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Patent foramen ovale and the risk of ischemic stroke in a multiethnic population.
J Am Coll Cardiol. 2007 Feb 20; 49(7):797-802.JACC

Abstract

OBJECTIVES

We sought to assess the risk of ischemic stroke from a patent foramen ovale (PFO) in the multiethnic prospective cohort of northern Manhattan.

BACKGROUND

Patent foramen ovale has been associated with increased risk of ischemic stroke, mainly in case-control studies. The actual PFO-related stroke risk in the general population is unclear.

METHODS

The presence of PFO was assessed at baseline by using transthoracic 2-dimensional echocardiography with contrast injection in 1,100 stroke-free subjects older than 39 years of age (mean age 68.7 +/- 10.0 years) from the Northern Manhattan Study (NOMAS). The presence of atrial septal aneurysm (ASA) also was recorded. Subjects were followed annually for outcomes. We assessed PFO/ASA-related stroke risk after adjusting for established stroke risk factors.

RESULTS

We detected PFO in 164 subjects (14.9%); ASA was present in 27 subjects (2.5%) and associated with PFO in 19 subjects. During a mean follow-up of 79.7 +/- 28.0 months, an ischemic stroke occurred in 68 subjects (6.2%). After adjustment for demographics and risk factors, PFO was not found to be significantly associated with stroke (hazard ratio 1.64, 95% confidence interval [CI] 0.87 to 3.09). The same trend was observed in all age, gender, and race-ethnic subgroups. The coexistence of PFO and ASA did not increase the stroke risk (adjusted hazard ratio 1.25, 95% CI 0.17 to 9.24). Isolated ASA was associated with elevated stroke incidence (2 of 8, or 25%; adjusted hazard ratio 3.66, 95% CI 0.88 to 15.30).

CONCLUSIONS

Patent foramen ovale, alone or together with ASA, was not associated with an increased stroke risk in this multiethnic cohort. The independent role of ASA needs further assessment in appositely designed and powered studies.

Authors+Show Affiliations

Department of Medicine, Columbia University Medical Center, New York, New York 10032, USA. md42@columbia.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17306710

Citation

Di Tullio, Marco R., et al. "Patent Foramen Ovale and the Risk of Ischemic Stroke in a Multiethnic Population." Journal of the American College of Cardiology, vol. 49, no. 7, 2007, pp. 797-802.
Di Tullio MR, Sacco RL, Sciacca RR, et al. Patent foramen ovale and the risk of ischemic stroke in a multiethnic population. J Am Coll Cardiol. 2007;49(7):797-802.
Di Tullio, M. R., Sacco, R. L., Sciacca, R. R., Jin, Z., & Homma, S. (2007). Patent foramen ovale and the risk of ischemic stroke in a multiethnic population. Journal of the American College of Cardiology, 49(7), 797-802.
Di Tullio MR, et al. Patent Foramen Ovale and the Risk of Ischemic Stroke in a Multiethnic Population. J Am Coll Cardiol. 2007 Feb 20;49(7):797-802. PubMed PMID: 17306710.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patent foramen ovale and the risk of ischemic stroke in a multiethnic population. AU - Di Tullio,Marco R, AU - Sacco,Ralph L, AU - Sciacca,Robert R, AU - Jin,Zhezhen, AU - Homma,Shunichi, Y1 - 2007/02/05/ PY - 2006/06/27/received PY - 2006/08/11/revised PY - 2006/08/14/accepted PY - 2007/2/20/pubmed PY - 2007/3/14/medline PY - 2007/2/20/entrez SP - 797 EP - 802 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 49 IS - 7 N2 - OBJECTIVES: We sought to assess the risk of ischemic stroke from a patent foramen ovale (PFO) in the multiethnic prospective cohort of northern Manhattan. BACKGROUND: Patent foramen ovale has been associated with increased risk of ischemic stroke, mainly in case-control studies. The actual PFO-related stroke risk in the general population is unclear. METHODS: The presence of PFO was assessed at baseline by using transthoracic 2-dimensional echocardiography with contrast injection in 1,100 stroke-free subjects older than 39 years of age (mean age 68.7 +/- 10.0 years) from the Northern Manhattan Study (NOMAS). The presence of atrial septal aneurysm (ASA) also was recorded. Subjects were followed annually for outcomes. We assessed PFO/ASA-related stroke risk after adjusting for established stroke risk factors. RESULTS: We detected PFO in 164 subjects (14.9%); ASA was present in 27 subjects (2.5%) and associated with PFO in 19 subjects. During a mean follow-up of 79.7 +/- 28.0 months, an ischemic stroke occurred in 68 subjects (6.2%). After adjustment for demographics and risk factors, PFO was not found to be significantly associated with stroke (hazard ratio 1.64, 95% confidence interval [CI] 0.87 to 3.09). The same trend was observed in all age, gender, and race-ethnic subgroups. The coexistence of PFO and ASA did not increase the stroke risk (adjusted hazard ratio 1.25, 95% CI 0.17 to 9.24). Isolated ASA was associated with elevated stroke incidence (2 of 8, or 25%; adjusted hazard ratio 3.66, 95% CI 0.88 to 15.30). CONCLUSIONS: Patent foramen ovale, alone or together with ASA, was not associated with an increased stroke risk in this multiethnic cohort. The independent role of ASA needs further assessment in appositely designed and powered studies. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/17306710/Patent_foramen_ovale_and_the_risk_of_ischemic_stroke_in_a_multiethnic_population_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(06)02995-0 DB - PRIME DP - Unbound Medicine ER -