Reply One More “C” for CHA 2 DS 2 -VASc Score

We thank Dr. Siu for his comments regarding our recently published paper (1) about the usefulness of the CHA2DS2-VASc score for refining stroke risk stratification among patients with atrial fibrillation (AF) having an ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) score of 0 to 5. We agree that the risk of ischemic stroke for Chinese AF patients with a CHA2DS2-VASc score of 0 is higher than that of Caucasians. However, it does not mean that non-vitamin K antagonist oral anticoagulants (NOACs) should be routinely prescribed for these patients. Our previous study demonstrated that the risk of ischemic stroke for AF and non-AF patients with a CHA2DS2-VASc score of 0 was similar (2). Therefore, the better way to reduce stroke risk among these patients is to try to identify “novel” risk factors that were not included in the CHA2DS2-VASc scheme for these “low-risk” patients. For example, hyperuricemia, defined as having at least 1 episode of gout attack necessitating long-term treatment with uric acid–lowering agents, was shown to be an important risk factor of ischemic stroke for AF patients in Taiwan (3). Interestingly, hyperuricemia was associated with a higher risk of ischemic stroke even among patients with a CHA2DS2-VASc score of 0, suggesting that it may refine stroke risk stratification in this “low-risk” population.
Source: Journal of the American College of Cardiology - Category: Cardiology Source Type: research