Association of Atrial Fibrillation With Incidence of Extracranial Systemic Embolic Events: The ARIC Study

Mengyuan Shi, Lin Y. Chen, Wobo Bekwelem, Faye L. Norby, Elsayed Z. Soliman, Aniqa B. Alam, Alvaro Alonso

Research output: Contribution to journalArticlepeer-review


Background Atrial fibrillation (AF) increases the risk of stroke and extracranial systemic embolic events (SEEs), but little is known about the magnitude of the association of AF with SEE. Methods and Results This analysis included 14 941 participants of the ARIC (Atherosclerosis Risk in Communities) study (mean age, 54.2±5.8, 55% women, 74% White) without AF at baseline (1987-1989) followed through 2017. AF was identified from study ECGs, hospital discharges, and death certificates, while SEEs were ascertained from hospital discharges. CHA2DS2-VASc was calculated at the time of AF diagnosis. Cox regression was used to estimate associations of incident AF with SEE risk in the entire cohort, and between CHA2DS2-VASc score and SEE risk in those with AF. Among eligible participants, 3114 participants developed AF and 270 had an SEE (59 events in AF). Incident AF was associated with increased risk of SEE (hazard ratio [HR], 3.58; 95% CI, 2.57-5.00), after adjusting for covariates. The association of incident AF with SEE was stronger in women (HR, 5.26; 95% CI, 3.28-8.44) than in men (HR, 2.68; 95% CI, 1.66-4.32). In those with AF, higher CHA2DS2-VASc score was associated with increased SEE risk (HR per 1-point increase, 1.24; 95% CI, 1.05-1.47). Conclusions AF is associated with more than a tripling of the risk of SEE, with a stronger association in women than in men. CHA2DS2-VASc is associated with SEE risk in AF patients, highlighting the value of the score to predict adverse outcomes and guide treatment decisions in people with AF.

Original languageEnglish (US)
Pages (from-to)e016724
JournalJournal of the American Heart Association
Issue number18
StatePublished - Sep 15 2020


  • CHA2DS2‐VASc score
  • atrial fibrillation
  • extracranial systemic embolism

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

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