Single and persistent elevation of C-reactive protein levels and the risk of atrial fibrillation in a general population: The Ansan-Ansung Cohort of the Korean Genome and Epidemiology Study

Abstract

BackgroundInflammation has been reported to cause atrial fibrillation (AF). However, it remains unclear whether C-reactive protein (CRP) levels predict AF. We investigated whether there was an association between serum CRP levels and the development of AF. MethodsA total of 10,030 subjects aged between 40 and 69 years were enrolled and followed biennially over a 12-year period in the Ansan-Ansung cohort study. Serum CRP levels were measured at baseline and high-sensitivity CRP (hsCRP) levels were measured at every revisit. AF was identified using 12-lead standard electrocardiography. Inverse probability of treatment weighting was applied to balance the confounders of AF development between groups. ResultsSerum CRP levels were higher in subjects with AF at baseline and those with new-onset AF than in those without AF. Cox-regression analysis showed that high CRP levels (>3 mg/L) and intermediate CRP levels (1–3 mg/L) at baseline were not associated with a higher risk of new-onset AF compared with low CRP levels (<1 mg/L) after adjustments for covariates. The weighted incidences of AF also did not differ according to the CRP levels. In contrast, persistent elevation of CRP or hsCRP levels (≥1 mg/L at all visits) was associated with a higher risk of AF compared with nonpersistent elevation of CRP or hsCRP levels after adjustment for covariates in both unweighted and weighted cohorts. ConclusionA high CRP level at a single measurement was not associated with the risk of AF, whereas persistently elevated CRP levels independently predicted the development of AF.