Subclinical measures of peripheral atherosclerosis and risk of new-onset atrial fibrillation in men and women from general population

Abstract

Abstract Background Limited data on the link between peripheral vascular atherosclerosis measures and the risk of new-onset atrial fibrillation (AF) in the general population exists. Moreover, comprehensive assessment of the association between the two conditions among men and women is sparse. Purpose To determine the association between baseline and longitudinal measures of carotid intima-media thickness (cIMT), carotid plaque, and ankle-brachial index (ABI) with new-onset AF. Methods 12840 participants free of AF at baseline were included in this large prospective population-based cohort study. Among the 12840 included participants, 11998 had at least one available measure for cIMT and 8532 for ABI. Presence of carotid plaque was only measured at baseline (n=11766). Three repeated measurements for cIMT and two repeated measurements for ABI were available during follow-up. The association between baseline cIMT, carotid plaque, and ABI as well as longitudinal changes in cIMT and ABI with incident AF were assessed using Cox regression and joint models respectively. Models were adjusted for age and traditional cardiovascular risk factors. Results During a median follow-up of 9.1 years, 1362 incident AF occurred. Baseline cIMT (adjusted hazard ratio–HR; 95% confidence interval–CI: 3.46; 1.97–6.05) and longitudinal changes in cIMT (adjusted HR; 95% CI: 3.35; 1.89–5.95) showed strong independent associations with incident AF among women (Figure 1). Baseline ABI showed a significant association with incident AF among men (adjusted HR; 95% CI: 0.61; 0.38–0.97) and a borderline significant association among women (adjusted HR; 95% CI: 0.65; 0.41–1.02). Longitudinal changes in ABI were not associated with the risk of incident AF independent of traditional risk factors. Conclusions Carotid atherosclerosis at baseline and progression of carotid atherosclerosis during follow-up were strongly associated with new-onset AF among women. Lower extremity peripheral atherosclerosis at baseline, but not its longitudinal changes during follow-up, was significantly associated with incident AF, in particular among men. Our findings imply that screening and monitoring for carotid atherosclerosis carry a potential for prevention of AF among women. Figure 1. HR of baseline cIMT and AF Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Netherlands Organization for the Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE)