Murphy, R. et al. (2024) Variations in the prevalence of atrial fibrillation, and in the strength of its association with ischemic stroke, in countries with different income levels: INTERSTROKE case–control study. International Journal of Stroke, (doi: 10.1177/17474930241227783) (PMCID:38204182) (Early Online Publication)
Full text not currently available from Enlighten.
Abstract
Background: The contribution of atrial fibrillation (AF) to the etiology and burden of stroke may vary by country income level. Aims: We examined differences in the prevalence of AF and described variations in the magnitude of the association between AF and ischemic stroke by country income level. Methods: In the INTERSTROKE case–control study, participants with acute first ischemic stroke were recruited across 32 countries. We included 10,363 ischemic stroke cases and 10,333 community or hospital controls who were matched for age, sex, and center. Participants were grouped into high-income (HIC), upper-middle-income (subdivided into two groups—UMIC-1 and UMIC-2), and lower-middle-income (LMIC) countries, based on gross national income. We evaluated the risk factors for AF overall and by country income level, and evaluated the association of AF with ischemic stroke. Results: AF was documented in 11.9% (n = 1235) of cases and 3.2% (n = 328) of controls. Compared to HIC, the prevalence of AF was significantly lower in UMIC-2 (aOR 0.35, 95% CI 0.29–0.41) and LMIC (aOR 0.50, 95% CI 0.41–0.60) on multivariable analysis. Hypertension, female sex, valvular heart disease, and alcohol intake were stronger risk factors for AF in lower-income countries, and obesity a stronger risk factor in higher-income countries. The magnitude of association between AF and ischemic stroke was significantly higher in lower-income countries compared to higher-income countries. The population attributable fraction for AF and stroke varied by region and was 15.7% (95% CI 13.7–17.8) in HIC, 14.6% (95% CI 12.3–17.1) in UMIC-1, 5.7% (95% CI 4.9–6.7) in UMIC-2, and 6.3% (95% CI 5.3–7.3) in LMIC. Conclusion: Risk factors for AF vary by country income level. AF contributes to stroke burden to a greater extent in higher-income countries than in lower-income countries, due to a higher prevalence and despite a lower magnitude of odds ratio.
| Item Type: | Articles |
|---|---|
| Additional Information: | The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The INTERSTROKE study was funded by the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Swedish Research Council, Swedish Heart and Lung Foundation, AFA insurance, The Health and Medical Care Committee of the Regional Executive Board, Region Västra Götaland, and through unrestricted grants from several pharmaceutical companies with major contributions from Astra Zeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), Merck, Sharp and Dohme, Swedish Heart and Lung Foundation, Chest, and Heart and Stroke, Scotland and UK Stroke Association. C.J. was supported by the Irish Clinical Academic Training (ICAT) Program, the Wellcome Trust, and the Health Research Board (grant no. 203930/B/16/Z), the Health Service Executive, National Doctors Training and Planning, and the Health and Social Care, Research and Development Division, Northern Ireland. M.O.D. was supported by the European Research Council (COSIP grant no. 640580). |
| Keywords: | Neurology, Neurology (clinical) |
| Status: | Early Online Publication |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Langhorne, Professor Peter |
| Authors: | Murphy, R., Damasceno, A., Reddin, C., Hankey, G. J., Iversen, H. K., Oveisgharan, S., Lanas, F., Czlonkowska, A., Langhorne, P., Ogunniyi, A., Wasay, M., Rumboldt, Z., Judge, C., Oguz, A., Mondo, C., Winter, Y., Rosengren, A., Pogosova, N., Avezum, A., Nilanont, Y., Penaherrera, E., Xavier, D., Lopez-Jaramillo, P., Wang, X., Yusuf, S., and O’Donnell, M. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
| Journal Name: | International Journal of Stroke |
| Publisher: | SAGE Publications |
| ISSN: | 1747-4930 |
| ISSN (Online): | 1747-4949 |
| Published Online: | 30 January 2024 |
University Staff: Request a correction | Enlighten Editors: Update this record
Deposit and Record Details
Deposit and Record Details