Does CHA2DS2-VASc improve stroke risk stratification in postmenopausal women with atrial fibrillation?

Joellyn M. Abraham, Joseph Larson, Mina K. Chung, Anne B. Curtis, Kamakshi Lakshminarayan, Jonathan D. Newman, Marco Perez, Kathryn Rexrode, Nawar M. Shara, Allen J. Solomon, Marcia L. Stefanick, James C. Torner, Bruce L. Wilkoff, Sylvia Wassertheil-Smoller

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11 Scopus citations


Background Risk stratification of atrial fibrillation patients with a congestive heart failure (C), hypertension (H), age ≥ 75 (A), diabetes (D), stroke or transient ischemic attack (TIA) (S2) (CHADS2) score of <2 remains imprecise, particularly in women. Our objectives were to validate the CHADS2 and congestive heart failure (C), hypertension (H), age ≥ 75 (A2), diabetes (D), stroke, TIA or prior thromboembolic disease (S2)- vascular disease (V), age 65-74 (A), female gender (S) (CHA2DS2-VASc) stroke risk scores in a healthy cohort of American women with atrial fibrillation and to determine whether CHA2DS2-VASc further risk-stratifies individuals with a CHADS2 score of <2. Methods We identified a cohort of 5981 women with atrial fibrillation not on warfarin at baseline (mean age 65.9 ± 7.2 years) enrolled in the Women's Health Initiative and followed for a median of 11.8 years. Univariate and multivariate proportional hazards analyses were used to examine these 2 risk scores, with main outcome measures being annualized event rates of ischemic stroke or transient ischemic attack stratified by risk score. Results Annualized stroke/transient ischemic attack rates ranged from 0.36% to 2.43% with increasing CHADS2 score (0-4+) (hazard ratio [HR] 1.57; 95% confidence interval [CI], 1.45-1.71 for each 1-point increase) and 0.20%-2.02% with increasing CHA2DS 2-VASc score (1-6+) (HR 1.50; 95% CI, 1.41-1.60 for each 1-point increase). CHA2DS2-VASc had a higher c statistic than CHADS2: 0.67 (95% CI, 0.65-0.69) versus 0.65 (95% CI, 0.62-0.67), P <.01. For CHADS2 scores <2, stroke risk almost doubled with every additional CHA2DS2-VASc point. Conclusions Although both CHADS2, and CHA2DS2-VASc are predictive of stroke risk in postmenopausal women with atrial fibrillation, CHA 2DS2-VASc further risk-stratifies patients with a CHADS2 score <2.

Original languageEnglish (US)
Pages (from-to)1143.e1-1143.e8
JournalAmerican Journal of Medicine
Issue number12
StatePublished - Dec 2013

Bibliographical note

Funding Information:
Funding: The Women's Health Initiative program is funded by the National Heart, Lung, and Blood Institute , National Institutes of Health , US Department of Health and Human Services through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C.


  • Atrial fibrillation
  • Stroke
  • Women


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