Patent foramen ovale and the risk of first ischemic stroke

Abstract

Evaluation of: Di Tullio MR, Sacco RL, Sciacca RR, Jin Z, Homma S. Patent foramen ovale and the risk of ischemic stroke in a multiethnic population. J. Am. Coll. Cardiol. 49(7), 797–802 (2007).

Several case–controlled studies have demonstrated an association between patent foramen ovale (PFO) and cryptogenic stroke. However, the risk of first stroke associated with a PFO in the general population is unknown. Di Tullio et al. sought to determine prospectively the relationship between PFO and the occurrence of first ischemic stroke in a population- based study of 1148 participants. No statistically significant association between PFO and ischemic stroke was found (hazard ratio: 1.64; 95% confidence interval: 0.87–3.09). Additional subgroup analysis stratifying groups according to age and gender also did not reveal a statistically significant association between the two conditions. Hence, this study demonstrates that a PFO conveys no increased risk for the development of ischemic stroke in the general population, a somewhat expected finding. However, considering all factors the main question should have been: which subset of PFOs causes cryptogenic stroke? A question that has not yet been addressed.

Keywords::

• cryptogenic stroke
• patent foramen ovale

Financial disclosure

The authors have no relevant financial interests related to this manuscript, including employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.