Atrial fibrillation (AF) is an important, independent risk factor for stroke and is estimated to cause a 5-fold increase in ischemic stroke risk. The aim of this article is to describe the changing epidemiology of AF in the United States and to assess the implications for stroke prevention and treatment.
AF prevalence is increasing in the general population. This is likely due to the aging of the population, the improvements in coronary care and the rising prevalence of AF risk factors such as diabetes. Risk factors such as rheumatic heart disease and hypertension have decreased in prevalence over the past few decades. However, novel risk factors such as obesity and possibly the metabolic syndrome have been identified and these have the potential to further increase AF prevalence. The utilization of warfarin has improved and this is reflected in falling ischemic stroke rates in the AF population. There is evidence for an increased incidence of anticoagulant associated intraparenchymal hemorrhages during the 1990s.
Although the decline in stroke rates in AF is laudable, the rising prevalence of AF, the changing profile of risk factors, and the recent plateauing of warfarin use indicate that stroke in AF patients will continue to be a significant public health problem.
From the *Department of Neurology and Zeenat Qureshi Stroke Research Center, University of Minnesota; and †Division of Cardiology, Department of Internal Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
Supported by an NINDS/NIH career development award K23NS051377 (to K.L.) and Astra Zeneca (to C.A.H.).
Kamakshi Lakshminarayan, David C. Anderson, and Adnan I. Qureshi report no conflicts of interest.
Charles A. Herzog has served as a consultant to Medtronic and Guidant corporations.
Reprints: Kamakshi Lakshminarayan, MD, PhD, Department of Neurology, MMC 295, 420 Delaware Street S.E., Minneapolis, MN 55455. E-mail: email@example.com.