2013欧洲心脏病学会（ESC）年会公布的一项丹麦医疗登记研究分析发现，对于无卒中或心房纤颤（AF）病史的患者，其卒中风险随缺血性卒中危险因素数目增加而上升；当危险因素≥3个时，其卒中风险与有心房纤颤患者持平。

丹麦哥本哈根Gentofte医院Christine Benn博士称，“这是首次揭示无卒中或AF病史的患者，如果存在多个危险因素，仍可能为卒中高风险。危险因素包括心肌梗死、心衰、糖尿病、高血压、高龄等。”

研究自2000年开始历经10年，共纳入4,037,576例无AF成人患者；31,716例基线AF及131,153例随访中出现AF的患者。

研究中，危险因素≥5时，无持续或阵发性房颤患者卒中发生率为7.27/100人•年，有持续或突发心房纤颤患者为8.0/100人•年(详见表1.)。Christine Benn博士说，有或无AF的患者，在无卒中危险因素时，两组患者卒中发生率差异显著，随危险因素增加至1-2个、3-4个，这种差异逐渐减小，直至危险因素≥5时，两组几乎没有任何差异。

表1.无AF和有AF人群卒中发生率对比（/100人•年）

*危险因素=心肌梗死，周围动脉病，动脉栓塞，过度饮酒，心衰，颈动脉狭窄，视网膜血管闭塞，慢性全身炎症，慢性肾脏疾病，静脉血栓栓塞，癫痫，偏头痛，糖尿病，高血压，和年龄>75岁。

德国艾森大学医院Hans-Christoph Diener教授，作为ESC会议发言人，认为这一结果具有实践意义，拉开了对无AF或卒中史但存在中高危险因素的患者进行预防性治疗研究的序幕。

他指出，阿司匹林降低首次血管事件风险（ARRIVE）研究，在欧洲和北美七个国家入组12,000例患者，均存在2-4个心血管危险因素，无心血管事件病史。随机分为每日服用阿司匹林组和安慰剂组，正在进行随访，共随访5年。主要终点事件为首次非致命性心肌梗死或非致命性卒中或心血管疾病死亡（包括心肌梗死和卒中致死）。

编译自：With or Without AF, Risk of First Stroke Rises With Risk-Factor Prevalence.medscape.Aug 31, 2013

ESC 摘要原文：

Primary prevention of ischemic stroke: implication of multiple risk factors in patients with and without atrial fibrillation

Purpose: The majority of ischemic strokes occur in patients without atrial fibrillation We aimed to identify patients without atrial fibrillation with high risk of ischemic stroke based on multiple risk factors, secondly we compared stroke risk in patients with and without atrial fibrillation.

Methods: From Danish nationwide registries we retrieved information about discharge diagnoses and redeemed prescriptions 2000-2010. All Danish citizens were included in the analyses and Poisson regression was used for identifying factors associated with ischemic stroke, and stroke rates in relation to the number of present risk factors were calculated.

Results: We included 4,198,119 persons without prior stroke between 18 and 90 years of age. Of these 161,651 (3.85%) persons had atrial fibrillation. Significant stroke risk factors in patients without atrial fibrillation are shown in Figure 1. Patients with 0 risk factors and no atrial fibrillation had a stroke rate of 0.32 (95% confidence interval 0.31-0.32) per 100 person-years vs. 2.55 (2.47-2.64) in patients with atrial fibrillation. With 1-2 risk factors present the stroke rate was 1.77 (1.76-1.78) and 5.69 (5.61-5.78) without and with atrial fibrillation, respectively. For patients with 3-4 risk factors stroke rates were 4.88 (4.80-4.96) vs. 6.96 (6.79-7.14) and finally in the presence of 5 or more risk factors stroke rates were 7.27 (6.82-7.74) vs. 8.00 (7.34-8.71) per 100 person-years for patients without and with atrial fibrillation, respectively.

Conclusion: Patients with multiple risk factors have a high risk of stroke regardless of the presence of atrial fibrillation. Further knowledge on implication of multiple risk factors in patients without atrial fibrillation is warranted and might influence future strategies in stroke prevention.