8–11 This suggests that an abnormal ventricular substrate, with or without atrial myopathy, may serve as an independent risk factor. Several studies reported an association of both premature ventricular complexes (PVCs) and left ventricular hypertrophy (LVH) with incident stroke. Thus, it is essential to understand additional factors beyond those already accounted for in the risk assessment models. However, C-statistics for the stroke risk scores remain suboptimal (~0.6 to 0.7). 5 The most accurate stroke risk prediction is provided by CHA 2DS 2-VASc and P 2-CHA 2DS 2VASc risk scores 6 in persons with and without 7 atrial fibrillation (AF). 4 Nevertheless, a recent genome-wide association study of stroke identified 22 previously unknown genetic loci, pointing towards additional, currently unrecognised mechanisms of stroke. 3 Large portions, approximately 90.5% of stroke risk, could be attributed to traditional cardiovascular risk factors, such as hypertension, obesity, hyperlipidaemia, hyperglycaemic, renal dysfunction, smoking and sedentary lifestyle, as well as air pollution. 1 Despite declining stroke incidence in adults over 65 years of age, 2 the global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016. Stroke remains the leading cause of long-term disability and the fifth-leading cause of death in the USA. It is possible that the analyses were not sufficiently adjusted for AF, and the association between PVC and ES is weaker than reported. Over the study period, the precision of stroke diagnosis has been strengthened, and cerebral amyloid angiopathy diagnostic criteria have been changed.Īssessment of paroxysmal arrhythmic events (atrial fibrillation (AF), premature atrial complexes, premature ventricular contractions (PVCs), tachycardia-dependent intermittent bundle branch block) on a 10 s ECG cannot accurately represent the burden of arrhythmia. We kept the historical definition of hypertension (≥140/90 mm Hg) and also adjusted for actual blood pressure values, considering the paramount importance of hypertension as a stroke risk factor. In 2017, the American College of Cardiology/American Heart Association guideline lowered the threshold for the definition of hypertension in adults (≥130/80 mm Hg). The combined analysis of these two subtypes of ischaemic stroke is suboptimal and did not discriminate between these two types of TS. Thrombotic stroke (TS) included non-embolic and arterial embolic stroke (ES). While the statistical power for ischaemic stroke was adequate, there were fewer intracerebral haemorrhage events, which challenged a fair comparison of models for ischaemic and haemorrhagic stroke events. This large prospective cohort with long-term follow-up and well-adjudicated stroke events provided sufficient statistical power for rigorous adjustment.
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