Risk Factors of Stroke in Patients with Nonvalvular Atrial Fibrillation under 75 Years Old

LIU Bing; SONG Kunpeng; SHI Haili; QIN Li; LI Yan; GAO Wanli; GAO Yujie; ZHANG Qi

doi:10.12102/j.issn.1672-1349.2025.02.020

Abstract：Objective: To explore the high-risk factors for stroke and arterial thromboembolic events in patients under 75 years old with non-valvular atrial fibrillation. Methods: A total of 1,926 patients with atrial fibrillation under 75 years old were selected from the Zhengzhou Central Hospital between January 2018 and December 2021 through the ECG Nalong system. Patients with valvular heart disease, severe liver or kidney dysfunction, and coagulation disorders were excluded by reviewing the electronic medical records. Finally, 1,616 patients were included, of which 446 patients with stroke were classified into the stroke group, and the remaining 1,170 patients were classified into the control group. Relevant data were collected from the electronic medical records, including whether the patients had heart failure, hypertension, diabetes, vascular disease, age and gender, and heart rate (during atrial fibrillation episodes or persistence). Since the CHA2DS2-VASc score assigns 1 point to patients aged 65-75, indicating an increased risk of ischemia, this study used 65 years as the cutoff value and included it as a research factor. Binary logistic regression analysis was used to identify the risk factors for stroke in patients with non-valvular atrial fibrillation. The receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of high-risk factors for stroke in these patients. Results: The proportion of patients with hypertension, diabetes, and those aged 65-75 was higher in the stroke group compared to the control group, while heart rate was lower in the stroke group; these differences were statistically significant (P < 0.01). Binary logistic regression analysis showed that patients with hypertension, diabetes, and those aged 65-75 had significantly increased risk of stroke. For every 1 beat per minute decrease in heart rate, the risk of stroke increased by 0.6%. The ROC curve showed that the combination of hypertension, diabetes history, age 65-75, and low heart rate significantly increased the risk of stroke (P < 0.05). Conclusion: Hypertension, diabetes, age 65-75, and low heart rate in patients with atrial fibrillation increase the risk of stroke. If all four high-risk factors occur simultaneously, the risk of stroke in patients with atrial fibrillation is even higher. Controlling blood pressure and blood sugar well, and appropriately adjusting heart rate may reduce the mortality and disability rate associated with cardiogenic stroke.