Firstly, I must make it absolutely clear that I am not medically trained and the following is my interpretation of what we were told last evening with regard to this important question. Other members of the forum were also present, so I'm sure if they think I got the message wrong they will comment, but the purpose of the post is to share what was said which certainly made sense to me.
We have all read or heard it said many times that anyone with AF is 5 times more likely to experience a stroke than someone who does not have AF. Many AF'ers have actually asked what does that really mean in our world!
The questioner (not me) asked what I believe was a fictitious question, "I have a twin brother who is the same as me in every respect other than I have AF and he doesn't. What is my risk of having stroke compared with his! We were told that any one above a certain age, regardless of their health, lifestyle etc etc., was subject to a risk of stroke, albeit a very low of say 1% or 2%. So, if you base your interpretation on this person but add AF, their risk of stroke increases to 5% or 10%. However, provided that person is taking Warfarin, their risk of stroke reduces by 65% or probably 70% if taking a DOAC. This means their risk of stroke reduces and is now 1.75% compared to the 1% or 3.5% compared to the 5% and marginally lower if taking a DOAC.
But if the non AF person is obese, an alcoholic, diabetic and a smoker then his base risk is significantly higher and a similar person with AF would equally be exposed to a significantly higher stroke risk, but still benefits from the anticoagulant discount.
Because, due to a multitude of variables, it is impossible to make accurate comparisons between people with AF and others lucky enough NOT to have AF clearly these percentages become meaningless but the core principle applies. If we are exposed to a risk 5 times greater than people without AF, at least we can mitigate that risk by taking anticoagulants and improving our lifestyles which I assume means we can reduce our risk of stroke to levels well below those of many folk who do not have AF!!
Anyway, that is my understanding of what we were told. We were also told that there was no benefit in taking anticoagulants unless your CHADsVASc score was 1 or more/
My EP tried to simplify this early on when he explained that 5 times a very small number is still a small number (my Score is 0) but I think you are right to note that the increased variants of risks (hypertension etc..)can result in the 5 times increased risk being quite significant. It is a complex one to get your head around though- thanks for posting the information you were given.
You are pretty well on the ball there FJ . As our very own Dr Gupta has said it is not the AF but the company it keeps that is the risk. As we get older our stroke risk increases and as you will know there are two As in Chadsvasc, both for age.! The system is designed to guide patients and doctors to the best risk/benefit solution in most cases but as ever nothing is 100% foolproof. As we say in engine building"if you make something fool proof they will make a better fool! "
Thank you Flapjack.My night terror is to have an AF stroke like my mum did..didnt survive ,was not on anticoagulants.Dad had several strokes,even though he was anticoagulated...no AF but had bypass and valve replacement.Last one was life changing.
This puts things into calmer perspective for me.Wish i had been there,but live in Leafy Warwickshire.....best wishes
My personal feeling remains that we have the primary responsibilityfor our own health and if we can enlist the help of healthcare professionals that is also good.
I still struggle with figures because of the mighty bell curve that rules statistics and my optimism is my biggest tool when it comes to my health. I will always be ( in my eyes) the person who does better than average in the life expectancy stakes!!
On the face of it, I have no lifestyle changes to make, I take my medication, exercise, eat well and am not overweight, I don't think there is anything else I can do. I find it very very hard, given that I lost my sister to a stroke last year, not to think about it so I avoid articles and posts about strokes as it is still so raw and painful.
But the heading of your post, Flapjack, got me interested! I completely understand your points, and in the meantime, I remember Sir Winston Churchill's comment “Statistics are like a drunk with a lamp post: used more for support than illumination.”
Thank you that put it nicely into perspective, I think the way things get presented are for the benefit of the drug companies rather the patient. I have been concerned by the stats I have read after starting Digoxin 6 weeks ago but yesterday the Cardiologist explained the risk in real terms based on my particular condition, medication and dosage. It can be difficult to ask the right questions but if you do you will get a far better perspective than you can make by just reading the internet.
Thank you Flapjack - I find the whole issue of stroke risk very confusing. The company which AF keeps is Dr Gupta's theory but there is also research which points toward a condition in the atria which fosters AF in the first place. The intricacies are enormous so I plough on and keep taking the tablets.
When I was first diagnosed (4 years ago), my EP told me that the average risk was 2% and mine was five times higher (i.e. 10%). Still a fairly low risk, but not many are willing to take that risk. I'm not.
Much appreciated, I am in no way complacent but I agree with your sentiment that the x5 statistic is not questioned enough nor the focus on how lifestyle changes can reverse that statistic.
I have already had a stroke and stats say I'm 7 times more likely to have another. 7 times more likely than what? Does that go down if I stay away from doctors? LOL
The "five times stroke risk" combines everyone with AF into one entity, when everyone is unique and has their own stroke risk profile. The problem with pooling everyone together and declaring that they have a high stroke risk is that people with AF are more likely than the rest of the population to have other stroke risks, like high blood pressure and vascular disease. It's been pointed out that stroke risk in AF is mainly due to the "company it keeps" like high blood pressure. The key word is "mainly", because I suspect AF might also be an independent risk factor for stroke - but one that is difficult to demonstrate. Many people with AF take steps to lead a healthy lifestyle (to reduce their AF burden) and these "healthy" steps reduce their stroke risk, countering any stroke risk from AF and thereby making it hard to quantify in research outcomes. For this reason, I suspect if you have lone AF (i.e., no other risk factors) and lead a healthy lifestyle, you're *somewhat* more susceptible to stroke than a person who doesn't have AF and also leads a healthy lifestyle. Thus far, it's been hard for medical researchers to put a number on the increased risk from AF alone. It's unlikely to be as high as "five times" the risk, but it probably shouldn't be ignored. At this point, combining CHA₂DS₂-VASc with HAS-BLED is the best tool we have.
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HASBLED
