---
title: "Atrial fibrillation and thromboembolic risk in the EpiHealth cohort: arterial and noncerebral even"
id: "pubmed-42862737"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42862737"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42862737/"
doi: "10.1080/14017431.2026.2748120"
published_at: "2026-10-20T12:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Atrial fibrillation and thromboembolic risk in the EpiHealth cohort: arterial and noncerebral even
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42862737
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42862737/)
- **DOI:** [10.1080/14017431.2026.2748120](https://doi.org/10.1080%2F14017431.2026.2748120)
- **Published At:** 2026-10-20T12:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This population-based longitudinal cohort study used EpiHealth participants enrolled April 2011–December 2016 and followed via Swedish health registers until first thromboembolic event (TE), death, or 31 Dec 2016. - At baseline 873 of 22,616 participants (3.9%) had prevalent **atrial fibrillation**; 297 developed incident AF during follow-up. - Across 70,587 person-years, 484 participants experienced ≥1 TE; participants with AF had higher TE incidence (68 events, 5.9%; p < 0.001). - The TE burden in AF was predominantly arterial (73.5% of events), and 94% of arterial events involved the cerebral circulation. - Approximately one-quarter of TEs among participants with AF were outside the cerebral circulation and included both venous and non-cerebral arterial events. - Although incident AF represented <25% of the AF population, those individuals accounted for 40% of TEs within the AF group. - Oral anticoagulant (OAC) use rose from 39.0% to 50.4% during the observation period, with a documented switch from warfarin toward direct oral anticoagulants. - Time-dependent Cox regression adjusted for age, sex, and prior arterial TE showed untreated AF was associated with increased TE risk versus no AF (HR 2.53); OAC use was associated with lower risk (authors reported reduced risk but did not provide an exact hazard ratio in the abstract). - Authors conclude AF confers substantially increased thromboembolic risk, largely arterial and cerebral; they noted that one in five TEs among AF patients coincided with newly diagnosed AF, indicating potential windows for earlier detection and treatment.
## Clinical Analysis & Structured Key Points
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Epub 2026 Oct 20. # Beyond stroke: atrial fibrillation and the broader burden of thromboembolic events in the population-based EpiHealth study [Pernilla Höiby](https://pubmed.ncbi.nlm.nih.gov/?term=H%C3%B6iby+P&cauthor_id=42862737)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42862737/#full-view-affiliation-1 "Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden."), [Moncef Zarrouk](https://pubmed.ncbi.nlm.nih.gov/?term=Zarrouk+M&cauthor_id=42862737)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42862737/#full-view-affiliation-2 "Division of Vascular Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden."), [Lars Lind](https://pubmed.ncbi.nlm.nih.gov/?term=Lind+L&cauthor_id=42862737)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862737/#full-view-affiliation-3 "Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden."), [Rani Basna](https://pubmed.ncbi.nlm.nih.gov/?term=Basna+R&cauthor_id=42862737)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42862737/#full-view-affiliation-1 "Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden."), [Marie Claire Overton](https://pubmed.ncbi.nlm.nih.gov/?term=Overton+MC&cauthor_id=42862737)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42862737/#full-view-affiliation-1 "Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden."), [Sölve Elmståhl](https://pubmed.ncbi.nlm.nih.gov/?term=Elmst%C3%A5hl+S&cauthor_id=42862737)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42862737/#full-view-affiliation-1 "Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.") Affiliations Expand ### Affiliations * 1 Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden. * 2 Division of Vascular Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden. * 3 Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden. * PMID: **42862737** * DOI: [ 10.1080/14017431.2026.2748120 ](https://doi.org/10.1080/14017431.2026.2748120) Free article Item in Clipboard # Beyond stroke: atrial fibrillation and the broader burden of thromboembolic events in the population-based EpiHealth study Pernilla Höiby et al. Scand Cardiovasc J. 2027 Dec. Free article Show details Display options Display options Format Abstract PubMed PMID Scand Cardiovasc J Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Scand+Cardiovasc+J%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Scand+Cardiovasc+J%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42862737/) . 2027 Dec;61(1):2748120. doi: 10.1080/14017431.2026.2748120. Epub 2026 Oct 20. ### Authors [Pernilla Höiby](https://pubmed.ncbi.nlm.nih.gov/?term=H%C3%B6iby+P&cauthor_id=42862737)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42862737/#short-view-affiliation-1 "Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden."), [Moncef Zarrouk](https://pubmed.ncbi.nlm.nih.gov/?term=Zarrouk+M&cauthor_id=42862737)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42862737/#short-view-affiliation-2 "Division of Vascular Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden."), [Lars Lind](https://pubmed.ncbi.nlm.nih.gov/?term=Lind+L&cauthor_id=42862737)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42862737/#short-view-affiliation-3 "Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden."), [Rani Basna](https://pubmed.ncbi.nlm.nih.gov/?term=Basna+R&cauthor_id=42862737)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42862737/#short-view-affiliation-1 "Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden."), [Marie Claire Overton](https://pubmed.ncbi.nlm.nih.gov/?term=Overton+MC&cauthor_id=42862737)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42862737/#short-view-affiliation-1 "Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden."), [Sölve Elmståhl](https://pubmed.ncbi.nlm.nih.gov/?term=Elmst%C3%A5hl+S&cauthor_id=42862737)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42862737/#short-view-affiliation-1 "Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.") ### Affiliations * 1 Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden. * 2 Division of Vascular Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden. * 3 Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden. * PMID: **42862737** * DOI: [ 10.1080/14017431.2026.2748120 ](https://doi.org/10.1080/14017431.2026.2748120) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Objectives:** To investigate the distribution and risk of thromboembolic events (TEs) among adults with and without atrial fibrillation (AF), and to assess oral anticoagulant (OAC) use over time. **Design:** This population-based longitudinal cohort study included EpiHealth participants recruited between April 2011 and December 2016 and followed through linkage to Swedish health data registers from baseline until the first TE, death, or December 31, 2016. **Results:** At baseline, 873 of 22,616 participants (3.9%) had AF and 297 developed incident AF during follow-up. 484 participants experienced at least one TE during 70,587 person-years. Participants with AF had higher TE incidence (68 events, 5.9%; _p_ < 0.001), predominantly arterial (73.5%), with 94% of arterial events involving the cerebral circulation. Approximately one quarter of TEs among participants with AF occurred outside the cerebral circulation and comprised both venous and non-cerebral arterial events. Although participants with incident AF represented less than one quarter of participants with AF, they accounted for 40% of TEs in the AF group. OAC use increased from 39.0% to 50.4%, with a shift from predominantly warfarin to direct oral anticoagulants. In time-dependent Cox regression adjusted for age, sex, and prior arterial thromboembolism, untreated AF was associated with increased thromboembolic risk compared with no AF (HR 2.53), whereas OAC use was associated with lower risk. **Conclusions:** AF was associated with substantially increased thromboembolic risk, predominantly arterial in nature. One in five TEs among participants with AF coincided with newly diagnosed AF, suggesting potential opportunities for earlier AF detection and timely initiation of anticoagulant treatment. **Keywords:** Atrial fibrillation; arterial thromboembolism; oral anticoagulants; risk reduction; venous thromboembolism. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Effectiveness and Safety of Apixaban Initiation Following Newly-Diagnosed Atrial Fibrillation in Patients With Kidney Failure on Hemodialysis. ](https://pubmed.ncbi.nlm.nih.gov/41352721/) Winkelmayer WC, Erickson KF, Khairallah P, He M, Montez-Rath ME, Chang TI, Niu J.Winkelmayer WC, et al.Am J Kidney Dis. 2026 Mar;87(3):313-323. doi: 10.1053/j.ajkd.2025.10.009. Epub 2025 Dec 4.Am J Kidney Dis. 2026.PMID: 41352721 * [ Discontinuation of Oral Anticoagulation After Successful Atrial Fibrillation Ablation. ](https://pubmed.ncbi.nlm.nih.gov/40116829/) Iwawaki T, Yanagisawa S, Inden Y, Hiramatsu K, Yamauchi R, Miyamae K, Miyazawa H, Goto T, Kondo S, Tachi M, Shimojo M, Tsuji Y, Murohara T.Iwawaki T, et al.JAMA Netw Open. 2025 Mar 3;8(3):e251320. doi: 10.1001/jamanetworkopen.2025.1320.JAMA Netw Open. 2025.PMID: 40116829Free PMC article. * [ Screening for Atrial Fibrillation: An Evidence Review for the U.S. Preventive Services Task Force [Internet]. ](https://pubmed.ncbi.nlm.nih.gov/35171547/) Kahwati L, Asher GN, Kadro ZO, Keen S, Ali R, Coker-Schwimmer E, Jonas DE.Kahwati L, et al.Rockville (MD): Agency for Healthcare Research and Quality (US); 2022 Jan. Report No.: 21-05277-EF-1.Rockville (MD): Agency for Healthcare Research and Quality (US); 2022 Jan. Report No.: 21-05277-EF-1.PMID: 35171547Free Books & Documents.Review. * [ Incidence, Risk Factors, and Outcomes in Stressor-Associated Atrial Fibrillation: Insights From the VITAL-AF Trial. ](https://pubmed.ncbi.nlm.nih.gov/41662456/) Haimovich JS, Kany S, Chang Y, Borowsky LH, McManus DD, Atlas SJ, Singer DE, Lubitz SA, Ellinor PT, Khurshid S.Haimovich JS, et al.Circulation. 2026 Feb 10;153(6):367-378. doi: 10.1161/CIRCULATIONAHA.125.076421. Epub 2025 Nov 8.Circulation. 2026.PMID: 41662456Free PMC article.Clinical Trial. * [ Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. ](https://pubmed.ncbi.nlm.nih.gov/36321557/) Crider K, Williams J, Qi YP, Gutman J, Yeung L, Mai C, Finkelstain J, Mehta S, Pons-Duran C, Menéndez C, Moraleda C, Rogers L, Daniels K, Green P.Crider K, et al.Cochrane Database Syst Rev. 2022 Feb 1;2(2022):CD014217. doi: 10.1002/14651858.CD014217.Cochrane Database Syst Rev. 2022.Update in: [Cochrane Database Syst Rev. 2026 Feb 18;2:CD014217. doi: 10.1002/14651858.CD014217.pub2.](https://pubmed.ncbi.nlm.nih.gov/41705996/)PMID: 36321557Free PMC article.Updated. 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