Lower Risk Of Atrial Fibrillation Research Articles

Rate of atrial fibrillation by Holter-Stroke Risk Analysis in undetermined TIA/rapidly improving stroke symptoms patients.

Holter-SRA (Stroke Risk Analysis) is an automated analysis of ECG monitoring for Atrial Fibrillation (AF) detection. The aim of this study was to evaluate the rate of AF in undetermined TIA/Rapidly improving stroke symptoms (RISS) patients. Prospective study of undetermined TIA/RISS patients who presented to the emergency department. Early vascular studies (angio CT, transthoracic echocardiography and ECG) were performed in emergency department. The Holter-SRA device was placed for 2 h and the patients were classified into: confirmed AF, high risk of AF or low risk of AF. Prolonged ambulatory monitoring (7 days) was carried out every month for patients with a high-risk pattern. The results were evaluated until definitive detection of AF or low-risk pattern. The endpoints were rate of AF and vascular recurrence at 90 days. Over a period of 24 months, 83 undetermined TIA/RISS patients were enrolled. The mean age was 70 ± 10 years and 61% were men. The median ABCD2 score was 4 points (1-7). After 2 h of monitoring in the emergency department, AF was detected in one patient (1.2%), 51 patients with a low-risk pattern and 31 patients (37.3%) showed a high-risk pattern of AF. During the ambulatory monitoring, of the 31 patients high risk pattern patients, AF was diagnosed to 17 cases and of the 51 patients with a low-risk pattern, one case experienced a recurrent vascular due to undetected AF (1.9% false negative). Three patients (3.6%) suffered a vascular recurrence within the first 90 days, before AF diagnosis. In our study, AF was detected in 22.9% of the 83 patients with indeterminate TIA/RISS. Holter-SRA has allowed us to increase the detection of AF, especially those patients with a high-risk pattern in the first 3 months.

Genetically predicted dietary macronutrient intakes and atrial fibrillation risk: a Mendelian randomization study

Background and aimPrevious observational investigations have indicated a potential association between relative dietary macronutrient intakes and atrial fibrillation and flutter (AF) risk. In this study, we employed Mendelian Randomization (MR) to evaluate the presence of causality and to elucidate the specific causal relationship.MethodsWe employed six, five, and three single nucleotide polymorphisms (SNPs) as instrumental variables for relative carbohydrate, protein, and fat intake, identified from a genome-wide association study that included 268,922 individuals of European descent. Furthermore, we acquired summary statistics for genome-wide association studies on AF from the FinnGen consortium, which involved 22,068 cases and 116,926 controls. To evaluate the causal estimates, we utilized the random effect inverse variance weighted method (IVW) and several other MR methods, including MR-Egger, weighted median, and MR-PRESSO, to confirm the robustness of our findings.ResultsOur analysis indicates a convincing causal relationship between genetically predicted relative carbohydrate and protein intake and reduced AF risk. Inverse variance weighted analysis results for carbohydrates (OR = 0.29; 95% CI (0.14, 0.59); P < 0.001) and protein (OR = 0.47; 95% CI (0.26, 0.85); P = 0.01) support this association. Our MR analysis did not identify a significant causal relationship between relative fat intake and AF risk.ConclusionOur study provides evidence supporting a causal relationship between higher relative protein and carbohydrate intake and a lower risk of atrial fibrillation (AF).

Effect of physical activity on incident atrial fibrillation in individuals with varying duration of diabetes: a nationwide population study

BackgroundDiabetes mellitus (DM) duration affects incident atrial fibrillation (AF) risk; the effect of physical activity on mitigating AF risk related to varying DM duration remains unknown. We assessed the effect of physical activity on incident AF in patients with DM with respect to known DM duration.MethodsPatients with type 2 DM who underwent the Korean National Health Insurance Service health examination in 2015–2016 were grouped by DM duration: new onset and < 5, 5–9, and ≥ 10 years. Physical activity was classified into four levels: 0, < 500, 500–999, 1,000–1,499, and ≥ 1,500 metabolic equivalent task (MET)-min/week, with the primary outcome being new-onset AF.ResultsThe study enrolled 2,392,486 patients (aged 59.3 ± 12.0 years, 39.8% female) with an average follow-up of 3.9 ± 0.8 years and mean DM duration of 5.3 ± 5.1 years. Greater physical activity was associated with a lower AF risk. Lowering of incident AF risk varied with different amounts of physical activity in relation to known DM duration. Among patients with new-onset DM, DM duration < 5 years and 5–9 years and 1,000–1,499 MET-min/week exhibited the lowest AF risk. Physical activity ≥ 1,500 MET-min/week was associated with the lowest incident AF risk in patients with DM duration ≥ 10 years (by 15%), followed DM duration of 5–9 years (12%) and < 5 years (9%) (p-for-interaction = 0.002).ConclusionsLonger DM duration was associated with a high risk of incident AF, while increased physical activity generally reduced AF risk. Engaging in > 1,500 MET-min/week was associated with the greatest AF risk reduction in patients with longer DM duration, highlighting the potential benefits of higher activity levels for AF prevention.

Drug Target Mendelian Randomization Study of PCSK9 and HMG-CoA Reductase Inhibition and Atrial Fibrillation.

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia with significant clinical implications. The potential influence of lipid-lowering therapies, specifically PCSK9 inhibitors (PCSK9i) and HMG-CoA reductase inhibitors (statins), on AF risk remains a topic of interest. This Mendelian Randomization (MR) study aimed to elucidate the causal relationship between genetically predicted inhibition of PCSK9 and HMG-CoA reductase and the risk of AF. Utilizing publicly available, summary-level genome-wide association study (GWAS) data, we employed single-nucleotide polymorphisms (SNPs) associated with lower LDL-C levels as instruments for gene-simulated inhibition of PCSK9 and HMG-CoA reductase. Multiple MR techniques were applied to estimate the causal effects, and sensitivity analyses were conducted to validate the results. Genetically predicted inhibition of PCSK9 demonstrated a reduced risk of AF, with an odds ratio (OR) of 0.92 (95% CI: 0.85 to 0.99, p=0.01) using the inverse variance weighted (IVW) method. In contrast, the inhibition of HMG-CoA reductase did not exhibit a statistically significant association with AF risk (IVW: OR = 1.11, 95% CI: 1.00-1.22, p = 0.05). Our MR study suggests that genetically predicted inhibition of PCSK9, but not HMG-CoA reductase, is associated with a lower risk of AF. These findings provide evidence for a causal protective effect of PCSK9i on AF and support the use of PCSK9i for AF prevention in patients with dyslipidemia. Further studies are needed to elucidate the mechanisms underlying the differential effects of PCSK9i and statins on AF and to confirm the clinical implications of our findings.

Aldehyde Dehydrogenase 2 (ALDH2) Deficiency, Obesity, and Atrial Fibrillation Susceptibility: Unraveling the Connection.

Atrial fibrillation (AF), characterized by structural remodeling involving atrial myocardial degradation and fibrosis, is linked with obesity and transforming growth factor beta 1 (TGF-β1). Aldehyde dehydrogenase 2 (ALDH2) deficiency, highly prevalent in East Asian people, is paradoxically associated with a lower AF risk. This study investigated the impact of ALDH2 deficiency on diet-induced obesity and AF vulnerability in mice, exploring potential compensatory upregulation of nuclear factor erythroid 2-related factor 2 (Nrf2) and heme-oxygenase 1 (HO-1). Wild-type (WT) and ALDH2*2 knock-in (KI) mice were administered a high-fat diet (HFD) for 16 weeks. Despite heightened levels of reactive oxygen species (ROS) post HFD, the ALDH2*2 KI mice did not exhibit a greater propensity for AF compared to the WT controls. The ALDH2*2 KI mice showed equivalent myofibril degradation in cardiomyocytes compared to WT after chronic HFD consumption, indicating suppressed ALDH2 production in the WT mice. Atrial fibrosis did not proportionally increase with TGF-β1 expression in ALDH2*2 KI mice, suggesting compensatory upregulation of the Nrf2 and HO-1 pathway, attenuating fibrosis. In summary, ALDH2 deficiency did not heighten AF susceptibility in obesity, highlighting Nrf2/HO-1 pathway activation as an adaptive mechanism. Despite limitations, these findings reveal a complex molecular interplay, providing insights into the paradoxical AF-ALDH2 relationship in the setting of obesity.

Trends and Outcomes Associated With Bariatric Surgery and Pharmacotherapies With Weight Loss Effects Among Patients With Heart Failure and Obesity.

Utilization patterns of bariatric surgery among older patients with heart failure (HF), and the associations with cardiovascular outcomes, are not well known. Medicare beneficiaries with HF and at least class II obesity from 2013 to 2020 were identified with Medicare Provider Analysis and Review 100% inpatient files and Medicare 5% outpatient files. Patients who underwent bariatric surgery were matched to controls in a 1:2 ratio (matched on exact age, sex, race, body mass index, HF encounter year, and HF hospitalization rate pre-surgery/matched period). In an exploratory analysis, patients prescribed pharmacotherapies with weight loss effects (semaglutide, liraglutide, naltrexone-bupropion, or orlistat) were identified and matched to controls with a similar strategy in addition to HF medical therapy data. Cox models evaluated associations between weight loss therapies (as a time-varying covariate) and mortality risk and HF hospitalization rate (calculated as the rate of HF hospitalizations following index HF encounter per 100 person-months) during follow-up. Of 298 101 patients with HF and body mass index ≥35 kg/m2, 2594 (0.9%) underwent bariatric surgery (45% men; mean age, 56.2 years; mean body mass index, 51.5 kg/m2). In propensity-matched analyses over a median follow-up of 4.7 years, bariatric surgery was associated with lower risk of all-cause mortality (HR, 0.55 [95% CI, 0.49-0.63]; P<0.001), greater reduction in HF hospitalization rate (rate ratio, 0.72 [95% CI, 0.67-0.77]; P<0.001), and lower atrial fibrillation risk (HR, 0.78 [95% CI, 0.65-0.93]; P=0.006). Use of pharmacotherapies with weight loss effects was low (4.8%), with 96.3% prescribed GLP-1 (glucagon-like peptide-1) agonists (semaglutide, 23.6%; liraglutide, 72.7%). In propensity-matched analysis over a median follow-up of 2.8 years, patients receiving pharmacotherapies with weight loss effects (versus matched controls) had a lower risk of all-cause mortality (HR, 0.82 [95% CI, 0.71-0.95]; P=0.007) and HF hospitalization rate (rate ratio, 0.87 [95% CI, 0.77-0.99]; P=0.04). Bariatric surgery and pharmacotherapies with weight loss effects are associated with a lower risk of adverse outcomes among older patients with HF and obesity; however, overall utilization remains low.

Difference Between Estimated GFR Based on Cystatin C Versus Creatinine and Incident Atrial Fibrillation: A Cohort Study of the UK Biobank

The difference between cystatin C-based and creatinine-based estimated glomerular filtration rate (eGFRdiff) has been suggested to reflect factors distinct from kidney function that are associated with cardiovascular risk. However, the association between eGFRdiff and atrial fibrillation (AF) risk has not been extensively evaluated. Prospective cohort study. Using data from UK Biobank, this study included 363,494 participants with measured serum creatinine and cystatin C levels and without a prior diagnosis of AF or a history of related procedures. eGFRdiff, calculated as cystatin C-based eGFR minus creatinine-based eGFR. eGFRdiff was also categorized as negative (<-15 mL/min/1.73m2), midrange (-15 to 15 mL/min/1.73.m2), or positive (≥15 mL/min/1.73.m2). Incident AF. Sub-distribution hazard models were fit, treating death that occurred before development of AF as a competing event. During the median follow-up of 11.7 years, incident AF occurred in 18,994 (5.2%) participants. In the multivariable-adjusted model, participants with a negative eGFRdiff had a higher risk of incident AF (sub-distribution hazard ratios [sHRs], 1.25; 95% confidence interval [CI], 1.20-1.30), whereas participants with a positive eGFRdiff had a lower risk of AF (sHRs, 0.81; 95% CI, 0.77-0.87), compared to those with a midrange eGFRdiff. When eGFRdiff was treated as a continuous variable in the adjusted model, every 10 mL/min/1.73 m2 higher eGFRdiff was associated with a 0.90-fold decrease in the risk of incident AF. A single measurement of baseline serum creatinine and cystatin C levels. The difference between cystatin C- and creatinine-based eGFRs was associated with the risk of AF development. A higher eGFRdiff was associated with a lower risk of AF. These findings may have implications for the management of patients at risk of incident AF.

Ideal cardiovascular health and cardiovascular related events: a systematic review and meta-analysis.

The aim of this study was to systematically review and quantitatively summarise the evidence on the association between Life Simple's 7 (LS7) and multiple cardiovascular diseases (CVD) and cardiometabolic diseases (CMD). EMBASE and PubMed were searched from January 2010 to March 2022 for observational studies that investigated the association between ideal cardiovascular health (CVH) with CVD or CMD outcomes in an adult population. Two reviewers independently selected studies according to the eligibility criteria, extracted data, and evaluated risk of bias. Data were analysed with a random-effect meta-analysis. This meta-analysis included 59 studies (1,881,382 participants). Participants with ideal CVH had a considerably lower risk of a variety of CVDs and CMDs as compared to those with poor CVH, varying from 40% lower risk for atrial fibrillation (AF) (HR = 0.60 [95% CI 0.44-0.83]) to 82% lower risk for myocardial infarction (HR = 0.18 [95% CI 0.12-0.28]). Intermediate CVH was associated with 27%-57% lower risk in CVDs and CMDs compared to poor CVH, with the highest hazard for AF (HR = 0.73 [95% CI 0.59-0.91]), and the lowest hazard for peripheral arterial disease (HR = 0.43 [95% CI 0.30-0.60]). Ideal and moderate CVH were associated with a lower incidence of CVDs and CMDs than poor CVH. LS7 holds significant potential for promoting overall CVH and thereby contributing to the prevention of CVDs.

Protective effect of uridine on atrial fibrillation: a Mendelian randomisation study

Uridine, a pyrimidine nucleoside, is crucial in the synthesis of metabolites. According to observational studies, a higher plasma uridine level is associated with a lower risk of atrial fibrillation (AF). However, the casual relationship between uridine and AF is still unknown. In this study, we used the Mendelian randomisation (MR) approach to explore causality. Three genetic variants associated with uridine were identified from the Metabolomics GWAS server (7824 participants); summary-level datasets associated with AF were acquired from a genome-wide association study (GWAS) meta-analysis with 1,030,836 European participants (60,620 AF cases). We duplicated the MR analyses using datasets from AF HRC studies and the FinnGen Consortium, and then conducted a meta-analysis which combined the main results. The risk of AF was significantly associated with the genetically determined plasma uridine level (odds ratio [OR] 0.27; 95% confidence interval [CI] 0.16, 0.47; p = 2.39 × 10–6). The association remained consistent in the meta-analysis of the various datasets (OR 0.27; 95% CI 0.17, 0.42; p = 1.34 × 10–8). In conclusion, the plasma uridine level is inversely associated with the risk of AF. Raising the plasma uridine level may have prophylactic potential against AF.

Lower risk of atrial fibrillation development associated with SGLT-2 inhibitors in type 2 diabetic patients compared to DPP-4 inhibitors: a nationwide cohort study

Abstract Background Accumulating evidence shows that sodium-glucose co-transporter-2 (SGLT-2) inhibitors reduce cardiovascular outcomes. However, this favorable effect is unclear for newly atrial fibrillation (AF) development compared to other anti-diabetic drugs. Purpose We investigated the association of SGLT-2 inhibitor for newly AF development compared to dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with type 2 diabetes. Methods Using the Korean National Health Insurance Service database, among 2,160,911 type 2 diabetes patients (age ≥20 years) between 1 May 2016 and 31 December 2018, we studied 42,806 patients with SGLT-2 inhibitors and 448,715 patients with DPP-4 inhibitors who had not prior AF diagnosis. Propensity score-matching (1:1 ratio) was used to correct for differences between the groups. Results During a median follow-up of 1.3 years, after propensity score matching, compared with patients with DPP-4 inhibitors (n=42,786), patients with SGLT-2 inhibitors (n=42,786) have shown lower incidence and risk of AF (2.7 and 3.3 per 1000 person-years; hazard ratio 0.73, 95% confidence interval 0.55-0.97; p=0.028) aand an absolute rate difference of −0.7 [95% confidence interval (CI) −1.3 to −0.1, p=0.034] per 1000 person-years by on-treatment analysis. In intention-to-treat analysis, these results were consistent (2.6 and 3.2 per 1000 person-years; hazard ratio 0.83, 95% confidence interval 0.66-1.03; p=0.092) with an absolute rate difference of −0.5 [95% confidence interval (CI) −1.2 to −0.1, p=0.093] per 1000 person-years . In subgroup analysis, SGLT-2 inhibitors were associated with lower risks of AF in heart failure compared to their counterparts in intention-to-treat analysis (p for interaction=0.036). Conclusion Based on this nationwide cohort of type 2 diabetes patients treated with SGLT-2 inhibitors or DPP-4 inhibitors, SGLT-2 inhibitors were associated with protection against newly AF development after adjusting for clinical confounders.Incidence rates and adjusted HR

Burden and impact of comorbid depression on in-hospital outcomes of Hypertrophic Cardiomyopathy patients in the USA: a nationwide analysis, 2020

Abstract Background Depression has emerged as a critical risk factor for development and progression of various cardiovascular diseases; however, the association between depression and Hypertrophic Cardiomyopathy (HCM) outcomes is less clear. We aimed to determine the impact of comorbid depression on patients hospitalized with HCM. Methods The National Inpatient Sample (2020) was assessed to identify patients hospitalized with HCM using relevant ICD-10 codes. Propensity score matching of 1:1 was performed and the cohort was divided into two - those with comorbid depression (HCM-D+) and those without (HCM-D-). Baseline characteristics and comorbidities were compared between the two cohorts. Impact of comorbid depression on hospitalized HCM patients was evaluated using a multivariate regression analysis adjusting for confounders. Results We identified a cohort of 15530 in-hospital HCM patients with a median age of 67 years (66.9% females, 33.1% males, 74.6% whites, 19.1% blacks, 4.3% hispanics, 1.7% Asians). Amongst 15530, 85.5% admissions were non-elective. The HCM-D+ cohort had significantly higher rates of comorbidities such as hypertension (76.4% vs 71.4%), hyperlipidemia (62.5% vs 52.4%), obesity (27.9% vs 24.9%), smoking (28.1% vs 25.7%), dementia (8.2% vs 4.4%) and cancer (7.5% vs 5.8%) (p&amp;lt;0.001). When in-hospital outcomes were compared, HCM-D+ cohort paradoxically appeared to have 44% lower risk of all-cause mortality (OR-0.56; 95%CI: 0.37- 0.84), 22% lower risk of composite end points (all-cause mortality, heart failure, atrial fibrillation, cardiac arrest including ventricular fibrillation, acute ischemic stroke) (OR-0.78; 95%CI:0.66-0.91), 21% lower risk of atrial fibrillation alone (OR-0.79; 95%CI:0.67-0.92) (p&amp;lt;0.001). Conclusion Despite having higher rates of comorbidities, comorbid depression in HCM patients appeared to improve in-hospital outcomes. Further studies are needed to uncover the paradoxical protection provided by underlying depression.

The inflammatory proteome and risk of atrial fibrillation: genetic insights into causal relevance

Abstract Background Cardiac and systemic inflammation have been associated with a higher risk of atrial fibrillation (AF) in both animal models and human studies. Causality, however, has been questioned due to inconsistent efficacy of anti-inflammatory treatments in preventing incident or recurrent AF, and potentially confounding associations with AF risk factors such as ischaemic heart disease. Inflammatory processes are highly complex and involve a large number of proteins, but the individual relevance and causal role of these for AF remains unclear. Purpose To explore the nature of the relationship between the inflammatory proteome and risk of AF. Methods Associations between 26 inflammatory proteins and AF were assessed in a two-sample Mendelian randomization (MR) framework, with primary MR causal estimates with AF estimated among 339,214 White British UK Biobank (UKB) participants (AF cases=30,630). MR analyses for each inflammatory protein included independent variants previously associated with the relevant protein at genome-wide significance (p&amp;lt;5x10-8) across the genome (trans-protein quantitative trait loci [pQTLs]), or restricted to at least 50kb from the closest upstream gene and 50 kb downstream from the target gene (cis-pQTLs). Sensitivity analyses to assess potential pleiotropy were conducted (MR-Egger, weighted median, and weighted mode). Associations passing multiple testing threshold (p&amp;lt;0.002) in UKB were further validated in meta-analyses with independent datasets including over 50,000 AF cases (FinnGen and AFGen). Research undertaken using UKB application 14568. Results This inflammatory protein-wide study identified three proteins that have support for causal associations with AF. Genetically-predicted levels of IL6R, CD40, and Chitinase-3-like protein 1 (YKL40) each showed a negative association with risk of AF, with up to a 5% lower AF risk per standard deviation higher genetically-predicted levels of these proteins (Figure 1). These findings were further confirmed in meta-analysis with data from AFGen and FinnGen. No evidence of pleiotropy was identified, and results were also confirmed in cis-pQTL analyses, which were fully consistent with the trans-pQTL analyses (Table 1). Analyses stratified by various baseline characteristics highlighted stronger causal estimates in those with higher levels of C-reactive protein (with interaction p-values &amp;lt;0.001). Conclusions Genetic approaches support the relevance of lifelong differences in the inflammatory proteome for AF, and causal relationships between specific inflammatory markers and risk of AF. Greater soluble IL6R and CD40 as measured in proteomic analyses are both associated with lower levels of inflammation. As previous work indicates that genetically upregulated CD40 and IL6R are similarly associated with a lower risk of ischemic stroke, the risk-benefit of directly targeting these pathways needs further consideration.Figure 1Table 1

Association of predicted body composition with occurrence of atrial fibrillation.

Body mass index (BMI) is insufficient evidence as a risk factor for numerous health disorders. Body composition may be more appropriate for confirming the association with cardiovascular diseases, including atrial fibrillation (AF). This study aimed to examine the association between body composition and the occurrence of AF. A total of 2,673,108 participants (48.6% women) without AF at baseline from the Korean national health insurance data were included. Body composition including appendicular skeletal muscle mass, body fat mass, and lean body mass were indirectly measured through validated anthropometric prediction equations. The diagnosis of AF and comorbidities were defined. With a median of 9.5 (interquartile range 9.2-10.1) years' follow-up, 25,841 (0.96%) cases of incident AF were included. In multivariable analysis, higher appendicular skeletal muscle was related to low risk of AF [hazard ratio (HR) 0.829, 95% confidence interval (CI) 0.753-0.912 for men (fifth quintile) and HR 0.888, 95% CI 0.792-0.995 for women (fifth quintile)]. In contrast, a higher body fat mass [HR 1.345, 95% CI 1.221-1.483 for men (fifth quintile) and HR 1.420, 95% CI 1.274-1.591 for women (fifth quintile)] and lean body mass [HR 2.241, 95% CI 2.182-2.303 for men (fifth quintile) and HR 1.516, 95% CI 1.368-1.667 for women (fifth quintile)] were associated with the occurrence of AF. In this study, body composition parameters were associated with the occurrence of AF. It should be noted that when appendicular skeletal muscle mass decreases and body fat mass and lean body mass increase, the risk of AF may be increased in general population except underweighted BMI group.

Determinants and prognostic implications of left atrial reverse remodelling after coarctation of aorta repair in adults.

Left atrial (LA) dysfunction and atrial fibrillation are also relatively common in adults with coarctation of aorta (COA), and the severity of LA dysfunction is associated with a higher risk of atrial fibrillation in this population. The purpose of this study was to determine whether LA function improved after COA repair (LA reverse remodelling), and the relationship between LA reverse remodelling and atrial fibrillation. Retrospective cohort study of adults undergoing COA repair (2003-20). LA reservoir strain was assessed pre intervention and 12-24 months post intervention, using speckle tracking echocardiography. Incident atrial fibrillation was assessed from COA repair to last follow-up. Of 261 adults who underwent COA repair [age 37 ± 13 years; males 148 (57%)], 124 (47%) and 137 (53%) presented with native vs. recurrent COA, respectively. Of 261 patients, 231 (82%) and 48 (18%) underwent surgical and transcatheter COA repair, respectively. The LA reservoir strain increased from 32 ± 8% (pre intervention) to 39 ± 7% (post intervention), yielding a relative increase of 21 ± 5%. Older age [β ± standard error (SE) -0.16 ± 0.09 per 5 years, P = 0.02], higher systolic blood pressure (β ± SE -0.12 ± 0.04 per 5 mmHg, P = 0.005), and higher residual COA mean gradient (β ± SE -0.17 ± 0.06 per 5 mmHg, P = 0.002) post intervention were associated with less LA reverse remodelling, after adjustment for sex, hypertension diagnosis, and left ventricular indices. LA reverse remodelling (hazard ratio 0.97, 95% confidence interval 0.96-0.98 per 1% increase from pre-intervention LA function, P = 0.006) was associated with a lower risk of atrial fibrillation after adjustment for age, sex, pre-intervention LA reservoir strain, and history of atrial fibrillation. COA repair resulted in improved LA function and decreased risk for atrial fibrillation, especially in patients without residual hypertension or significant residual COA gradient.

880-P: Effects of Sodium–Glucose Cotransporter-2 Inhibitors on the Risk of Atrial Fibrillation in Older Adults with Type 2 Diabetes

Clinical evidence suggested a protective effect of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on the risk of atrial fibrillation (AF) in type 2 diabetes (T2D) patients, but the results were mixed. We aimed to compare the risk of AF in SGLT2i users compared to dipeptidyl peptidase-4 inhibitors (DPP4i) users and determine the effect in different subgroups. Using a 15% random sample of 2017-2018 Medicare claims data, we identified individuals with T2D, no preexisting AF, and initiated SGLT2i or DPP4i. The index date was defined as the date of the first filled prescription of SGLT2i or DPP4i. The outcome was the first incident of diagnosed AF. Inverse probability treatment weighted Cox regression models were used for analyses. Of the 97,660 eligible individuals (age 71.2±9.8 years, 54.6% women), 1.01% (n=989) had incident AF over a median follow-up of 361 days. The crude incidence rate was 8.39 (95% CI: 6.67-9.99) and 11.70 (95% CI: 10.9-12.55) per 1000 person-years in the SGLT2i group and DPP4i group, respectively. SGLT2i was associated with a significantly lower risk of incident AF (HR 0.72 [95% CI 0.56-0.89]) than DPP4i. The risk reduction of incident AF was more pronounced in Hispanic individuals and subgroups with existing cardiovascular (CV) and renal conditions. (Figure) Use of SGLT2i was associated with a lower risk of AF in individuals with T2D. Disclosure Y.Li: None. Y.Guo: None. S.Kimmel: Consultant; GlaxoSmithKline plc., Other Relationship; Janssen Research &amp; Development, LLC. J.Bian: None. D.Schatz: Advisory Panel; Medtronic, Avotres Inc., QuLab Medical Ltd., Kriya Therapeutics. J.Guo: Consultant; Pfizer Inc., Research Support; PhRMA Foundation, NIH - National Institutes of Health.

Recent Advances in Association Between Vitamin D Levels and Cardiovascular Disorders.

In this review, we discuss the evidence that vitamin D affects cardiovascular disease through interventional and observational studies and their corresponding association mechanisms. We also highlight the need for further research to definitively conclude clinical recommendations based on preliminary data and determine the extent to which vitamin D levels may impact the incidence and prognosis of major cardiovascular diseases in the future. Cardiovascular disease has long been recognized as the leading cause of morbidity and mortality worldwide, with many risk factors implicated in its pathogenesis. Vitamin D is a risk factor that, despite being known to be crucial for its role in maintaining bone health, also has several extra-skeletal effects due to vitamin D receptors in vascular smooth muscle and cardiomyocytes. Recent studies have documented a significant association between higher vitamin D levels and lower risk of each cardiovascular disease entity; 11 studies between serum vitamin D and heart failure, 7 studies between serum vitamin D and hypertension, 8 studies between serum vitamin D and coronary artery disease, and 5 studies between serum vitamin D and atrial fibrillation. More studies documenting a significant association between increased serum vitamin D and cardiovascular disease are in the context of heart failure compared to hypertension, coronary artery disease, and atrial fibrillation. Conversely, a significant association between increased serum vitamin D and a lower risk of atrial fibrillation is reported in fewer studies compared to the association of vitamin D with other cardiovascular disease entities. Although there is evidence documenting a clear significant association of vitamin D under each category, further research is still needed to definitively conclude the role of vitamin D in cardiovascular disease management.

AB-452666-1 EFFICACY AND OUTCOMES OF CATHETER ABLATION FOR ATRIAL FIBRILLATION IN PATIENTS WITH END-STAGE RENAL DISEASE: ANALYSIS OF NATIONWIDE READMISSION DATABASE

End-stage renal disease (ESRD) is an independent risk factor for atrial fibrillation (AF). Catheter ablation (CA) for AF is a well-established, safe treatment option and is increasingly utilized. However, there is a paucity of current data on the efficacy and safety of CA for AF in patients with ESRD. To investigate the efficacy of AF ablation in patients with ESRD. We conducted a retrospective analysis of the Nationwide Readmission Database (NRD) from January 2016 to December 2019. Patients with AF and ESRD were identified using ICD-10-CM codes. The study cohort was further divided into two groups based on CA. Any admission within 180 days of index admission was considered a readmission. Cox proportional hazard regression was used to adjust for confounders. The primary outcome was AF readmission and secondary outcomes were mortality readmission, ischemic stroke readmission, heart failure readmission, major bleeding readmission and all cause readmission. We identified 200,555 ESRD patients admitted with AF during the study period. Out of these, 786 (0.4%) patients underwent CA for AF. Patients who underwent CA for AF were younger (median age in years, 67 vs 71, p<0.001), less likely to be females (32.2% vs 41.5%, p<0.001). After adjusting for confounders, patients with ESRD who underwent AF ablation had a significantly lower risk of readmission for AF (adjusted HR 0.88, 95% CI 0.80-0.97, p=0.01). Patients who underwent CA for AF also had a lower risk of readmission for HF (aHR 0.83, 95% CI 0.74-0.92, p=0.01), major bleeding (aHR 0.59, 95% CI 0.41-0.85, p=0.005), and all-cause readmission (aHR 0.87, 95% CI 0.79-0.95, p=0.02). Lastly, patients in AF ablation group also had lower all-cause in-hospital mortality (aHR 0.74, 95% CI 0.57-0.96, p=0.02). In patients with ESRD and AF, catheter ablation was associated with a lower risk of AF, HF, and all-cause readmission compared to patients who did not undergo ablation. AF ablation was also associated with significantly lower all-cause mortality. Further research is needed to establish CA's efficacy and long-term outcomes in patients with ESRD and AF.

American Heart Association's life simple 7 and the risk of atrial fibrillation in the PREDIMED study cohort

Background and aimsThe American Heart Association proposed 7 ideal cardiovascular health metrics (Life's Simple 7 [LS7]) namely, not smoking, body mass index <25 kg/m2, healthy diet, moderate physical activity ≥150 min/week, total blood cholesterol <200 mg/dL, blood pressure <120/80 mmHg and fasting blood glucose <100 mg/dL. Our objective was to assess the association between these LS7 metrics and the incidence of atrial fibrillation (AF). Methods and resultsA total of 6,479 participants of the PREDIMED study were included. We calculated the participants’ baseline LS7 index ranging 0–7 points to categorize them according to their adherence to these LS7 health metrics. Multivariable Cox regression models were used to estimate Hazard Ratios (HR) and their 95% Confidence Intervals (95% CI). After a median follow-up of 4.8 years, we identified 250 incident cases of AF. After adjusting for potential confounders, adherence to LS7 index was not associated with the incidence of AF (adjusted HR 0.90 [95% CI: 0.56–1.45] for highest vs. lowest LS7 categories). Body mass index <25 kg/m2 was the only health metric individually associated with a lower risk of AF (HR 0.36 [95% CI: 0.16–0.78]). ConclusionsIn a high cardiovascular risk Spanish population, adherence to American Heart Association's LS7 metrics was not associated with the risk of incident AF.Clinical Trials number: ISRCTN35739639.

Nuts and Cardiovascular Disease Outcomes: A Review of the Evidence and Future Directions.

Nuts are nutrient-rich foods that contain many bioactive compounds that are beneficial for cardiovascular health. Higher consumption of nuts has been associated with a reduced risk of several cardiovascular diseases (CVD) in prospective cohort studies, including a 19% and 25% lower risk of CVD incidence and mortality, respectively, and a 24% and 27% lower risk of coronary heart disease incidence and mortality, respectively. An 18% lower risk of stroke mortality, a 15% lower risk of atrial fibrillation, and a 19% lower risk of total mortality have also been observed. The role of nuts in stroke incidence, stroke subtypes, peripheral arterial disease and heart failure has been less consistent. This narrative review summarizes recommendations for nuts by clinical practice guidelines and governmental organizations, epidemiological evidence for nuts and CVD outcomes, nut-containing dietary patterns, potential mechanisms of nuts and CVD risk reduction, and future research directions, such as the use of biomarkers to help better assess nut intake. Although there are still some uncertainties around nuts and CVD prevention which require further research, as summarized in this review, there is a substantial amount of evidence that supports that consuming nuts will have a positive impact on primary and secondary prevention of CVD.

Racial, ethnic, and sex disparities in atrial fibrillation management: rate and rhythm control.

Atrial fibrillation (AF) affects around 6 million Americans. AF management involves pharmacologic therapy and/or interventional procedures to control rate and rhythm, as well as anticoagulation for stroke prevention. Different populations may respond differently to distinct management strategies. This review will describe disparities in rate and rhythm control and their impact on outcomes among women and historically underrepresented racial and/or ethnic groups. This is a narrative review exploring the topic of sex and racial and/or ethnic disparities in rate and rhythm management of AF. We describe basic terminology, summarize AF epidemiology, discuss diversity in clinical research, and review landmark clinical trials. Despite having higher rates of traditional AF risk factors, Black and Hispanic adults have lower risk of AF than non-Hispanic White (NHW) patients, although those with AF experience more severe symptoms and report lower quality-of-life scores than NHW patients with AF. NHW patients receive antiarrhythmic drugs, cardioversions, and invasive therapies more frequently than Black and Hispanic patients. Women have lower rates of AF than men, but experience more severe symptoms, heart failure, stroke, and death after AF diagnosis. Women and people from diverse racial and ethnic backgrounds are inadequately represented in AF trials; prevalence findings may be a result of underdetection. Race, ethnicity, and gender are social determinants of health that may impact the prevalence, evolution, and management of AF. This impact reflects differences in biology as well as disparities in treatment and representation in clinical trials.