title: CHA2DS2-VASc Recalibration With an Additional Age Category (50-64 Years) Enhances Stroke Risk Stratification in Chinese Patients With Atrial Fibrillation.
abstract: Chinese patients with atrial fibrillation (AF) and a low CHA2DS2-VASc have a disproportionately high ischemic stroke risk; nonetheless, little is known about the impact of age on ischemic stroke risk in this population. In this study, we aimed to examine the age-related ischemic stroke risk in Chinese patients with nonvalvular AF without other risk factors for stroke.
  
  
  
  This was a hospital-based observational registry.
  
  
  
  A total of 1198 Chinese patients with AF (mean age, 73.6 ± 16.5 years; male sex, 53.3%) were included in this analysis. The mean CHA2DS2-VASc and HAS-BLED score were 1.81 ± 1.00 and 1.32 ± 0.77, respectively, and none of the patients was prescribed antiplatelet or anticoagulation therapy. After a mean follow-up of 2.95 years, there were 234 ischemic strokes (19.5%), with an annual ischemic stroke incidence of 6.62%/y. The overall annual ischemic stroke risk was 0.43%/y, 5.87%/y, 7.49%/y, and 8.04%/y for age groups < 50 years, 50-64 years, 65-74 years, and ≥ 75 years, respectively. There was a 10- to 20-fold gradient in ischemic stroke risk that increased sharply after the age of 50 years. The hazard ratios were 1.0, 13.0, 19.3, and 21.6 for age groups < 50 years, 50-64 years, 65-74 years and ≥ 75 years, respectively (P for trend < 0.0001). Similar trends were also observed in both male and female patients with AF.
  
  
  
  Chinese patients with AF and a low CHA2DS2-VASc were at a disproportionally high risk of ischemic stroke. Chinese patients between 50 and 64 years have a high risk for stroke despite a low CHA2DS2-VASc and a low bleeding risk. Only patients aged < 50 years have a truly low risk.
authors: Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong, China.
authors: Pak-Hei
authors: PH
authors: Chan
authors: Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong, China.
authors: Chu-Pak
authors: CP
authors: Lau
authors: Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong, China.
authors: Hung-Fat
authors: HF
authors: Tse
authors: Division of Cardiology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan.
authors: Chern-En
authors: CE
authors: Chiang
authors: Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong, China. Electronic address: cwdsiu@hku.hk.
authors: Chung-Wah
authors: CW
authors: Siu
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000453:epidemiology; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012107:Research Design; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology