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Prevalence, Risk Factors, and Relationship to Stroke in the Stroke Prevention in Atrial Fibrillation Study

Merrill C. Kanter, MD; Charles H. Tegeler, MD; Lesly A. Pearce, MS; Jesse Weinberger, MD; William M. Feinberg, MD; David C. Anderson, MD; Camilo R. Gomez, MD; John F. Rothrock, MD; Cathy M. Helgason, MD; Robert G. Hart, MD

Arch Intern Med. 1994;154(12):1372-1377.

Abstract
Background
Several mechanisms contribute to the increased stroke rate of patients with atrial fibrillation (AF). We assessed the frequency of carotid artery stenosis in patients with AF and its relationship to stroke during aspirin or warfarin therapy.

Methods
Carotid ultrasonography was done in 676 patients with AF enrolled in the Stroke Prevention in Atrial Fibrillation Study to detect cervical carotid stenosis of 50% or more of the luminal diameter. The presence of carotid stenosis was correlated with patient features and subsequent stroke during a mean of 2.6 years of follow-up.

Results
In patients with AF who were older than 70 years, the frequency of carotid stenosis was 12% in men and 11% in women. Carotid stenosis was independently associated with systolic hypertension (relative risk, 2.4; P=.002), diabetes (relative risk, 1.8; P=.04), and tobacco use (relative risk, 1.8; P=.02). Carotid stenosis did not add significantly to prediction of stroke when analyzed with other clinical risk factors for stroke in patients with AF (relative risk, 1.3; 95% confidence interval, 0.5 to 3.6; P=.55).

Conclusions
Carotid artery stenosis of 50% or more occurs in about 12% of elderly patients with AF, reflecting the substantial prevalence of hypertension and diabetes in these patients. Carotid stenosis was not usefully predictive of stroke in patients with AF who were given aspirin or warfarin. Routine ultrasonography to detect carotid stenosis does not appear warranted in patients with AF without previous symptoms of brain ischemia.

(Arch Intern Med. 1994;154:1372-1377)

Author Affiliations
From the Department of Medicine, University of Texas Health Sciences Center, San Antonio (Drs Kanter and Hart); Department of Neurology, Bowman-Gray School of Medicine, Winston-Salem, NC (Dr Tegeler); Statistics and Epidemiology Research Corp, Seattle, Wash (Ms Pearce); Department of Neurology, Mt Sinai Medical Center, New York, NY (Dr Weinberger); Department of Neurology, University of Arizona, Tucson (Dr Feinberg); Department of Neurology, Hennepin County Medical Center, Minneapolis, Minn (Dr Anderson); Department of Neurology, St Louis (Mo) University Medical Center (Dr Gomez); Department of Neurology, University of California—San Diego (Dr Rothroch); and Department of Neurology, University of Illinois, Chicago (Dr Helgason).

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