Author + information
- Rafel Ramos, MD, PhD∗ (, )
- Marc Comas-Cufí, MSc,
- Lia Alves-Cabratosa, MD and
- Maria García-Gil, MD, PhD
- ↵∗Research Unit, Family Medicine, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol) and Primary Care Services, Girona, Catalan Institute of Health (ICS), Carrer Maluquer Slavador, 11, 17002 Girona, Spain
We very much appreciate the interest of Dr. Keser and colleagues in our paper (1) and are pleased to provide a response to their comments. Keser et al. emphasize the importance of assessing the stroke risk in patients with nonvalvular atrial fibrillation (AF) with the CHA2DS2-VASc score for an optimal classification of the stroke risk, thus, to aid in decision making with regard to the management of antithrombotic therapy (2), all the more so if we consider the study population we focused on, who had asymptomatic peripheral arterial disease (PAD).
Indeed, we agree with the usefulness of the CHA2DS2-VASc score and with considering the inclusion of asymptomatic PAD in its calculation (3). Stroke risk assessment using CHA2DS2-VASc is valuable to be observed, not only in thromboprophylaxis decision making, but also in the general management of patients with AF.
Our study included 6% of patients with AF, which held a high thromboembolic risk; 177 were statin users and 182 nonusers.
More than 99% of participants with AF scored ≥1 in the CHA2DS2-VASc, and more than 96% scored ≥2. If we included an ankle-brachial index <0.95 in the definition of vascular disease of the CHA2DS2-VASc score, 100% of participants scored ≥1, and more than 99% scored ≥2. Stroke risk assessed by the CHA2DS2-VASc score did not differ between statin users and nonusers.
Antithrombotic therapy was dispensed to 95% of participants with AF, as expected in a population at high risk. The proportion of patients under antithrombotic therapy was also well balanced between statin users and nonusers.
We therefore concur with Dr. Keser and colleagues in finding a high risk of stroke as assessed by CHA2DS2-VASc score in the study participants with AF. This risk was even higher if we included asymptomatic PAD in the score.
However, we matched statin users and nonusers by the propensity score of being under statin treatment, ensuring equality in the distribution of the stroke risk between statin users and nonusers (AF was included in the propensity score regression). Thus, any statin effect that might be attributed to such increased risk would have been accounted for.
Finally, statin use in patients with AF has been associated with reduced AF recurrence, thus, beneficial in terms of stroke risk (4).
Please note: Drs. Ramos and Garcia-Gil collaborate (without receiving any personal fee) in 2 projects of the primary care institute IDIAP Jordi Gol funded by AstraZeneca and AMGEN. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
- Ramos R.,
- García-Gil M.,
- Comas-Cufí M.,
- et al.
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