Risk Of New Atrial Fibrillation Research Articles

Antidiabetic drugs use and new-onset atrial fibrillation in patients with diabetes mellitus

Abstract Background Diabetes is one of the most common chronic disorders worldwide and is an important cause of cardiovascular disease. Large studies investigating the risk of atrial fibrillation (AF) in diabetic patients taking different diabetes medications are still missing. Methods The analysis was based on the EGB (“Echantillon Généraliste des Bénéficiaires”) database, a 1/97 representative sample of the French nationwide claims and hospitalisation database. A cohort comprising 25,117 adult patients with diabetes and no previous AF seen between 2010 and 2018 was created and followed until December 2018 for incidence of new-onset AF. Among these diabetic patients, 36.0% were treated with metformin, 32.0% were treated with Sulfonylureas, 7.0% were treated with DPP4-inhibitors, 1.6% were treated with GLP1- analogues and 19.6% were treated with insulin. A Cox proportional hazards model was used to determine factors and different oral diabetes medications independently associated with the risk of AF during follow-up. Results During a follow-up of 4.8±3.5 years, there were 3,300 patients with new onset AF (yearly rate 2.7%). In multivariable analysis, among baseline characteristics, we found that older age, male sex, hypertension, heart failure, aortic stenosis, chronic kidney disease, anemia and diuretic use were independently associated with a higher risk of new AF. Among diabetes medications included in the multivariable model, use of sulfonylureas was independently associated with a lower risk of AF (HR 0.86, 95% CI 0.80–0.92, p<0.0001 vs no use). By contrast, use of GLP1-analogues (HR 2.27, 95% CI 1.49–3.46, p=0.0001 vs no use), DPP4-inhibitors (HR 1.88, 95% CI 1.59–2.22, p<0.0001 vs no use), metformin (HR 1.09, 95% CI 1.01–1.18, p=0.03 vs no use) and of insulin (HR 1.15, 95% CI 1.05–1.26, p=0.004 vs no use) were independently associated with a higher risk of AF. Conclusions Patients with different diabetes medications have significantly different long-term risk of AF. Specifically, sulfonylureas use was associated with a lower risk of incident AF whilst other antidiabetic drugs were associated with a higher risk of AF during follow-up. Funding Acknowledgement Type of funding sources: None.

On-treatment HDL cholesterol predicts incident atrial fibrillation in hypertensive patients with left ventricular hypertrophy

Purpose: Hypertensive patients are at increased risk of atrial fibrillation (AF). Although low baseline high density lipoprotein (HDL) cholesterol has been associated with a higher risk of AF, this has not been verified in recent population-based studies. Whether changing levels of HDL over time are more strongly related to the risk of new AF in hypertensive patients has not been examined.Material and methods: Incident AF was examined in relation to baseline and on-treatment HDL levels in 8267 hypertensive patients with no history of AF, in sinus rhythm on their baseline electrocardiogram, randomly assigned to losartan- or atenolol-based treatment. HDL levels at baseline and each year of testing were categorised into quartiles according to baseline HDL levels.Results: During 4.7 ± 1.10 years of follow-up, 645 patients (7.8%) developed new AF. In univariate Cox analyses, compared with the highest quartile of HDL levels (>1.78 mmol/l), patients with on-treatment HDL in the lowest quartile (≤ 1.21 mmol/l) had a 53% greater risk of new AF. Patients with on-treatment HDL in the second and third quartiles had intermediate increased risks of AF. Baseline HDL in the lowest quartile was not a significant predictor of new AF (hazard ratio (HR): 1.14, 95% confidence interval (CI): 0.90–1.43). In multivariable Cox analyses adjusting for multiple baseline and time-varying covariates, the lowest quartile of on-treatment HDL remained associated with a nearly 54% increased risk of new AF (HR: 1.54, 95% CI: 1.16–2.05) whereas a baseline HDL≤ ⩽1.21 mmol/l was not predictive of new AF (HR: 1.01, 95% CI: 0.78–1.31).Conclusion: Lower on-treatment HDL is strongly associated with risk of new AF. These findings suggest that serial assessment of HDL can estimate AF risk better than baseline HDL in hypertensive patients with left ventricular hypertrophy. Future studies may investigate whether therapies that increase HDL can lower risk of developing AF.Clinical Trials Registration: http://clinicaltrials.gov/ct/show/NCT00338260?order=1

P1886Neutrophil to lymphocyte ratio is associated with increased risk of new atrial fibrillation among asymptomatic middle age adults

P1886Neutrophil to lymphocyte ratio is associated with increased risk of new atrial fibrillation among asymptomatic middle age adults

Sleep characteristics that predict atrial fibrillation

The relationship between sleep disruption, independent of obstructive sleep apnea (OSA), and atrial fibrillation (AF) is unknown. The purpose of this study was to determine whether poor sleep itself is a risk factor for AF. We first performed an analysis of participants in the Health eHeart Study and validated those findings in the longitudinal Cardiovascular Health Study, including a subset of patients undergoing polysomnography. To determine whether the observed relationships readily translated to medical practice, we examined 2005-2009 data from the California Healthcare Cost and Utilization Project. Among 4553 Health eHeart participants, the 526 with AF exhibited more frequent nighttime awakening (odd ratio [OR] 1.47; 95% confidence interval [CI] 1.14-1.89; P = .003). In 5703 Cardiovascular Health Study participants followed for a median 11.6 years, frequent nighttime awakening predicted a 33% greater risk of AF (hazard ratio [HR] 1.33; 95% CI 1.17-1.51; P <.001). In patients with polysomnography (N = 1127), every standard deviation percentage decrease in rapid eye movement (REM) sleep was associated with a 18% higher risk of developing AF (HR 1.18; 95% CI 1.00-1.38; P = .047). Among 14,330,651 California residents followed for a median 3.9 years, an insomnia diagnosis predicted a 36% increased risk of new AF (HR 1.36; 95% CI 1.30-1.42; P <.001). Sleep disruption consistently predicted AF before and after adjustment for OSA and other potential confounders across several different populations. Sleep quality itself may be important in the pathogenesis of AF, potentially representing a novel target for prevention.

Relation of Orthostatic Hypotension With New-Onset Atrial Fibrillation (From the Framingham Heart Study)

Previous studies have reported that orthostatic hypotension (OH) is associated with increased risk of atrial fibrillation (AF). We sought to determine whether the association persists after adjusting for hypertension and other cardiovascular risk factors. We studied the Framingham Heart Study Original cohort participants evaluated between 1981 and 1984 without baseline AF. OH was defined as drop in standing systolic blood pressure (BP) of at least 20 mm Hg or standing diastolic BP of at least 10 mm Hg from their supine values after standing for 2 minutes. We estimated Cox proportional hazards regression models to calculate multivariable-adjusted hazard ratios (HR) for association between OH and risk of incident AF, adjusting for age, sex, seated systolic BP and diastolic BP, resting heart rate, height, weight, current tobacco use, hypertension treatment, diabetes, and history of myocardial infarction and heart failure. Of 1,736 participants (mean age, 71.7 ± 6.5 years, 60% women), 256 (14.8%) had OH at baseline. During 10 years of follow-up, 224 participants developed new AF. In our multivariable-adjusted model, OH (HR 1.61, 95% confidence interval 1.17 to 2.20) and greater orthostatic decrease in mean arterial pressure (MAP) (HR 1.11, 95% confidence interval 1.02 to 1.22 per 8.6 mm Hg change in MAP) were both associated with higher risk of new AF. In conclusion, in our longitudinal community-based sample, OH and orthostatic decline in MAP were significantly associated with increased risk of incident AF after adjustment for systolic BP, diastolic BP, and hypertension treatment.

OP.7B.06] RELATIONSHIP OF INCIDENT ATRIAL FIBRILLATION TO THE ELECTROCARDIOGRAPHIC STRAIN PATTERN IN HYPERTENSIVE PATIENTS WITH ELECTROCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY

Objective: Atrial fibrillation (AF) is strongly related to hypertension and to left ventricular hypertrophy (LVH), and both regression of ECG-LVH and achievement of lower systolic blood pressure (SBP) are associated with lower incidence of AF. The ECG strain pattern of lateral ST depression and T-wave inversion has been associated with more severe LVH, decreased LV systolic function and an increased risk of cardiovascular morbidity and mortality, including new heart failure (HF). However, whether ECG strain is associated with an increased risk of new AF is unclear. Design and method: Risk of new-onset AF was examined in relation to the presence of the strain pattern on baseline ECG in 7921 hypertensive patients with ECG-LVH with no history of AF, who were in sinus rhythm on their baseline ECG, had baseline strain determination and were randomized to losartan- vs. atenolol-based treatment. Results: During 4.7 ± 1.1 yrs. of follow-up, new-onset AF was diagnosed in 621 patients (7.8%). Baseline ECG strain was present in 882 patients (11.1%) and was associated with a significantly higher 5-yr. incidence of AF in Kaplan-Meier estimates (12.2 vs 7.4%, p < 0.001) and with a 66% greater risk of new AF in a univariate Cox model (HR 1.66, 95% CI 1.34–2.06, p < 0.001), compared with the absence of ECG strain. After adjusting for other univariate predictors of new AF in this population, including age, sex, race, prior anti-hypertensive treatment, randomized treatment allocation, prevalent diabetes, history of ischemic heart disease, prior myocardial infarction, stroke or HF, baseline serum cholesterol and urine albumin/creatinine ratio entered as standard covariates and incident HF and on-treatment diastolic BP, SBP, heart rate and Cornell product LVH entered as time-varying covariates, ECG strain remained associated with a 39% greater risk of new-onset AF (HR 1.39, 95% CI 1.09–1.76, p = 0.008). Conclusions: The presence of baseline ECG strain is strongly associated with an increased risk of developing new-onset AF in hypertensive patients with ECG-LVH, independent of other AF risk factors and the effects of incident HF, LVH regression and SBP reduction. These findings suggest that hypertensive patients with ECG strain should be followed for development of new AF.

Abstract 11359: Relationship of Incident Atrial Fibrillation to the Electrocardiographic Strain Pattern in Hypertensive Patients With Electrocardiographic Left Ventricular Hypertrophy

Background: Atrial fibrillation (AF) is strongly related to hypertension and to left ventricular hypertrophy (LVH) and both regression of ECG LVH and achievement of lower systolic blood pressure (SBP) are associated with lower incidence of AF. The ECG strain pattern of lateral ST depression and T-wave inversion has been associated with more severe LVH, decreased LV systolic function and an increased risk of cardiovascular mortality and morbidity, including new heart failure (HF). However, whether ECG strain is associated with an increased risk of new AF is unclear. Methods: Risk of new-onset AF was examined in relation to the presence of the strain pattern on baseline ECG in 7921 hypertensive patients with ECG LVH with no history of AF, who were in sinus rhythm on their baseline ECG, had baseline strain determination and were randomized to losartan- vs atenolol-based treatment. Results: During 4.7±1.1 years follow-up, new-onset AF was diagnosed in 621 patients (7.8%). Baseline ECG strain was present in 882 patients (11.1%) and was associated with a significantly higher 5-year incidence of AF in Kaplan-Meier estimates (12.2 vs 7.4%, p&lt;0.001) and with a 66% greater risk of new AF in a univariate Cox model (HR 1.66, 95% CI 1.34-2.06, p&lt;0.001), compared with the absence of ECG strain. After adjusting for other univariate predictors of new AF in this population, including age, sex, race, prior anti-hypertensive treatment, randomized treatment allocation, prevalent diabetes, history of ischemic heart disease, prior myocardial infarction, stroke or HF, baseline serum cholesterol and urine albumin/creatinine ratio entered as standard covariates and incident HF and on-treatment diastolic BP, SBP, heart rate and Cornell product LVH entered as time-varying covariates, ECG strain remained associated with a 39% greater risk of new-onset AF (HR 1.39, 95% CI 1.09-1.76, p=0.008). Conclusions: The presence of strain on a baseline ECG is strongly associated with an increased risk of developing new-onset AF in hypertensive patients with ECG LVH, independent of other AF risk factors and the effects of incident HF, LVH regression and SBP reduction. These findings suggest that hypertensive patients with ECG strain should be followed closely for development of new AF.

Effect of Lower On-Treatment Systolic Blood Pressure on the Risk of Atrial Fibrillation in Hypertensive Patients

There is a well-established association between hypertension and atrial fibrillation (AF); indeed, even upper normal systolic blood pressures (SBP) are long-term predictors of incident AF. These findings suggest that more aggressive BP control may reduce the risk of new AF. However, whether lower achieved SBP is associated with a lower incidence of AF remains unclear. The risk of new-onset AF was examined in relation to last in-treatment SBP before AF diagnosis or last in-study measurement in the absence of new AF in 8831 hypertensive patients with ECG left ventricular hypertrophy with no history of AF, in sinus rhythm on their baseline ECG, randomly assigned to losartan- or atenolol-based treatment. Patients with in-treatment SBP ≤130 mm Hg (lowest quintile at last measurement) and SBP between 131 and 141 mm Hg were compared with patients with in-treatment SBP ≥142 mm Hg (median SBP at last measurement). During follow-up of 4.6±1.1 years, new-onset AF was diagnosed in 701 patients (7.9%). In multivariate Cox analyses, compared with in-treatment SBP ≥142 mm Hg, in-treatment SBP ≤130 mm Hg entered as a time-varying covariate was associated with a 40% lower risk (95% confidence interval, 18%-55%) and in-treatment SBP of 131 to 141 mm Hg with a 24% lower risk (95% confidence interval, 7%-38%) of new AF. Thus, achieved SBP ≤130 mm Hg is associated with a lower risk of new-onset AF in hypertensive patients with ECG left ventricular hypertrophy. Further study is needed to determine whether targeting hypertensive patients without AF to lower SBP goals can reduce the burden of new AF in this high-risk population. URL: http://clinicaltrials.gov. Unique identifier: NCT00338260.

Racial Differences in Incident Atrial Fibrillation Among Hypertensive Patients During Antihypertensive Therapy

Blacks have a higher prevalence of risk factors for atrial fibrillation (AF), such as hypertension, obesity, and heart failure, than nonblacks. Although population-based studies have demonstrated a lower prevalence and incidence of AF in blacks, the relationship of incident AF to race among hypertensive patients undergoing blood pressure lowering has been less extensively examined. Incident AF was examined in 518 black and 8,313 nonblack hypertensive patients with electrocardiographic left ventricular hypertrophy (LVH) with no history of AF in sinus rhythm on their baseline electrocardiogram, who were randomly assigned to losartan- or atenolol-based treatment. During a mean of 4.7±1.1 years of follow-up, new-onset AF occurred in 701 patients (7.9%); 5-year AF incidence was significantly lower in black than nonblack patients (6.1 vs. 8.3%; P = 0.03). In univariable Cox analyses, black race was associated with a 37% lower risk of new AF (hazard ratio (HR) = 0.63; 95% confidence interval (CI) = 0.45-1.00; P = 0.05). In multivariable Cox analyses adjusting for randomized treatment, age, sex, diabetes, history of heart failure, myocardial infarction, ischemic heart disease, stroke, peripheral vascular disease, smoking status, baseline body mass index, serum total and high-density lipoprotein cholesterol, creatinine, glucose, and urine albumin/creatinine ratio as standard risk factors, and for incident myocardial infarction, in-treatment heart rate, systolic and diastolic pressure, Cornell product, and Sokolow-Lyon voltage LVH treated as time-varying covariables, black race remained associated with a 45% decreased risk of developing new AF (HR = 0.55; 95% CI = 0.35-0.87; P = 0.01). Incident AF is substantially less common among black than nonblack hypertensive patients.

Abstract 9405: Lower Achieved Systolic Pressure (=130 mm Hg) is Associated With a Decreased Risk of New Atrial Fibrillation in Hypertensive Patients With Electrocardiographic Left Ventricular Hypertrophy: The LIFE Study

Background: There is a well-established association between hypertension and atrial fibrillation (AF), with recent studies demonstrating that even upper normal systolic blood pressures (SBP) are long-term predictors of incident AF. These findings suggest that more aggressive control of BP may reduce the risk of new AF. However, whether more aggressive reduction of SBP is associated with a lower incidence of AF remains unclear. Methods: Risk of new-onset AF was examined in relation to last in-treatment SBP prior to AF diagnosis or last in-study measurement in the absence of new AF in 8831 hypertensive patients with ECG LVH with no history of AF, in sinus rhythm on their baseline ECG, randomly assigned to losartan- or atenolol-based treatment. Patients with in-treatment SBP ≤130 mm Hg (lowest quintile at last measurement) and SBP between 131 and 141, were compared with patients with in-treatment SBP ≥142 (median SBP at last measurement). Results: During 4.6±1.1 years follow-up, new-onset AF was diagnosed in 701 patients (7.9%). In univariate analyses, compared with in-treatment SBP ≥142, in-treatment SBP ≤130 entered as a time-varying covariate was associated with a 46% lower risk (95% CI 31-58%) and in-treatment SBP between 131 and 141 with the same 46% lower risk (95% CI 35-55%) of developing AF. After adjusting for randomized treatment, age, sex, race, diabetes, history of ischemic heart disease, MI or heart failure, prior antihypertensive therapy, baseline serum glucose, creatinine, HDL and total cholesterol entered as standard covariates, and for incident MI, heart failure and in-treatment Cornell product LVH, heart rate, diastolic BP and HDL treated as time-varying covariates, achievement of a SBP ≤130 remained associated with a 40% lower risk (95% CI 18-55%) and in-treatment SBP of 131 to 141 with a 24% lower risk (95% CI 7-38%) of new AF. Conclusions: Achieved SBP ≤130 is associated with a lower risk of developing new-onset AF in hypertensive patients with ECG LVH, independent of other known and possible risk factors for AF. Further study will be needed to determine whether targeting hypertensive patients without AF to lower SBP goals can reduce the burden of new AF in this high-risk population.

Abstract 9371: Low In-Treatment HDL Cholesterol Strongly Predicts Incident Atrial Fibrillation: The LIFE Study

Background: Hypertensive patients are at increased risk of atrial fibrillation (AF). Although low baseline HDL levels have been associated with a higher risk of AF in some analyses, this has not been born out in recent population-based studies; whether changing levels of HDL over time are more strongly related to the risk of new AF has not been examined. Methods: Incident AF was examined in relation to baseline and in-treatment HDL levels prior to development of AF in 8267 hypertensive patients with no history of AF, in sinus rhythm on their baseline ECG, randomly assigned to losartan- or atenolol-based treatment. HDL levels at baseline and each year of testing were categorized into quartiles according to baseline HDL levels. Results: During 4.7±1.1 years follow-up, new AF developed in 645 patients (7.8%). In univariate analyses, compared with HDL &gt;1.78 mMol/L, patients with in-treatment HDL &lt;1.21 entered as a time-varying covariate had a 53% greater risk of new AF; patients with in-treatment HDL in the 2 nd or 3 rd quartiles had intermediate increased risks of AF. Baseline HDL was only a weak predictor of new AF. In multivariate Cox analyses adjusting for multiple AF risk factors, including the previously demonstrated predictive value of in-treatment heart rate and Cornell product LVH, there was no attenuation of the risk of new AF associated with low in-treatment HDL. In-treatment non-HDL cholesterol (p=0.171) and statin use (p=0.626) were not significant predictors of new AF in the multivariate model including in-treatment HDL. Baseline HDL was not a significant predictor of AF in multivariate analysis. Conclusions: Lower in-treatment HDL is strongly associated with risk of new AF, even after adjusting for other potential AF risk factors and treatment effects. These findings suggest that serial assessment of HDL can better estimate AF risk in hypertensive patients. Further study is indicated to determine whether therapies that increase HDL can lower risk of developing AF.

Frequent premature atrial complexes... truly a benign finding?

I read with great interest the study by Chong et al. 1 titled ‘Frequent premature atrial complexes predict new occurrence of atrial fibrillation and adverse cardiovascular events’. The authors compared the incidence, time course, and clinical predictors of new occurrence of atrial fibrillation (AF) and adverse cardiovascular events in symptomatic patients with and without frequent premature atrial complexes (PACs) [defined as >100 PACs in a 24 h electrocardiogram (ECG) monitoring] and concluded that frequent PACs conferred a significantly higher risk of new AF, ischaemic stroke, heart failure, and death. These findings should be accepted with caution and hopefully reproduced in studies comprising larger cohorts of symptomatic patients. Some considerations could be made:

Blood pressure and other determinants of new-onset atrial fibrillation in patients at high cardiovascular risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease studies

Evidence on new-onset atrial fibrillation in high-risk vascular patients without heart failure is limited. New-onset atrial fibrillation was a prespecified secondary objective of the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET)/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (TRANSCEND) studies. We studied 30 424 ONTARGET/TRANSCEND patients (mean age ± SD, 66.4 ± 7.0) with vascular disease or complicated diabetes who were in sinus rhythm at entry. A copy of ECG was sent to central office every time new atrial fibrillation was detected by investigators. During a median follow-up period of 4.7 years, new atrial fibrillation occurred in 2092 patients (15.1 per 1000 patient-years). Risk of atrial fibrillation increased with age, SBP and pulse pressure, left ventricular hypertrophy, BMI, serum creatinine and history of hypertension, coronary artery disease and cerebrovascular disease (all P < 0.01). After adjustment for BMI and other variables, atrial fibrillation risk increased with hip circumference. History of hypertension was associated with a 34% higher risk of new atrial fibrillation. New atrial fibrillation portended an increased risk of congestive heart failure [hazard ratio 2.89, 95% confidence interval (CI) 2.45-3.40, P < 0.01] and cardiovascular death (hazard ratio 1.22, 95% CI 1.05-1.41, P < 0.01). Risk of stroke was unaffected (hazard ratio 1.14, 95% CI 0.93-1.40), whereas that of myocardial infarction was reduced (hazard ratio 0.64, 95% CI 0.50-0.82). Patients with new atrial fibrillation were more likely to receive vitamin K antagonists (P < 0.01), statins (P < 0.05) and β-blockers (P < 0.01) than those in sinus rhythm. New atrial fibrillation is common in high-risk vascular patients and is associated with several risk factors including history of hypertension. Hip circumference was the strongest anthropometric predictor. Despite extensive use of modern therapies, new atrial fibrillation carries a high risk of congestive heart failure and death over a relatively short term.

Blood Pressure Variability and Risk of New-Onset Atrial Fibrillation

Increased visit-to-visit variability in blood pressure (BP) is a powerful risk factor for stroke, but the mechanism is uncertain. We hypothesized that BP variability might affect the risk of new atrial fibrillation (AF). We did a systematic review of large randomized controlled trials reporting new-onset AF by treatment allocation, excluding studies in heart failure and acute myocardial infarction. Estimates of the risk of new AF by treatment allocation were related to effects of treatment on group variability in BP. Of 94 eligible randomized controlled trials, 14 reported rates of new AF. Although there was considerable heterogeneity between trials in effects of treatment on variance ratio (P<0.0001), lower variance ratio was unrelated to new-onset AF either on meta-analysis (OR=1.02; 95% CI 0.90 to 1.15; 125 878 patients; 13 comparisons) or on metaregression (log OR versus log variance ratio of systolic blood pressure r(2)=0.109, P=0.270). Angiotensin receptor blockers tended to reduce new-onset AF (OR 0.85; 95% CI 0.71 to 1.01; P=0.067; 4 trials; 47 482 patients) with significant reductions in 2 individual trials but had no consistent reduction on variability in BP. Effects of randomized treatment on variability in BP are unrelated to risk of new-onset AF, suggesting that other mechanisms account for the link between variability and stroke risk. However, a lower incidence of AF in patients randomized to angiotensin receptor blockers may explain reductions in stroke risk in some trials.

Atrial fibrillation in hemodialysis patients: clinical features and associations with anticoagulant therapy

Using data from the international Dialysis Outcomes and Practice Patterns Study (DOPPS), we determined incidence, prevalence, and outcomes among hemodialysis patients with atrial fibrillation. Cox proportional hazards models, to identify associations with newly diagnosed atrial fibrillation and clinical outcomes, were stratified by country and study phase and adjusted for descriptive characteristics and comorbidities. Of 17,513 randomly sampled patients, 2188 had preexisting atrial fibrillation, with wide variation in prevalence across countries. Advanced age, non-black race, higher facility mean dialysate calcium, prosthetic heart valves, and valvular heart disease were associated with higher risk of new atrial fibrillation. Atrial fibrillation at study enrollment was positively associated with all-cause mortality and stroke. The CHADS2 score identified approximately equal-size groups of hemodialysis patients with atrial fibrillation with low (less than 2) and higher risk (more than 4) for subsequent strokes on a per 100 patient-year basis. Among patients with atrial fibrillation, warfarin use was associated with a significantly higher stroke risk, particularly in those over 75 years of age. Our study shows that atrial fibrillation is common and associated with elevated risk of adverse clinical outcomes, and this risk is even higher among elderly patients prescribed warfarin. The effectiveness and safety of warfarin in hemodialysis patients require additional investigation.

The Long- and Short-Term Impact of Elevated Body Mass Index on the Risk of New Atrial Fibrillation: The WHS (Women's Health Study)

The purpose of this study was to characterize the relationship between changes in body mass index (BMI) and incident atrial fibrillation (AF) in a large cohort of women. Obesity and AF are increasing public health problems. The importance of dynamic obesity-associated AF risk is uncertain, and mediators are not well characterized. Cases of AF were confirmed by medical record review in 34,309 participants in the Women's Health Study. Baseline and updated measures of BMI were obtained from periodic questionnaires. During 12.9 +/- 1.9 years of follow-up, 834 AF events were confirmed. BMI was linearly associated with AF risk, with a 4.7% (95% confidence interval [CI]: 3.4 to 6.1, p < 0.0001) increase in risk with each kilogram per square meter. Adjustment for inflammatory markers minimally attenuated this risk. When updated measures of BMI were used to estimate dynamic risk, overweight (hazard ratio [HR]: 1.22; 95% CI: 1.02 to 1.45, p = 0.03), and obesity (HR: 1.65; 95% CI: 1.36 to 2.00; p < 0.0001) were associated with adjusted short-term increases in AF risk. Participants becoming obese during the first 60 months had a 41% adjusted increase in risk of the development of AF (p = 0.02) compared with those maintaining BMI <30 kg/m(2). The prevalence of overweight and obesity increased over time. The adjusted proportion of incident AF attributable to short-term elevations in BMI was substantial (18.3%). In this population of apparently healthy women, BMI was associated with short- and long-term increases in AF risk, accounting for a large proportion of incident AF independent of traditional risk factors. A strategy of weight control may reduce the increasing incidence of AF. (Women's Health Study [WHS]: A Randomized Trial of Low-Dose Aspirin and Vitamin E in the Primary Prevention of Cardiovascular Disease and Cancer; NCT00000479).

Reduced lung function and risk of atrial fibrillation in the Copenhagen City Heart Study.

Chronic obstructive pulmonary disease has been associated with a high frequency of arrhythmias. Few studies have analysed the role of reduced lung function in predicting atrial fibrillation (AF). The aim of the present study was to investigate the relationship between forced expiratory volume in one second (FEV1) and risk of first episode of AF in a prospective study. Data from 13,430 males and females without previous myocardial infarction, who participated in the Copenhagen City Heart Study, were analysed. New AF was assessed at re-examination after 5 yrs and by hospital admission for AF during a period of 13 yrs. Multivariate analyses were used with adjustment for cardiopulmonary risk factors. There were 62 new cases of AF at 5-yr follow-up (0.58%) and 290 cases (2.20%) diagnosed at hospitalisations. Risk of new AF at re-examination was 1.8-times higher for FEV1 between 60-80% of predicted compared with FEV1 > or = 80% after adjustment for sex, age, smoking, blood pressure, diabetes and body mass index. The risk of AF hospitalisation was 1.3-times higher for FEV1 between 60-80% and 1.8-times higher for FEV1 < 60% compared with FEV1 > or = 80%, when additional adjustment was made for education, treatment with diuretics and chest pain at activity. The authors conclude that reduced lung function is an independent predictor for incident atrial fibrillation.