 (6.2%) ischemic stroke events were detected. The incidence rate (per 1,000 person-years) of ischemic stroke among those with aIAB (incidence rate 8.05, 95% confidence interval [CI] 5.7, 11.4) was more than twice the rate in those without aIAB (incidence rate 3.14, 95% CI 2.94, 3.35). In a multivariable Cox regression analysis adjusted for stroke risk factors and potential confounders, aIAB was associated with an increased risk of ischemic stroke (hazard ratio 1.63, 95% CI 1.13, 2.34). The results were consistent across subgroups of participants stratified by age, sex, and race.
  
  
  
  In the ARIC, aIAB was associated with incident ischemic stroke, which strengthens the hypothesis that left atrial disease should be considered an independent stroke risk factor.
authors.affiliation: From the Department of Medicine (W.T.O.) and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (Z.-M.Z., E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; and Department of Medicine, Cardiovascular Division (L.Y.C.), and Division of Epidemiology and Community Health, School of Public Health (A.A.), University of Minnesota, Minneapolis, MN. W.T.O. is currently with the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA; and A.A. is currently with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA. wesley.oneal@emory.edu.
authors.forename: Wesley T
authors.initials: WT
authors.lastname: O'Neal
authors.affiliation: From the Department of Medicine (W.T.O.) and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (Z.-M.Z., E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; and Department of Medicine, Cardiovascular Division (L.Y.C.), and Division of Epidemiology and Community Health, School of Public Health (A.A.), University of Minnesota, Minneapolis, MN. W.T.O. is currently with the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA; and A.A. is currently with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
authors.affiliation: From the Department of Medicine (W.T.O.) and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (Z.-M.Z., E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; and Department of Medicine, Cardiovascular Division (L.Y.C.), and Division of Epidemiology and Community Health, School of Public Health (A.A.), University of Minnesota, Minneapolis, MN. W.T.O. is currently with the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA; and A.A. is currently with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Zhu-Ming
authors.initials: ZM
authors.lastname: Zhang
authors.affiliation: From the Department of Medicine (W.T.O.) and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (Z.-M.Z., E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; and Department of Medicine, Cardiovascular Division (L.Y.C.), and Division of Epidemiology and Community Health, School of Public Health (A.A.), University of Minnesota, Minneapolis, MN. W.T.O. is currently with the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA; and A.A. is currently with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Lin Y
authors.initials: LY
authors.lastname: Chen
authors.affiliation: From the Department of Medicine (W.T.O.) and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (Z.-M.Z., E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; and Department of Medicine, Cardiovascular Division (L.Y.C.), and Division of Epidemiology and Community Health, School of Public Health (A.A.), University of Minnesota, Minneapolis, MN. W.T.O. is currently with the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA; and A.A. is currently with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.affiliation: From the Department of Medicine (W.T.O.) and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (Z.-M.Z., E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; and Department of Medicine, Cardiovascular Division (L.Y.C.), and Division of Epidemiology and Community Health, School of Public Health (A.A.), University of Minnesota, Minneapolis, MN. W.T.O. is currently with the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA; and A.A. is currently with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
mesh_terms: D001741:Black or African American; D001281:Atrial Fibrillation / Q000453:epidemiology; D016279:Atrial Function, Left; D054537:Atrioventricular Block / Q000150:complications / Q000453:epidemiology*; D002545:Brain Ischemia / Q000453:epidemiology* / Q000209:etiology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology