Micronutrient deficiencies and new-onset atrial fibrillation in a community-based cohort: data from PREVEND

Abstract

Abstract Background Impaired nutritional status has been linked to cardiovascular diseases. Both selenium and iron deficiency have been associated with impaired exercise tolerance and worse prognosis in patients with heart failure (HF) as well as mitochondrial dysfunction in human cardiomyocytes. With exception of magnesium, little is known about the role of micronutrients in the development of atrial fibrillation (AFib). Purpose To elucidate the association of micronutrient deficiencies with new-onset AFib. Methods Selenium, magnesium and iron parameters were measured in a well-characterized Dutch prospective cohort study (N=5452). Selenium deficiency was defined as selenium <70 μg/L, iron deficiency as ferritin <30 μg/L, and magnesium deficiency as magnesium <0.85 mmol/L. New-onset AFib was the primary outcome. All cases with suspected AFib as determined by electronic screening based on 12-lead ECG were manually reviewed and validated by 2 independent cardiologists. Competing-risk regression analyses were performed with death as a competing risk. Additionally, we tested for interaction between selenium deficiency and smoking status on the outcome because of the known lower serum selenium concentrations in smokers in various cohorts. Results The mean age was 53.3 (12.0) years and 2843 (52.1%) of all participants were women. During a mean follow-up of 6.2 years, 136 (2.5%) participants developed new-onset AFib. Of the participants who developed AFib, 25.7% had selenium deficiency, 5.1% had iron deficiency, and 75% had magnesium deficiency, compared to 21.1%, 14.9% and 65.8% of those who did not develop AFib, respectively. Smoking status significantly interacted with selenium deficiency on outcome (p=0.075). After multivariable adjustment for components of the CHARGE-AF model, selenium deficiency was associated with new-onset AFib in non-smokers (HR: 1.69, 95% CI: 1.08 to 2.66, p=0.022), but not in smokers (HR: 0.71, 95% CI: 0.27 to 1.90, p=0.494). There was no significant association between the new-onset AFib and magnesium deficiency (HR: 1.40, 95% CI: 0.93 to 2.12, p=0.108) or iron deficiency (HR: 0.59, 95% CI: 0.23–1.49, P=0.266). Participants with two or more deficiencies had higher risk to develop AFib compared to those without deficiencies (HR: 1.75, 95% CI: 1.00 to 3.06, p=0.050). Conclusion In a community-based cohort, selenium deficiency was associated with new-onset AFib in non-smoking participants. Interventional studies that investigate the effects of optimizing micronutrients status in a population at risk are needed to assess causality, especially in those with selenium deficiency. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): ENW-KLEIN grantthe Junior Scientific Masterclass-MD/PhD program of the UMCG