Risk of Stroke in Patients With Atrial Fibrillation Is Associated With Stroke in Siblings: A Nationwide Study

• Published in: Journal of the American Heart Association Vol. 9; no. 3; p. e014132
• Main Authors: Berntsson, John, Li, Xinjun, Zöller, Bengt, Martinsson, Andreas, Andell, Pontus, Lubitz, Steven A., Engström, Gunnar, Sundquist, Kristina, Smith, J. Gustav
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 04.02.2020; Wiley
• Subjects: Adult; Aged; atrial fibrillation; Atrial Fibrillation - epidemiology; Atrial Fibrillation - genetics; Atrial Fibrillation - mortality; Brain Ischemia - epidemiology; Brain Ischemia - genetics; Brain Ischemia - mortality; Cardiology and Cardiovascular Disease; Cause of Death; Clinical Medicine; family history; Female; Genetic Predisposition to Disease; genetics; Heredity; Humans; Incidence; Kardiologi och kardiovaskulära sjukdomar; Klinisk medicin; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Middle Aged; Original Research; Prevalence; Prognosis; Registries; Risk Assessment; Risk Factors; Siblings; stroke; Stroke - epidemiology; Stroke - genetics; Stroke - mortality; Sweden - epidemiology; Time Factors; Sweden; atrial fibrillation; risk factors; genetics; stroke; family history
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.119.014132

Background It remains unclear whether heritable factors can contribute to risk stratification for ischemic stroke in patients with atrial fibrillation (AF). We examined whether having a sibling with ischemic stroke was associated with increased risk of ischemic stroke and mortality in patients with AF. Methods and Results In this nationwide study of the Swedish population, patients with AF and their siblings were identified from the Swedish patient registers and the Swedish MGR (Multi-Generation Register). Ischemic stroke events were retrieved from the Swedish patient registers and CDR (Cause of Death Register). Risk of ischemic stroke was compared between patients with AF with and without a sibling affected by ischemic stroke, AF, or both ischemic stroke and AF. The total study population comprised 113 988 subjects (mean age, 60±12 years) diagnosed with AF between 1989 and 2012. In total, 11 709 of them were diagnosed with a first ischemic stroke and 20 097 died during a mean follow-up time of 5.5 years for ischemic stroke and 5.9 years for mortality. After adjustment for covariates having a sibling with ischemic stroke, or both ischemic stroke and AF, was associated with increased risk of ischemic stroke (hazard ratio, 1.31; 95% CI, 1.23-1.40 or hazard ratio, 1.36; 95% CI, 1.24-1.49, respectively). Furthermore, ischemic stroke in a sibling was associated with all-cause mortality (hazard ratio, 1.09; 95% CI, 1.05-1.14). In contrast, the risk of stroke was only marginally increased for patients with AF with a spouse affected by ischemic stroke. Conclusions Having a sibling affected by ischemic stroke confers an increased risk of ischemic stroke and death independently of traditional risk factors in patients with AF.