Is there a connection between HDL and atrial fibrillation?

Abstract

In the current issue, Tajik et al., found that among Finnish men in the Kuopio Ischaemic Heart Disease Risk Factor Study, higher high density lipoprotein cholesterol (HDL-C) and higher apolipoprotein A1 (apoA1) levels are associated with lower risk of atrial fibrillation (AF) over 22 years of follow-up. 1 Tajik B Tuomainen TP Jarroch R Kauhanen J Lip GYH 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; Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar In contrast, no associations were found with apolipoprotein B (apoB), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDLC), non-HDL-C or very low-density lipoprotein cholesterol (VLDL-C). 1 Tajik B Tuomainen TP Jarroch R Kauhanen J Lip GYH 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; Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar The current study provides new information about an inverse association of apoA1 with AF risk, and agrees with prior longitudinal studies and meta-analyses showing inverse associations of HDL-C with incident AF. 2 Guan B Li X Xue W et al. Blood lipid profiles and risk of atrial fibrillation: A systematic review and meta-analysis of cohort studies. J Clin Lipidol. 2020; 14 (e3): 133-142 Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar , 3 Yao Y Liu F Wang Y Liu Z. Lipid levels and risk of new-onset atrial fibrillation: A systematic review and dose-response meta-analysis. Clin Cardiol. 2020; 43: 935-943 Crossref PubMed Scopus (10) Google Scholar , 4 Zheng Y Xie Z Li J et al. Meta-analysis of metabolic syndrome and its individual components with risk of atrial fibrillation in different populations. BMC Cardiovasc Disord. 2021; 21: 90 Crossref PubMed Scopus (6) Google Scholar , 5 Boudi FB Kalayeh N Movahed MR. High-Density Lipoprotein Cholesterol (HDL-C) Levels Independently Correlates With Cardiac Arrhythmias and Atrial Fibrillation. J Intensive Care Med. 2020; 35: 438-444 Crossref PubMed Scopus (5) Google Scholar , 6 Alonso A Yin X Roetker NS et al. Blood lipids and the incidence of atrial fibrillation: the Multi-Ethnic Study of Atherosclerosis and the Framingham Heart Study. J Am Heart Assoc. 2014; 3e001211 Crossref Scopus (81) Google Scholar , 7 Barkas F Elisaf M Liberopoulos E. Low high-density lipoprotein cholesterol levels improve the performance of the CHADS2 and CHA2DS2-VASc scores for the prediction of new-onset atrial fibrillation. Int J Cardiol. 2017; 247: 18 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar , 8 Barkas F Elisaf M Korantzopoulos P Tsiara S Liberopoulos E. The CHADS(2) and CHA(2)DS(2)-VASc scores predict atrial fibrillation in dyslipidemic individuals: Role of incorporating low high-density lipoprotein cholesterol levels. Int J Cardiol. 2017; 241: 194-199 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar , 9 Okin PM Hille DA Wachtell K Kjeldsen SE Julius S Devereux RB On-treatment HDL cholesterol predicts incident atrial fibrillation in hypertensive patients with left ventricular hypertrophy. Blood Press. 2020; 29: 319-326 Crossref PubMed Scopus (1) Google Scholar In contrast to the current study, several prior studies have found paradoxical inverse associations of TC and LDL-C (but not TG) with incident AF, 4 Zheng Y Xie Z Li J et al. Meta-analysis of metabolic syndrome and its individual components with risk of atrial fibrillation in different populations. BMC Cardiovasc Disord. 2021; 21: 90 Crossref PubMed Scopus (6) Google Scholar ,5 Boudi FB Kalayeh N Movahed MR. High-Density Lipoprotein Cholesterol (HDL-C) Levels Independently Correlates With Cardiac Arrhythmias and Atrial Fibrillation. J Intensive Care Med. 2020; 35: 438-444 Crossref PubMed Scopus (5) Google Scholar ,10 Li X Gao L Wang Z et al. Lipid profile and incidence of atrial fibrillation: A prospective cohort study in China. Clin Cardiol. 2018; 41: 314-320 Crossref PubMed Scopus (38) Google Scholar , 11 Xue Y Zhou Q Shen J et al. Lipid Profile and New-Onset Atrial Fibrillation in Patients With Acute ST-Segment Elevation Myocardial Infarction (An Observational Study in Southwest of China). Am J Cardiol. 2019; 124: 1512-1517 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar , 12 Lopez FL Agarwal SK Maclehose RF et al. Blood lipid levels, lipid-lowering medications, and the incidence of atrial fibrillation: the atherosclerosis risk in communities study. Circ Arrhythm Electrophysiol. 2012; 5: 155-162 Crossref PubMed Scopus (98) Google Scholar and with recurrent AF following ablation. 13 Shang Y Chen N Wang Q et al. Blood lipid levels and recurrence of atrial fibrillation after radiofrequency catheter ablation: a prospective study. J Interv Card Electrophysiol. 2020; 57: 221-231 Crossref PubMed Scopus (2) Google Scholar Meanwhile, another large study found that genetic scores for HDL-C, LDL-C, TC and TG were not associated with incident AF. 14 Norby FL Eryd SA Niemeijer MN et al. Association of Lipid-Related Genetic Variants with the Incidence of Atrial Fibrillation: The AFGen Consortium. PLoS One. 2016; 11e0151932 Crossref Scopus (13) Google Scholar Two Mendelian randomization studies have reported that HDL-C, apoA1, LDL-C, TC, TG, and apoB 15 Jiang Q Qin D Yang L et al. Causal effects of plasma lipids on the risk of atrial fibrillation: A multivariable mendelian randomization study. Nutr Metab Cardiovasc Dis. 2021; 31: 1569-1578 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar ,16 Yang S Pudasaini R Zhi H Wang L. The Relationship between Blood Lipids and Risk of Atrial Fibrillation: Univariable and Multivariable Mendelian Randomization Analysis. Nutrients. 2021; : 14 PubMed Google Scholar are not causally related to AF, although evidence for a causal relationship of lipoprotein(a) to AF was found. 15 Jiang Q Qin D Yang L et al. Causal effects of plasma lipids on the risk of atrial fibrillation: A multivariable mendelian randomization study. Nutr Metab Cardiovasc Dis. 2021; 31: 1569-1578 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar