Selenium deficiency is associated with new-onset atrial fibrillation in PREVEND: a prospective general population cohort

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): A grant of the Dutch Kidney Foundation (E0.13)Dutch Research Council (NWO) Open Competition ENW-M grant (OCENW.KLEIN.483) Background Recent studies suggest a link between nutritional status and new-onset atrial fibrillation (AF). Both selenium deficiency (SeD) and iron deficiency (ID) are known to impair mitochondrial function in human cardiomyocytes and both have been associated with worse prognosis in patients with cardiovascular disease. However, little is known about the role of these micronutrients in the development of AF. Purpose To elucidate the association of SeD and ID with new-onset AF in the general population. Methods Selenium and iron parameters were measured in a well-characterized Dutch prospective cohort study (N = 5591) with a mean follow-up of 6.2 years. SeD was defined as selenium concentrations < 70ug/L, and ID as ferritin concentrations <30 ug/L. New-onset AF was the primary outcome. All cases with suspected AF as determined by electronic screening were manually reviewed and validated by 2 independent experts. Competing-risk regression analyses were performed with death as a competing risk. We tested for interaction between SeD and smoking status because it was previously reported and because of the known lower serum selenium concentrations in smokers. Results In the PREVEND cohort, mean age was 53.5 (±12) years and 2917 subjects (52%) were females. SeD and ID were observed in 1212 (21%) and 891 (15%) subjects, respectively. Both deficiencies had similar associates, including sex, BMI, smoking status, cholesterol levels and anemia. Of the subjects who developed AF, 25% had SeD and 5% had ID. There was a significant interaction between SeD and smoking in association with the outcome (P= 0.084). After adjusting for the validated CHARGE-AF model in the addition of potential confounders, SeD was independently associated with new onset AF in nonsmokers (Hazard Ratio (HR): 1.72, 95% Confidence Interval (CI): 1.07 to 2.76, P = 0.024), but not in smokers (HR: 0.81, 95% CI: 0.32 to 2.05, P = 0.658). ID, however, was not associated with new-onset AF (HR: 0.62, 95% CI: 0.26 to 1.46, P = 0.272), regardless of sex stratification or smoking status. Conclusion In a general population cohort, SeD was independently associated with new-onset AF in nonsmokers. No association was found between ID and AF. Interventional studies that investigate the effects of selenium supplementation in a population at risk are needed.