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Stroke Prevention in Atrial Fibrillation: Focus on Asian Patients
Yan-Guang Li,이소령,최의근,Gregory Y.H. Lip 대한심장학회 2018 Korean Circulation Journal Vol.48 No.8
Atrial fibrillation (AF) is the most common arrhythmia conferring a fivefold increased risk of stroke. Stroke prevention is the cornerstone of management of patients with AF. Asians have a generally higher incidence of AF-related risks of stroke and bleeding (particularly intracranial bleeding), compared with non-Asians. Despite the well-documented efficacy and relative safety of oral anticoagulation for stroke prevention among Asians, the suboptimal use of oral anticoagulation remains common. The current narrative review aims to provide a summary of the available evidence on stroke prevention among patients with AF focused on the Asia region, regarding stroke and bleeding risk evaluation, the performance of oral anticoagulation, and current use of thromboprophylaxis.
안효정,Lee So-Ryoung,최의근,이승우,한경도,권순,오세일,Gregory Y. H. Lip 한국지질동맥경화학회 2023 지질·동맥경화학회지 Vol.12 No.1
Objective: Higher levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) are associated with a lower risk of atrial fibrillation (AF). Statin use might exert confounding effects on the paradoxical associations; however, the relationships that distinguish statin users from non-users have not been thoroughly evaluated. Methods: From the Korean National Health Insurance Database, we included 9,778,014 adults who underwent a health examination in 2009. The levels of TC and LDL-C at the health examination were categorized into quartile values of the total study population. We grouped the study population into statin users and non-users and investigated the associations between TC, LDL-C, and the risk of incident AF. Results: Of the total population, 867,336 (8.9%) were taking statins. During a mean follow-up of 8.2 years, inverse associations of TC – AF and LDL-C – AF were observed; higher levels of TC and LDL-C were associated with the lower risk of AF in the total population. Overall, statin users showed higher AF incidence rate than non-users, but the inverse associations of TC – AF and LDL-C – AF were consistently observed irrespective of statin usage; adjusted hazard ratio with 95% confidence interval was 0.81 (0.79–0.84) for statin users and 0.81 (0.80–0.83) for non-users in the highest TC quartile, and 0.84 (0.82–0.87) for statin users and 0.85 (0.84–0.86) for non-users in the highest LDL-C quartile (all p<0.001). Conclusion: The paradoxical relationship between lipid levels (TC and LDL-C) and the risk of AF remains consistent in both statin users and non-users.
유희태,Pil-Sung Yang,Jinseub Hwang,Soorack Ryu,Eunsun Jang,김태훈,엄재선,김종윤,박희남,이문형,Gregory Y.H. Lip,정보영 대한심장학회 2020 Korean Circulation Journal Vol.50 No.3
Background and Objectives: Nationwide social inequalities of oral anticoagulation (OAC) usage after the introduction of non-vitamin K antagonist oral anticoagulants (NOACs) have not been well identified in patients with atrial fibrillation (AF). This study assessed overall rate and social inequalities of OAC usage after the introduction of NOAC in Korea. Methods: Between January 2002 and December 2016, we identified 888,540 patients with AF in the Korea National Health Insurance system database. The change of OAC rate in different medical systems after the introduction of NOAC were evaluated. Results: In all population, overall OAC use increased from 13.2% to 23.4% (p for trend <0.001), and NOAC use increased from 0% to 14.6% (p for trend <0.001). Compared with pre-reimbursement (0.48%), the annual increase of OAC use was significantly higher after partial (1.16%, p<0.001), and full reimbursement of OAC (3.72%, p<0.001). Full reimbursement of NOAC (adjusted odds ratio, 2.10; 95% confidence interval, 2.04–2.15) was independently associated with higher OAC use. However, the difference of overall OAC usage between tertiary referral hospitals and nursing or public health centers increased from 17.9% in 2010 to 36.8% in 2016. Moreover, usage rate of NOAC was significantly different among different medical systems from 37.2% at the tertiary referral hospital and 5.5% at nursing or public health centers. Conclusions: Introduction of NOACs in routine practice for stroke prevention in AF was associated with improved rates of overall OAC use. However, significant practice-level variations in OAC and NOAC use remain producing social inequalities of OAC despite full reimbursement.
Cha, Myung-Jin,Choi, Eue-Keun,Han, Kyung-Do,Lee, So-Ryoung,Lim, Woo-Hyun,Oh, Seil,Lip, Gregory Y.H. American Heart Association 2017 Stroke Vol. No.
<P>Conclusions-In real-world practice among a high-risk Asian atrial fibrillation population, all 3 NOACs demonstrated similar risk of ischemic stroke and lower risk of ICH compared with warfarin. All-cause mortality was significantly lower only with dabigatran and apixaban.</P>
Edoxaban in Asian Patients With Atrial Fibrillation : Effectiveness and Safety
Lee, So-Ryoung,Choi, Eue-Keun,Han, Kyung-Do,Jung, Jin-Hyung,Oh, Seil,Lip, Gregory Y.H. Elsevier 2018 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY - Vol.72 No.8
<P><B>Abstract</B></P> <P><B>Background</B></P> <P>It is unclear whether edoxaban shows better risk reduction of ischemic stroke, bleeding, and all-cause mortality than warfarin in Asian patients with nonvalvular atrial fibrillation (AF).</P> <P><B>Objectives</B></P> <P>This study compared the effectiveness and safety of edoxaban with those of warfarin in a Korean population with AF.</P> <P><B>Methods</B></P> <P>Using the Korean National Health Insurance Service database, we included new users of edoxaban and warfarin in patients with AF from January 2014 to December 2016 (n = 4,200 on edoxaban, and n = 31,565 on warfarin) and analyzed the risk of ischemic stroke, intracranial hemorrhage (ICH), hospitalization for gastrointestinal (GI) bleeding, hospitalization for major bleeding, and all-cause death. The propensity score matching method was used to balance covariates across edoxaban and warfarin users.</P> <P><B>Results</B></P> <P>We compared a 1:3 propensity score−matched cohort of patients with AF who were new users of edoxaban and warfarin (n = 4,061 and n = 12,183, respectively). Baseline characteristics were balanced between the 2 groups (median age 72 years; median CHA<SUB>2</SUB>DS<SUB>2</SUB>-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke, transient ischemic attack, or thromboembolism, vascular disease, age 65–74 years, sex category (female)] score 3). Edoxaban users had a significantly lower risk of ischemic stroke (hazard ratio [HR]: 0.693; 95% confidence interval [CI]: 0.487 to 0.959), ICH (HR: 0.407; 95% CI: 0.182 to 0.785), hospitalization for GI bleeding (HR: 0.597; 95% CI: 0.363 to 0.930), hospitalization for major bleeding (HR: 0.532; 95% CI: 0.352 to 0.773), and all-cause death (HR: 0.716; 95% CI: 0.549 to 0.918) than warfarin users. All subgroups (age, sex, CHA<SUB>2</SUB>DS<SUB>2</SUB>-VASc score, renal function, edoxaban dose) showed better clinical outcomes with edoxaban than with warfarin.</P> <P><B>Conclusions</B></P> <P>In this real-world Asian population with AF, edoxaban might be associated with reduced risk of ischemic stroke, major bleeding, and all-cause death compared with warfarin. These benefits were consistent across various high-risk subgroups.</P>
Kim, Tae-Hoon,Yang, Pil-Sung,Kim, Daehoon,Yu, Hee Tae,Uhm, Jae-Sun,Kim, Jong-Youn,Pak, Hui-Nam,Lee, Moon-Hyoung,Joung, Boyoung,Lip, Gregory Y.H. American Heart Association 2017 Stroke Vol. No.
<P>Conclusions-The CHA(2)DS(2)-VASc score shows good performance in defining truly low-risk Asian patients with atrial fibrillation for stroke compared with CHADS(2) and ATRIA scores.</P>
Kim, Tae-Hoon,Yang, Pil-Sung,Uhm, Jae-Sun,Kim, Jong-Youn,Pak, Hui-Nam,Lee, Moon-Hyoung,Joung, Boyoung,Lip, Gregory Y.H. American Heart Association, Inc. 2017 Stroke Vol.48 No.6
<P>Conclusions-The performance of CHA(2)DS(2)-VASc score in Asians is comparable with that in Western populations. The score shows good performance in defining the truly-low-risk AF patients for stroke/thromboembolism.</P>