1
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Wu G, Wu J, Lu Q, Cheng Y, Mei W. Association between cardiovascular risk factors and atrial fibrillation. Front Cardiovasc Med 2023; 10:1110424. [PMID: 37753167 PMCID: PMC10518410 DOI: 10.3389/fcvm.2023.1110424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
Background The most prevalent sustained arrhythmia in medical practice, atrial fibrillation (AF) is closely associated with a high risk of cardiovascular disease. Nevertheless, the risk of AF associated with cardiovascular risk factors has not been well elucidated. We pooled all published studies to provide a better depiction of the relationship among cardiovascular risk factors with AF. Methods Studies were searched in the MEDLINE, Web of Science, and EMBASE databases since initiation until January 15, 2022. Prospective cohort studies assessing the relationship a minimum of single cardiovascular risk factors to AF incidence were included if they contained adequate data for obtaining relative risks (RR) and 95% confidence intervals (CI). Random-effects models were utilized to perform independent meta-analyses on each cardiovascular risk factor. PROSPERO registry number: CRD42022310882. Results A total of 17,098,955 individuals and 738,843 incident cases were reported for data from 101 studies included in the analysis. In all, the risk of AF was 1.39 (95% CI, 1.30-1.49) for obesity, 1.27 (95% CI, 1.22-1.32) per 5 kg/m2 for increase in body mass index, 1.19 (95% CI, 1.10-1.28) for former smokers, 1.23 (95% CI, 1.09-1.38) for current smokers, 1.31 (95% CI, 1.23-1.39) for diabetes mellitus, 1.68 (95% CI, 1.51-1.87) for hypertension, and 1.12 (95% CI, 0.95-1.32) for dyslipidemia. Interpretation Adverse cardiovascular risk factors correlate with an increased risk of AF, yet dyslipidemia does not increase the risk of AF in the general population, potentially providing new insights for AF screening strategies among patients with these risk factors. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, PROSPERO identifier (CRD42022310882).
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Affiliation(s)
- Guohao Wu
- Department of General Practice, Huadu District People's Hospital, Southern Medical University, Guangzhou, China
| | - Jingguo Wu
- Department of Emergency Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qin Lu
- Department of General Practice, The First Affiliated Hospital, Sun Yat-Sen University,Guangzhou, China
| | - Yunjiu Cheng
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University,Guangzhou, China
| | - Weiyi Mei
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University,Guangzhou, China
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2
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Ahn HJ, Lee SR, Choi EK, Lee SW, Han KD, Kwon S, Oh S, Lip GYH. Evaluation of the Paradoxical Association Between Lipid Levels and Incident Atrial Fibrillation According to Statin Usage: A Nationwide Cohort Study. J Lipid Atheroscler 2023; 12:73-86. [PMID: 36761066 PMCID: PMC9884554 DOI: 10.12997/jla.2023.12.1.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/14/2022] [Accepted: 11/17/2022] [Indexed: 01/26/2023] Open
Abstract
Objective Higher levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) are associated with a lower risk of atrial fibrillation (AF). Statin use might exert confounding effects on the paradoxical associations; however, the relationships that distinguish statin users from non-users have not been thoroughly evaluated. Methods From the Korean National Health Insurance Database, we included 9,778,014 adults who underwent a health examination in 2009. The levels of TC and LDL-C at the health examination were categorized into quartile values of the total study population. We grouped the study population into statin users and non-users and investigated the associations between TC, LDL-C, and the risk of incident AF. Results Of the total population, 867,336 (8.9%) were taking statins. During a mean follow-up of 8.2 years, inverse associations of TC - AF and LDL-C - AF were observed; higher levels of TC and LDL-C were associated with the lower risk of AF in the total population. Overall, statin users showed higher AF incidence rate than non-users, but the inverse associations of TC - AF and LDL-C - AF were consistently observed irrespective of statin usage; adjusted hazard ratio with 95% confidence interval was 0.81 (0.79-0.84) for statin users and 0.81 (0.80-0.83) for non-users in the highest TC quartile, and 0.84 (0.82-0.87) for statin users and 0.85 (0.84-0.86) for non-users in the highest LDL-C quartile (all p<0.001). Conclusion The paradoxical relationship between lipid levels (TC and LDL-C) and the risk of AF remains consistent in both statin users and non-users.
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Affiliation(s)
- Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Woo Lee
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gregory Y. H. Lip
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest & Heart Hospital, Liverpool, United Kingdom.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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3
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Maloberti A, Fabbri S, Colombo V, Gualini E, Monticelli M, Daus F, Busti A, Galasso M, De Censi L, Algeri M, Merlini PA, Giannattasio C. Lipoprotein(a): Cardiovascular Disease, Aortic Stenosis and New Therapeutic Option. Int J Mol Sci 2022; 24:ijms24010170. [PMID: 36613613 PMCID: PMC9820656 DOI: 10.3390/ijms24010170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Atherosclerosis is a chronic and progressive inflammatory process beginning early in life with late clinical manifestation. This slow pathological trend underlines the importance to early identify high-risk patients and to treat intensively risk factors to prevent the onset and/or the progression of atherosclerotic lesions. In addition to the common Cardiovascular (CV) risk factors, new markers able to increase the risk of CV disease have been identified. Among them, high levels of Lipoprotein(a)-Lp(a)-lead to very high risk of future CV diseases; this relationship has been well demonstrated in epidemiological, mendelian randomization and genome-wide association studies as well as in meta-analyses. Recently, new aspects have been identified, such as its association with aortic stenosis. Although till recent years it has been considered an unmodifiable risk factor, specific drugs have been developed with a strong efficacy in reducing the circulating levels of Lp(a) and their capacity to reduce subsequent CV events is under testing in ongoing trials. In this paper we will review all these aspects: from the synthesis, clearance and measurement of Lp(a), through the findings that examine its association with CV diseases and aortic stenosis to the new therapeutic options that will be available in the next years.
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Affiliation(s)
- Alessandro Maloberti
- Cardiology 4, Cardio Center A. De Gasperis, ASST GOM Niguarda, 20162 Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
- Correspondence: ; Tel.: +39-02-644-478-55; Fax: +39-02-644-425-66
| | - Saverio Fabbri
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Valentina Colombo
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Elena Gualini
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | | | - Francesca Daus
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Andrea Busti
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Michele Galasso
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Lorenzo De Censi
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Michela Algeri
- Cardiology 4, Cardio Center A. De Gasperis, ASST GOM Niguarda, 20162 Milan, Italy
| | | | - Cristina Giannattasio
- Cardiology 4, Cardio Center A. De Gasperis, ASST GOM Niguarda, 20162 Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
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4
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Mackey RH, Rohatgi A. Is there a connection between HDL and atrial fibrillation? J Clin Lipidol 2022; 16:386-388. [PMID: 35988955 DOI: 10.1016/j.jacl.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Rachel H Mackey
- Assistant Professor of Epidemiology (Adjunct), University of Pittsburgh School of Public Health, Pittsburgh, PA 15261; Principal Research Scientist, Premier Applied Sciences, Premier, Inc., Charlotte, NC 28277.
| | - Anand Rohatgi
- Professor of Medicine, Cardiovascular Director of Academic Development, Preventive Cardiology, South Asian Heart Program, Division of Cardiology/Department of Internal Medicine, UT Southwestern Medical Center
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5
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Tajik B, Tuomainen TP, Jarroch R, Kauhanen J, Lip GY, Isanejad M. Lipid levels, apolipoproteins, and risk of incident atrial fibrillation in men: A report from the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD). J Clin Lipidol 2022; 16:447-454. [DOI: 10.1016/j.jacl.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 04/07/2022] [Accepted: 04/20/2022] [Indexed: 12/25/2022]
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6
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Tanaka Y, Matsuyama S, Tada H, Hayashi K, Takamura M, Kawashiri MA, Passman R, Greenland P. Association of Lower Urinary Tract Symptoms Based on the International Prostate Symptom Score and Cardiovascular Disease. Circ J 2021; 85:2092-2099. [PMID: 34219077 DOI: 10.1253/circj.cj-21-0278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Because it is unclear whether lower urinary tract symptoms (LUTS) are associated with cardiovascular disease (CVD) in the Japanese population, we explored the association in general Japanese men aged 55-75 years.Methods and Results:The cross-sectional study included male participants who had both national health checkup data and the International Prostate Symptom Score (IPSS) in the same calendar year between 2009 and 2017. LUTS severity was evaluated by IPSS. A robust Poisson regression model was used to assess the association between LUTS severity and the composite CVD outcome [coronary artery disease (CAD), stroke, or atrial fibrillation (AF)] and each component of the composite outcome. Prevalence ratio (PR) was adjusted for conventional cardiovascular risk factors. Of 16,781 male participants (mean age, 67±5 years), mild LUTS were observed in 9,243 (55.1%); moderate, 6,445 (38.4%); and severe, 1,093 (6.5%). Compared with the mild LUTS group, moderate LUTS [PR 1.18, 95% confidence interval (CI) 1.10-1.25, P<0.001] and severe LUTS (PR 1.38, 95% CI 1.24-1.53, P<0.001) were significantly associated with a higher prevalence of CVD. LUTS severity was associated with higher prevalence of CAD and stroke, but not AF. CONCLUSIONS The severity of LUTS was associated with a higher prevalence of CVD, especially CAD and stroke, independent of conventional CVD risk factors.
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Affiliation(s)
- Yoshihiro Tanaka
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine.,Center for Arrhythmia Research, Northwestern University Feinberg School of Medicine.,Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | | | - Hayato Tada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Masa-Aki Kawashiri
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Rod Passman
- Center for Arrhythmia Research, Northwestern University Feinberg School of Medicine.,Division of Cardiology, Northwestern University Feinberg School of Medicine
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
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7
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Garg PK, Guan W, Karger AB, Steffen BT, O'Neal W, Heckbert SR, Michos ED, Tsai MY. Lp(a) (Lipoprotein [a]) and Risk for Incident Atrial Fibrillation: Multi-Ethnic Study of Atherosclerosis. Circ Arrhythm Electrophysiol 2020; 13:e008401. [PMID: 32302223 DOI: 10.1161/circep.120.008401] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Parveen K Garg
- Division of Cardiology, University of Southern California, Los Angeles (P.K.G.)
| | - Weihua Guan
- Division of Biostatistics, School of Public Health (W.G.), University of Minnesota, Minneapolis
| | - Amy B Karger
- Department of Laboratory Medicine and Pathology (A.B.K., B.T.S., M.Y.T.), University of Minnesota, Minneapolis
| | - Brian T Steffen
- Department of Laboratory Medicine and Pathology (A.B.K., B.T.S., M.Y.T.), University of Minnesota, Minneapolis
| | - Wesley O'Neal
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (W.O.)
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle (S.R.H.)
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (E.D.M.)
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology (A.B.K., B.T.S., M.Y.T.), University of Minnesota, Minneapolis
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8
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Guan B, Li X, Xue W, Tse G, Waleed KB, Liu Y, Zheng M, Wu S, Xia Y, Ding Y. Blood lipid profiles and risk of atrial fibrillation: A systematic review and meta-analysis of cohort studies. J Clin Lipidol 2019; 14:133-142.e3. [PMID: 31926850 DOI: 10.1016/j.jacl.2019.12.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is an increasing body of evidence associating traditional cardiovascular risk factors with atrial fibrillation (AF), but the relationship between blood lipid profiles and the risk of AF remains controversial. OBJECTIVE This study aimed to conduct a systemic review and meta-analysis of large cohort studies to evaluate the relationship between blood lipid profiles and incident AF. METHODS PubMed and Embase were searched up to January 31, 2019, for cohort studies that reported the relationship between blood lipid levels and incident AF. The hazard ratios or odds ratios of the highest vs lowest categories of lipid levels were extracted to calculate pooled estimates. Sensitivity analysis and meta-regression were performed to explore potential sources of heterogeneity. RESULTS Eleven studies were included in the meta-analysis, including 9 studies for total cholesterol (TC), 5 for low-density lipoprotein cholesterol (LDL-C), 8 for high-density lipoprotein cholesterol (HDL-C), and 8 for triglyceride. Serum TC and LDL-C levels were inversely related to AF risk (relative risk [RR] = 0.81, 95% confidence interval [CI]: 0.72-0.92; RR = 0.79, 95% CI: 0.70-0.88, respectively). Likewise, elevated HDL-C levels were associated with a reduced AF risk (RR = 0.86, 95% CI: 0.76-0.97), whereas no significant association was observed between triglyceride levels and incident AF (RR = 1.02, 95% CI: 0.90-1.17). CONCLUSIONS Our meta-analysis of large cohort studies found an inverse relationship between serum TC, LDL-C, and HDL-C levels and AF risk, although there was no significant association between TG levels and incident AF. Future studies regarding AF risk stratification may take these blood lipids into consideration, and further efforts are needed to investigate the potential mechanisms.
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Affiliation(s)
- Bo Guan
- Department of Geriatrics, The First People's Hospital of Changzhou, Changzhou, China; Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xintao Li
- Department of Cardiology, The First People's Hospital of Changzhou, Changzhou, China; Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wenqiang Xue
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Gary Tse
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Khalid Bin Waleed
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yichen Liu
- Department of Cardiology, The First People's Hospital of Taicang, Suzhou, China
| | - Mengyi Zheng
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Yi Ding
- Department of Geriatrics, The First People's Hospital of Changzhou, Changzhou, China.
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9
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Lee H, Lee S, Choi E, Han K, Oh S. Low Lipid Levels and High Variability are Associated With the Risk of New-Onset Atrial Fibrillation. J Am Heart Assoc 2019; 8:e012771. [PMID: 31771440 PMCID: PMC6912974 DOI: 10.1161/jaha.119.012771] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background While high levels of lipids and lipid variability are established risk factors for atherosclerotic cardiovascular disease, their roles in the development of atrial fibrillation (AF) are unclear, with previous studies suggesting a “cholesterol paradox.” Methods and Results A nationwide population‐based cohort of 3 660 385 adults (mean age 43.4 years) from the Korean National Health Insurance Service database, with ≥3 annual lipid measurements from 2009 to 2012 and without a history of AF or prescription of lipid‐lowering medication before 2012, were identified. Total cholesterol, low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol, and triglycerides levels were measured, and lipid variability was calculated using variability independent of the mean. The cohort was divided into quartiles by lipid levels and lipid variability and followed up for incident AF. During a median 5.4 years of follow‐up, AF was newly diagnosed in 27 581 (0.75%). AF development was inversely associated with high lipid levels (for top versus bottom quartile; total cholesterol, HR 0.78, 95% CI 0.76–0.81; low‐density lipoprotein cholesterol, HR 0.81, 95% CI 0.78–0.84; high‐density lipoprotein cholesterol, HR 0.94, 95% CI 0.91–0.98; triglycerides, HR 0.88, 95% CI 0.85–0.92). Meanwhile, AF development was associated with high lipid variability (for top versus bottom quartile; total cholesterol, HR 1.09, 95% CI 1.06–1.13; low‐density lipoprotein cholesterol, HR 1.12, 95% CI 1.08–1.16; high‐density lipoprotein cholesterol, HR 1.08, 95% CI 1.04–1.12; triglycerides, HR 1.05, 95% CI 1.01–1.08). Men showed greater risk reduction with high triglyceride levels and greater risk with high triglyceride variability for incident AF. Conclusions Low cholesterol levels and high cholesterol variability were associated with a higher risk of AF development.
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Affiliation(s)
- Hyun‐Jung Lee
- Department of Internal MedicineSeoul National University HospitalSeoulRepublic of Korea
| | - So‐Ryoung Lee
- Department of Internal MedicineSeoul National University HospitalSeoulRepublic of Korea
| | - Eue‐Keun Choi
- Department of Internal MedicineSeoul National University HospitalSeoulRepublic of Korea
| | - Kyung‐Do Han
- Department of Medical StatisticsCollege of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Seil Oh
- Department of Internal MedicineSeoul National University HospitalSeoulRepublic of Korea
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10
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Roh E, Chung HS, Lee JS, Kim JA, Lee YB, Hong SH, Kim NH, Yoo HJ, Seo JA, Kim SG, Kim NH, Baik SH, Choi KM. Total cholesterol variability and risk of atrial fibrillation: A nationwide population-based cohort study. PLoS One 2019; 14:e0215687. [PMID: 31017966 PMCID: PMC6481829 DOI: 10.1371/journal.pone.0215687] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/05/2019] [Indexed: 12/24/2022] Open
Abstract
Background Long-term variability of cardiometabolic risk factors have been suggested as the risk factors for cardiovascular disease and mortality. However, the effect of long-term variability of total cholesterol (TC) on incident atrial fibrillation (AF) has not been examined. Methods and findings We explored whether visit-to-visit TC variability are associated with the risk of incident AF in 160,165 Korean adults, using the population-based Korean National Health Insurance Service–Health Screening Cohort (NHIS-HEALS) database, over a median duration of 8.4 years. TC variability was measured as coefficients of variance (TC-CV), standard deviation (TC-SD), and variability independent of the mean (TC-VIM). Kaplan–Meier analysis demonstrated a decreased disease-free probability in the highest quartile group of TC variability compared to that in the other groups. In the multivariate Cox proportional hazard analysis, the risk of AF increased significantly in the highest quartile group of TC variability. After multivariate adjustment for confounding variables including mean TC levels, the hazard ratio for incident AF was 1.15 (95% confidence interval 1.05–1.25; P = 0.0035) when comparing the highest with the lowest TC variability quartile (TC-CV). These relationships were consistent with TC variability defined using TC-SD or TC-VIM. Subgroup analyses, including age, sex, body mass index, and cardiometabolic disorders, showed similar results. Conclusions The present study is the first to demonstrate that high TC variability was associated with an increased risk of AF.
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Affiliation(s)
- Eun Roh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hye Soo Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung A. Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - So-hyeon Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ji A. Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- * E-mail:
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11
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Homan EA, Reyes MV, Hickey KT, Morrow JP. Clinical Overview of Obesity and Diabetes Mellitus as Risk Factors for Atrial Fibrillation and Sudden Cardiac Death. Front Physiol 2019; 9:1847. [PMID: 30666210 PMCID: PMC6330323 DOI: 10.3389/fphys.2018.01847] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/07/2018] [Indexed: 12/22/2022] Open
Abstract
The epidemics of obesity and diabetes mellitus are associated with an increased incidence of both atrial fibrillation (AF), the most common sustained arrhythmia in adults, and sudden cardiac death (SCD). Obesity and DM are known to have adverse effects on cardiac structure and function. The pathologic mechanisms are thought to involve cardiac tissue remodeling, metabolic dysregulation, inflammation, and oxidative stress. Clinical data suggest that left atrial size, epicardial fat pad thickness, and other modifiable risk factors such as hypertension, glycemic control, and obstructive sleep apnea may mediate the association with AF. Data from human atrial tissue biopsies demonstrate alterations in atrial lipid content and evidence of mitochondrial dysfunction. With respect to ventricular arrhythmias, abnormalities such as long QT syndrome, frequent premature ventricular contractions, and left ventricular hypertrophy with diastolic dysfunction are commonly observed in obese and diabetic humans. The increased risk of SCD in this population may also be related to excessive cardiac lipid deposition and insulin resistance. While nutritional interventions have had limited success, perhaps due to poor long-term compliance, weight loss and improved cardiorespiratory fitness may reduce the frequency and severity of AF.
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Affiliation(s)
- Edwin A Homan
- Columbia University Medical Center, New York, NY, United States
| | - Michael V Reyes
- Columbia University Medical Center, New York, NY, United States
| | | | - John P Morrow
- Columbia University Medical Center, New York, NY, United States
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12
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Lipidomic profiling reveals free fatty acid alterations in plasma from patients with atrial fibrillation. PLoS One 2018; 13:e0196709. [PMID: 29723222 PMCID: PMC5933795 DOI: 10.1371/journal.pone.0196709] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/18/2018] [Indexed: 12/18/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its incidence is increasing worldwide. One method used to restore sinus rhythm is direct current cardioversion (DCCV). Despite the high success rate of DCCV, AF typically recurs within the first 2 weeks. However, our understanding of the pathophysiology of AF recurrence, incidence, and progression are highly limited. Lipidomic profiling was applied to identify altered lipids in plasma from patients with AF using ultra-performance liquid chromatography/quadrupole time-of-flight mass spectrometry coupled with multivariate statistical analysis. Partial least-squares discriminant analysis revealed a clear separation between AF patients and healthy controls. The levels of several lipid species, including fatty acids and phospholipids, were different between AF patients and healthy controls, indicating that oxidative stress and inflammation are associated with the pathogenesis of AF. Similar patterns were also detected between recurrent and non-recurrent AF patients. These results suggest that the elevated saturated fatty acid and reduced polyunsaturated fatty acid levels in AF patients may be associated with enhanced inflammation and that free fatty acid levels may play a crucial role in the development and progression of AF.
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Zuo H, Svingen GFT, Tell GS, Ueland PM, Vollset SE, Pedersen ER, Ulvik A, Meyer K, Nordrehaug JE, Nilsen DWT, Bønaa KH, Nygård O. Plasma Concentrations and Dietary Intakes of Choline and Betaine in Association With Atrial Fibrillation Risk: Results From 3 Prospective Cohorts With Different Health Profiles. J Am Heart Assoc 2018; 7:JAHA.117.008190. [PMID: 29650710 PMCID: PMC6015426 DOI: 10.1161/jaha.117.008190] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Although choline metabolism has been associated with atherosclerotic heart disease, less research attention has been paid to the associations of choline and its oxidative metabolite betaine with cardiac arrhythmias. Methods and Results We evaluated associations of plasma concentrations and dietary intakes of choline and betaine with long‐term atrial fibrillation (AF) risk in a community‐based cohort, HUSK ([the Hordaland Health Study] n=6949), and validated the findings in 2 patient cohorts: the Western Norway Coronary Angiography Cohort (n=4164) and the NORVIT (Norwegian B‐Vitamin) Trial (n=3733). Information on AF was obtained from the CVDNOR (Cardiovascular Disease in Norway) project. In HUSK, WECAC (Western Norway Coronary Angiography Cohort), and NORVIT, 552, 411, and 663 AF cases were identified during a median follow‐up time of 10.9, 7.3, and, 8.7 years, respectively. Plasma concentrations of choline and betaine were significantly positively associated with later AF risk after multivariable adjustments in HUSK. Such associations were independently replicated in the 2 external prospective patient cohorts. The pooled hazard ratio was 1.13 (95% confidence interval 1.08‐1.19, P<0.001) and 1.16 (95% confidence interval 1.10‐1.22, P<0.001) per SD increment for log‐transformed choline and betaine, respectively. Moreover, dietary intake of choline was marginally associated with AF risk (pooled hazard ratio 1.29, 95% confidence interval 1.01‐1.66, fifth versus first quintile), whereas no significant association was observed between dietary betaine and AF risk. Conclusions Our findings indicate that plasma concentrations as well as dietary intake of choline, but not betaine, are associated with subsequent risk of AF, suggesting a potential role of choline metabolism in the pathogenesis of AF. Clinical Trial Registration URL: https://www.clinicaltrials.gov.Unique identifier: NCT00671346.
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Affiliation(s)
- Hui Zuo
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Gard F T Svingen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Norway.,Division of Mental and Physical Health, Department of Noncommunicable Diseases, Norwegian Institute of Public Health, Bergen, Norway
| | - Per M Ueland
- Department of Clinical Science, University of Bergen, Norway.,Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Stein E Vollset
- Department of Global Public Health and Primary Care, University of Bergen, Norway.,Centre for Burden of Disease, Norwegian Institute of Public Health, Bergen, Norway
| | - Eva R Pedersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | | | - Jan E Nordrehaug
- Department of Clinical Science, University of Bergen, Norway.,Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Dennis W T Nilsen
- Department of Clinical Science, University of Bergen, Norway.,Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Kaare H Bønaa
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway.,Clinic for Heart Disease, St. Olav's University Hospital, Trondheim, Norway
| | - Ottar Nygård
- Department of Clinical Science, University of Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Pol T, Held C, Westerbergh J, Lindbäck J, Alexander JH, Alings M, Erol C, Goto S, Halvorsen S, Huber K, Hanna M, Lopes RD, Ruzyllo W, Granger CB, Hijazi Z. Dyslipidemia and Risk of Cardiovascular Events in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Therapy: Insights From the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) Trial. J Am Heart Assoc 2018; 7:e007444. [PMID: 29419390 PMCID: PMC5850246 DOI: 10.1161/jaha.117.007444] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 12/04/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Dyslipidemia is a major risk factor for cardiovascular events. The prognostic importance of lipoproteins in patients with atrial fibrillation is not well understood. We aimed to explore the association between apolipoprotein A1 (ApoA1) and B (ApoB) and cardiovascular events in patients with atrial fibrillation receiving oral anticoagulation. METHODS AND RESULTS Using data from the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial, ApoA1 and ApoB plasma levels were measured at baseline in 14 884 atrial fibrillation patients. Median length of follow-up was 1.9 years. Relationships between continuous levels of ApoA1 and ApoB and clinical outcomes were evaluated using Cox models adjusted for cardiovascular risk factors, medication including statins, and cardiovascular biomarkers. A composite ischemic outcome (ischemic stroke, systemic embolism, myocardial infarction, and cardiovascular death) was used as the primary end point. Median (25th, 75th) ApoA1 and ApoB levels were 1.10 (0.93, 1.30) and 0.70 g/L (0.55, 0.85), respectively. In adjusted analyses, higher levels of ApoA1 were independently associated with a lower risk of the composite ischemic outcome (hazard ratio, 0.81; P<0.0001). Similar results were observed for the individual components of the composite outcome. ApoB was not significantly associated with the composite ischemic outcome (P=0.8240). Neither apolipoprotein was significantly associated with major bleeding. There was no interaction between lipoproteins and randomized treatment for the primary outcome (both P values ≥0.2448). CONCLUSIONS In patients with atrial fibrillation on oral anticoagulation, higher levels of ApoA1 were independently associated with lower risk of ischemic cardiovascular outcomes. Investigating therapies targeting dyslipidemia may thus be useful to improve cardiovascular outcomes in patients with atrial fibrillation. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00412984.
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Affiliation(s)
- Tymon Pol
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Claes Held
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Johan Westerbergh
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Johan Lindbäck
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | | - Marco Alings
- Working Group on Cardiovascular Research the Netherlands, Utrecht, The Netherlands
| | - Cetin Erol
- Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Shinya Goto
- Department of Medicine, School of Medicine, Tokai University, Isehara, Japan
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway
- University of Oslo, Norway
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenshopital, Vienna, Austria
- Medical School, Sigmund Freud University, Vienna, Austria
| | | | - Renato D Lopes
- Duke Clinical Research Institute, Duke Health, Durham, NC
| | | | | | - Ziad Hijazi
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
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15
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Interaction between TCF7L2 polymorphism and dietary fat intake on high density lipoprotein cholesterol. PLoS One 2017; 12:e0188382. [PMID: 29182660 PMCID: PMC5705148 DOI: 10.1371/journal.pone.0188382] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 10/18/2017] [Indexed: 12/25/2022] Open
Abstract
Recent evidence suggests that lifestyle factors influence the association between the Melanocortin 4 receptor (MC4R) and Transcription Factor 7-Like 2 (TCF7L2) gene variants and cardio-metabolic traits in several populations; however, the available research is limited among the Asian Indian population. Hence, the present study examined whether the association between the MC4R single nucleotide polymorphism (SNP) (rs17782313) and two SNPs of the TCF7L2 gene (rs12255372 and rs7903146) and cardio-metabolic traits is modified by dietary factors and physical activity. This cross sectional study included a random sample of normal glucose tolerant (NGT) (n = 821) and participants with type 2 diabetes (T2D) (n = 861) recruited from the urban part of the Chennai Urban Rural Epidemiology Study (CURES). A validated food frequency questionnaire (FFQ) was used for dietary assessment and self-reported physical activity measures were collected. The threshold for significance was set at P = 0.00023 based on Bonferroni correction for multiple testing [(0.05/210 (3 SNPs x 14 outcomes x 5 lifestyle factors)]. After Bonferroni correction, there was a significant interaction between the TCF7L2 rs12255372 SNP and fat intake (g/day) (Pinteraction = 0.0001) on high-density lipoprotein cholesterol (HDL-C), where the ‘T’ allele carriers in the lowest tertile of total fat intake had higher HDL-C (P = 0.008) and those in the highest tertile (P = 0.017) had lower HDL-C compared to the GG homozygotes. In a secondary analysis of SNPs with the subtypes of fat, there was also a significant interaction between the SNP rs12255372 and polyunsaturated fatty acids (PUFA, g/day) (Pinteraction<0.0001) on HDL-C, where the minor allele carriers had higher HDL-C in the lowest PUFA tertile (P = 0.024) and those in the highest PUFA tertile had lower HDL-C (P = 0.028) than GG homozygotes. In addition, a significant interaction was also seen between TCF7L2 SNP rs12255372 and fibre intake (g/day) on HDL-C (Pinteraction<0.0001). None of the other interactions between the SNPs and lifestyle factors were statistically significant after correction for multiple testing. Our findings indicate that the association between TCF7L2 SNP rs12255372 and HDL-C may be modified by dietary fat intake in this Asian Indian population.
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