Association of arterial stiffness with incident atrial fibrillation: a cohort study

Zakaria Almuwaqqat,J.’Neka S Claxton,Kunihiro Matsushita,Alvaro Alonso,Pamela L Lutsey,Jingkai Wei,Faye L Norby,Elsayed Z Soliman,Gerardo Heiss,Lin Y Chen

doi:10.1186/s12872-021-02057-8

Abstract

BackgroundStiff arteries increase left ventricular (LV) end-systolic workload, leading over time to left atrial and ventricular remodeling, and providing the substrate for atrial fibrillation (AF) development. We investigated if carotid femoral pulse wave velocity (cfPWV), a measure of central arterial stiffness, is associated with incident AF.MethodsIn 2011–2013, cfPWV was measured in 3882 participants of the Atherosclerosis Risk in Communities Cohort Study (ARIC) without prevalent AF. Participants were followed through 2017 for the incidence of AF. Individuals were categorized in cfPWV quartiles based on visit measurements. Multivariable Cox regression models were used to evaluate the association of cfPWV with incident AF.ResultsMean age was 75 years (SD 5), 60% were female and 20% were African American. Over a median follow-up of 5.5 years we identified 331 incident cases of AF. cfPWV demonstrated U-shaped associations with AF risk. In models adjusted for age, race, center, sex, education levels, and hemodynamic and clinical factors, hazard ratios (HR) of AF for participants in the first, third and fourth quartiles were 1.49 (95% CI 1.06, 2.10), 1.59 (1.14, 2.10), and 1.56(1.10, 2.19), respectively, compared to those in the second quartile.ConclusionAmong community-dwelling older adults, low and high central arterial stiffness is associated with AF risk.

Highlights

Stiff arteries increase left ventricular (LV) end-systolic workload, leading over time to left atrial and ventricular remodeling, and providing the substrate for atrial fibrillation (AF) development
Ascertainment of other covariates We considered the following covariates assessed in visit 5: sex, age, race, study center, education level, systolic blood pressure (SBP), diastolic blood pressure (DBP), smoking status, alcohol drinking status, diabetes history, heart failure (HF) history, myocardial infarction (MI) history, use of aspirin medications, use of statin medications, echocardiographic left ventricular ejection fraction (LVEF), and left atrial (LA) volume
Increasing carotid femoral pulse wave velocity (cfPWV) was associated with advanced age, male sex, African American race, higher SBP, higher heart rate, higher prevalence of Diabetes Mellitus (DM)

Summary

Introduction

Stiff arteries increase left ventricular (LV) end-systolic workload, leading over time to left atrial and ventricular remodeling, and providing the substrate for atrial fibrillation (AF) development. Impaired ventricular diastolic function and increased atrial pressure might result in fibrosis and electrical remodeling in the Almuwaqqat et al BMC Cardiovasc Disord (2021) 21:247 and lacked control over markers of left atrial overload [9, 10]. In this analysis, we examined associations of segment-specific PWV measures with the incidence of AF in a large cohort of community-dwelling black and white older adults without a history of prevalent AF in the Atherosclerosis Risk in Communities (ARIC) study

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Conclusion