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Peripheral arterial disease and atrial fibrillation and risk of stroke, heart failure hospitalization and cardiovascular death: A nationwide cohort study

  • Author Footnotes
    1 Equally contributed as co-first authors.
    Yu-Sheng Lin
    Footnotes
    1 Equally contributed as co-first authors.
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan

    Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Centre for Evidence-Based Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
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  • Author Footnotes
    1 Equally contributed as co-first authors.
    Tao-Hsin Tung
    Footnotes
    1 Equally contributed as co-first authors.
    Affiliations
    Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan

    Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
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  • Jui Wang
    Affiliations
    Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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  • Yu-Fen Chen
    Affiliations
    Department of Health, Taipei City Government, Taipei, Taiwan

    Institute of Health and Welfare Policy, National Yang Ming University, Taipei, Taiwan

    Department of Nursing, Kang-Ning Junior College of Medical Care and Management, Taipei, Taiwan
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  • Tien-Hsing Chen
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
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  • Ming-Sheng Lin
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Yulin, Taiwan
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  • Ching-Chi Chi
    Correspondence
    Correspondence to: C.-C. Chi, Department of Dermatology, Chang Gung Memorial Hospital, Chiayi, 6, Sec West, Chia-Pu Rd, Puzih, Chiayi 61363, Taiwan.
    Affiliations
    Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Centre for Evidence-Based Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan

    Department of Dermatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
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  • Mien-Cheng Chen
    Correspondence
    Correspondence to: M.-C. Chen, Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao Sung District, Kaohsiung 83301, Taiwan.
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Author Footnotes
    1 Equally contributed as co-first authors.
Published:October 18, 2015DOI:https://doi.org/10.1016/j.ijcard.2015.10.091

      Abstract

      Background

      Peripheral arterial disease (PAD) and atrial fibrillation (AF) share several comorbidities and contribute to similar cardiovascular (CV) outcomes. Only few studies have evaluated the correlation between PAD, AF, and their interaction effects on CV outcomes.

      Methods

      We included 597,164 adults from Taiwan's National Health Insurance Research Database to conduct a cohort study to assess whether PAD was an independent risk factor of AF and vice versa. We also examined if PAD and AF increased the incident stroke, heart failure hospitalization and CV death.

      Results

      People with PAD had a significant higher risk of incident AF than those without PAD [adjusted hazard ratio (HR): 1.29, 95% confidence interval (CI): 1.17–1.42]. Meanwhile, people with AF did not have an increased risk of incident PAD compared to those without AF (adjusted HR: 1.00, 95% CI: 0.89–1.11). Both AF and PAD increased the risk of stroke [adjusted HR being 1.29 (95% CI: 1.17–1.43) and 1.41 (95% CI: 1.35–1.47), respectively], heart failure hospitalization [adjusted HR being 1.96 (95% CI: 1.77–2.17) and 1.35 (95% CI: 1.28–1.42), respectively], and CV death [adjusted HR being 3.33 (95% CI: 2.58–4.30) and 2.08 (95% CI: 1.80–2.41), respectively]. However, we found no interaction effects of AF and PAD on these outcomes.

      Conclusions

      PAD is an independent risk factor of incident AF but not vice versa. Both PAD and AF are independent risk factors for stroke, heart failure hospitalization, and CV death.

      Keywords

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