For decades, stroke has been the principally recognized and most clinically relevant sequelae of atrial fibrillation (AF).1 However, a recent analysis demonstrated that AF may also lead to worsening renal function, a particularly important observation given that chronic kidney disease has been primarily considered a risk factor for the development of AF.2 While coronary artery disease and myocardial infarction (MI) have been demonstrated to increase AF risk,1 Soliman et al,3 in this issue of JAMA Internal Medicine, show that AF itself may also lead to an increased risk of incident MI. These data therefore add to the growing recognition of important bidirectional relationships between AF and other cardiovascular comorbidities. Just as “AF begets AF,”4 we are learning it may also lead to kidney disease, heart failure, and now MI. As we consider these new findings and their implications, we must first carefully examine the strengths and limitations of this recent study as well as the mechanisms through which these observed associations might occur.
Results are presented as relative risk (RR) of myocardial infarction of warfarin vs placebo or warfarin vs antiplatelet therapy with 95% CI. An RR less than 1 favors anticoagulation use, while an RR greater than 1 favors placebo or antiplatelet therapy. The results for trials using placebo as a comparator alone and antiplatelet agents (including aspirin) as a comparator alone are shown by pale-shaded diamonds. The dark-shaded diamond shows the overall result for the meta-analysis of all studies.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 3
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Does This Patient Have a Hemorrhagic Stroke?
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.