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Chen ZT, Guo DC, Gao JW, Gao QY, Zhang YP, He WB, Wu MX, Liu PM, Wang JF, Zhang HF, Chen YX. Low remnant cholesterol and the subsequent risk of new-onset atrial fibrillation: A prospective cohort study. Heart Rhythm 2024; 21:1258-1266. [PMID: 38815780 DOI: 10.1016/j.hrthm.2024.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/24/2024] [Accepted: 05/24/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common arrhythmia with high morbidity and mortality implications. Several studies have described a paradoxical inverse relationship between serum cholesterol and the risk of AF, but it remains unknown whether remnant cholesterol (RC) is associated with AF incidence. OBJECTIVE This study aims to prospectively investigate the association between RC and AF. METHODS A total of 392,783 participants free of AF at baseline from the UK Biobank were included for the analysis. Cox proportional hazards model, subgroup analysis, and sensitivity analyses were used to evaluate the independent association between RC levels and the risk of new-onset AF. Furthermore, we performed a discordance analysis by using the median cutoff points of low-density lipoprotein cholesterol (LDL-C) and RC. RESULTS After a median follow-up of 12.8 years (interquartile range 12.0-13.6 years), a total of 23,558 participants experienced incident AF. Compared with the highest RC level, the lower RC level was associated with an increased risk of AF incidence (quartile 1 vs quartile 4: hazard ratio 1.396; 95% confidence interval [CI] 1.343-1.452). The results remained robust across a series of sensitivity analyses. In the discordance analyses, a significantly higher risk of AF was observed in participants with discordant low RC/high LDL-C levels than in those with concordant high RC/LDL-C levels. In the low LDL-C group, RC reduction even contributed to an additional 15.8% increased rate of incident AF (low RC/low LDL-C: hazard ratio 1.303; 95% CI 1.260-1.348 vs high RC/low LDL-C: hazard ratio 1.125; 95% CI 1.079-1.172). CONCLUSION Low RC levels were associated with an increased risk of incident AF independent of traditional cardiovascular risk factors.
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Affiliation(s)
- Zhi-Teng Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China; Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, P.R. China
| | - Da-Chuan Guo
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China; Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, P.R. China
| | - Jing-Wei Gao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China; Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, P.R. China
| | - Qing-Yuan Gao
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China; Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, P.R. China
| | - Yi-Peng Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China; Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, P.R. China
| | - Wan-Bing He
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China; Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, P.R. China
| | - Mao-Xiong Wu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China; Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, P.R. China
| | - Pin-Ming Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China; Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, P.R. China
| | - Jing-Feng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China; Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, P.R. China.
| | - Hai-Feng Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China; Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, P.R. China.
| | - Yang-Xin Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China; Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, P.R. China.
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Rafaqat S, Sharif S, Naz S, Gluscevic S, Mercantepe F, Ninic A, Klisic A. Cardiometabolic Risk Factors Related to Atrial Fibrillation and Metabolic Syndrome in the Pakistani Population. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1190. [PMID: 39202472 PMCID: PMC11356279 DOI: 10.3390/medicina60081190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/15/2024] [Accepted: 07/20/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: This study aimed to examine the relationship between cardiometabolic risk factors and atrial fibrillation (AF) and the simultaneous presence of AF and metabolic syndrome (MetS) in the Pakistani population. Materials and Methods: A total of 690 subjects were enrolled (n = 230 patients with AF, n = 230 patients with AF and MetS, and n = 230 controls). The associations between cardiometabolic parameters and AF with and without MetS were analyzed by univariable and multivariable binary regression analyses. Results: Body mass index (BMI), fasting blood glucose (FBG), and triglycerides (TG) were independently positively correlated, but the glomerular filtration rate (GFR) and sodium were independently negatively correlated with AF. An increase in BMI, FBG, and TG levels by one unit measure increased the probability by 55.1%, 20.6%, and 1.3%, respectively, for the AF occurrence. A decrease in GFR and sodium levels increased the probability by 4.3% and 33.6%, respectively, for the AF occurrence. On the other hand, uric acid was independently negatively correlated, whereas sodium was independently positively correlated, with MetS and AF. A decrease in uric acid levels and an increase in sodium levels by 1 unit measure increased the probability for MetS and AF by 23.2% and 7.5%, respectively. Conclusions: Cost-effective and routinely measured parameters, i.e., BMI, FBG TG, GFR, and sodium levels, can be reliable indicators of AF, whereas serum uric acid and sodium levels are independently associated with AF and MetS in the Pakistani population. Timely recognition and the control of modifiable cardiometabolic risk factors are of great significance in the prevention of AF development.
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Affiliation(s)
- Saira Rafaqat
- Department of Zoology, Lahore College for Women University, Lahore 44444, Punjab, Pakistan
| | - Saima Sharif
- Department of Zoology, Lahore College for Women University, Lahore 44444, Punjab, Pakistan
| | - Shagufta Naz
- Department of Zoology, Lahore College for Women University, Lahore 44444, Punjab, Pakistan
| | - Sanja Gluscevic
- Department of Neurology, Clinical Center of Montenegro, 81000 Podgorica, Montenegro
| | - Filiz Mercantepe
- Department of Endocrinology and Metabolism, Faculty of Medicine, Recep Tayyip Erdogan University, 53100 Rize, Turkey
| | - Ana Ninic
- Department for Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, 11158 Belgrade, Serbia
| | - Aleksandra Klisic
- Faculty of Medicine, University of Montenegro, 81000 Podgorica, Montenegro
- Center for Laboratory Diagnostics, Primary Health Care Center, 81000 Podgorica, Montenegro
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Gower B, Blacket C, Girard D, Boyle T, Davison K. Prospective associations between systolic blood pressure, serum cholesterol, and physical activity behaviour and the development of cardiovascular disease. Prev Med 2024; 183:107958. [PMID: 38657686 DOI: 10.1016/j.ypmed.2024.107958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/22/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
AIMS To systematically appraise and summarise meta-analyses of longitudinal studies to determine the effect size, and quality and certainty of the evidence summaries for systolic blood pressure (SBP), serum cholesterol, and physical activity behaviour in developing cardiovascular disease (CVD). METHODS AND RESULTS An umbrella review was conducted by searching MEDLINE, Embase, and Scopus databases. Eligible meta-analyses were longitudinal studies investigating the association between SBP, serum cholesterol, or physical activity behaviour on CVD development. Summary risk estimates were extracted. Quality and certainty of the evidence summaries of included records were performed using AMSTAR 2 and GRADE, respectively. Forty-one eligible records were found of which thirteen related to SBP, five to cholesterol, and twenty-three to physical activity behaviour. The quality and certainty of the evidence summaries were variable, with most studies rating 'low'. Reported risk estimates for the risk of developing CVD ranged from: no change to a 68% decreased risk for lower SBP; a 21% increased risk to a 44% decreased risk for lower cholesterol; and a 1% decreased risk to a 56% decreased risk for higher physical activity levels. CONCLUSIONS There were strong associations with CVD risk at the meta-analysis level for all three exposures, with a proportionally greater number of meta-analyses and primary studies for physical activity than SBP or serum cholesterol. Given the number of meta-analyses and similar CVD risk reductions and certainty of evidence associated with physical activity behaviour, there is a strong case for its routine assessment alongside SBP and serum cholesterol in primary CVD prevention.
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Affiliation(s)
- Bethany Gower
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia; Alliance for Research in Exercise, Nutrition and Activity (ARENA), Adelaide, Australia.
| | - Chloe Blacket
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia; Alliance for Research in Exercise, Nutrition and Activity (ARENA), Adelaide, Australia
| | - Danielle Girard
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia; Alliance for Research in Exercise, Nutrition and Activity (ARENA), Adelaide, Australia
| | - Terry Boyle
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia; University of South Australia, Australian Centre for Precision Health, Adelaide, Australia
| | - Kade Davison
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia; Alliance for Research in Exercise, Nutrition and Activity (ARENA), Adelaide, Australia
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Gu Q, Deng Y, Wei J, Chen Q, Cai D, Xiao T, Deng L, Wang Y, Wang Q, Sun L, Ji Y. Plasma triglyceride is associated with the recurrence of atrial fibrillation after radiofrequency catheter ablation: A retrospective study. Clin Cardiol 2024; 47:e24276. [PMID: 38812437 PMCID: PMC11137329 DOI: 10.1002/clc.24276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND The purpose of this study was to explore the association between triglycerides (TGs) and the risk of atrial fibrillation (AF) recurrence. METHODS AND RESULTS Included were adult patients with AF who underwent radiofrequency catheter ablation in the Affiliated Changzhou Second People's Hospital of Nanjing Medical University. The enrolled patients were divided into the AF recurrence group and the sinus rhythm (SR) maintenance group. The univariate Cox regression analysis and Kaplan-Meier survival curve were performed estimate the association between TG and the risk of AF recurrence. Of the 402 patients, 79 (19.7%) experienced recurrence of AF after ablation. The TG level was significantly higher in the AF recurrence group than in the SR-maintaining group. Patients were grouped by quartile of TG levels, with Quartile 1 and Quartile 2 defined as the low concentration group, Quartile 3 as the moderate concentration group, and Quartile 4 as the high concentration group. Multivariate Cox regression analysis showed that the moderate concentration group (p = .02, hazard ratio [HR]: 2.331, 95% confidence interval [CI]: 1.141-4.762) and high concentration group (p = .007, HR: 2.873, 95% CI: 1.332-6.199) were associated with an increased risk of AF recurrence compared with the low concentration group. The median follow-up was 1.17 years, it is indicated that a higher risk of recurrent AF was observed in the moderate concentration and high concentration group (log-rank: χ2 = 7.540, p = .023). CONCLUSION Our data suggest that an elevated TG level measured before catheter ablation is associated with an increased risk of AF recurrence.
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Affiliation(s)
- Qingqing Gu
- Department of CardiologyThe Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Medical CenterChangzhouJiangsuChina
| | - Ye Deng
- Department of CardiologyThe Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Medical CenterChangzhouJiangsuChina
| | - Jun Wei
- Department of Cardiovascular SurgeryThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouJiangsuChina
- Department of Cardiovascular SurgeryThe First Affiliated Hospital of Wannan Medical CollegeWuhuAnhuiChina
| | - Qianwen Chen
- Department of CardiologyThe Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Medical CenterChangzhouJiangsuChina
| | - Dabei Cai
- Department of CardiologyThe Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Medical CenterChangzhouJiangsuChina
- Dalian Medical UniversityDalianLiaoningChina
| | - Tingting Xiao
- Department of CardiologyThe Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Medical CenterChangzhouJiangsuChina
| | - Li Deng
- Department of CardiologyThe Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Medical CenterChangzhouJiangsuChina
| | - Yu Wang
- Department of CardiologyThe Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Medical CenterChangzhouJiangsuChina
| | - Qingjie Wang
- Department of CardiologyThe Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Medical CenterChangzhouJiangsuChina
| | - Ling Sun
- Department of CardiologyThe Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Medical CenterChangzhouJiangsuChina
- Dalian Medical UniversityDalianLiaoningChina
| | - Yuan Ji
- Department of CardiologyThe Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Medical CenterChangzhouJiangsuChina
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Guo J, Tian M, Li Y, Guo Y, Zhang T, Liu X, Shen J, Zhang L, Yu Y, Cao L, Gu H, Li Y, Duan S, Wang Q. Exploring clinical indicator variations in stroke patients with multiple risk factors: focus on hypertension and inflammatory reactions. Eur J Med Res 2024; 29:81. [PMID: 38287458 PMCID: PMC10823715 DOI: 10.1186/s40001-024-01653-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/10/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Stroke stands as the second leading cause of death worldwide. Currently, extensive research has been conducted on stroke risk factors. However, when stroke patients contend with multiple risk factors, the impact on clinical indicators remains uncertain. OBJECTIVES This study seeks to investigate potential significant variations among distinct ranges of clinical indicators in instances where stroke patients experience multiple risk factors and various ischemic stroke subtypes. MATERIAL AND METHODS The research encompassed 440 stroke patients admitted to the First People's Hospital of Wenling City, Zhejiang Province, China. These patients were classified based on the type and quantity of risk factors and subtypes of ischemic stroke they presented. The χ2 test was employed to assess the relationship between the risk of comorbid diseases and clinical indicators in stroke patients. RESULTS The results of our study have underscored a significant correlation between various comorbid risk factors in stroke patients and the patients' age (P < 0.010). Furthermore, we observed noteworthy disparities in the plasma levels of IL-2, IL-4, IL-6, IL-10, TNF-α, and INF-γ between patients devoid of risk factors and those presenting with comorbid risk factors associated with stroke. Significant differences in INF-γ were observed between the two subtypes of ischemic stroke, namely lacunar infarction and cardioembolic stroke. CONCLUSION Age is correlated with an elevated risk of stroke. Individuals exhibiting multiple stroke risk factors and diverse ischemic stroke subtypes commonly present with abnormal lipid levels and imbalances in Th1/Th2 cytokines. These factors significantly contribute to the onset and progression of stroke. Furthermore, inflammatory responses, particularly those induced by atherosclerosis, play a pivotal role in the genesis of stroke and exert a substantial influence on its prognosis.
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Affiliation(s)
- Jiejie Guo
- Zhejiang Key Laboratory of Pathophysiology, NBU Health Science Center, Ningbo University, Ningbo, 315211, Zhejiang, China
- Department of Clinical Laboratory, The Affiliated Wenling Hospital, Wenzhou Medical University, Wenling, 317500, Zhejiang, China
- Department of Neurology, The Affiliated Wenling Hospital, Wenzhou Medical University, Wenling, 317500, Zhejiang, China
| | - Mei Tian
- College of Pharmacy, Zhejiang University of Technology, Hangzhou, 310014, Zhejiang, China
- Key Laboratory of Novel Targets and Drug Study for Neural Repair of Zhejiang Province, School of Medicine, Hangzhou City University, Hangzhou, 310015, Zhejiang, China
| | - Yongang Li
- Department of Neurology, The Affiliated Wenling Hospital, Wenzhou Medical University, Wenling, 317500, Zhejiang, China
| | - Yitong Guo
- Key Laboratory of Novel Targets and Drug Study for Neural Repair of Zhejiang Province, School of Medicine, Hangzhou City University, Hangzhou, 310015, Zhejiang, China
| | - Ting Zhang
- Department of Clinical Laboratory, The Affiliated Wenling Hospital, Wenzhou Medical University, Wenling, 317500, Zhejiang, China
| | - Xuan Liu
- Department of Neurology, The Affiliated Wenling Hospital, Wenzhou Medical University, Wenling, 317500, Zhejiang, China
| | - Jinze Shen
- Key Laboratory of Novel Targets and Drug Study for Neural Repair of Zhejiang Province, School of Medicine, Hangzhou City University, Hangzhou, 310015, Zhejiang, China
| | - Lin Zhang
- Department of Neurology, The Affiliated Wenling Hospital, Wenzhou Medical University, Wenling, 317500, Zhejiang, China
| | - Yueqi Yu
- Key Laboratory of Novel Targets and Drug Study for Neural Repair of Zhejiang Province, School of Medicine, Hangzhou City University, Hangzhou, 310015, Zhejiang, China
| | - Ling Cao
- Ningbo Rehabilitation Hospital, Ningbo, 315040, China
| | - Haiyan Gu
- Ningbo Rehabilitation Hospital, Ningbo, 315040, China
| | - Yanfang Li
- Ningbo Rehabilitation Hospital, Ningbo, 315040, China
| | - Shiwei Duan
- Key Laboratory of Novel Targets and Drug Study for Neural Repair of Zhejiang Province, School of Medicine, Hangzhou City University, Hangzhou, 310015, Zhejiang, China.
| | - Qinwen Wang
- Zhejiang Key Laboratory of Pathophysiology, NBU Health Science Center, Ningbo University, Ningbo, 315211, Zhejiang, China.
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Guo J, Zhou Y, Zhou B. Development and Validation of a New Nomogram Model for Predicting Acute Ischemic Stroke in Elderly Patients with Non-Valvular Atrial Fibrillation: A Single-Center Cross-Sectional Study. Clin Interv Aging 2024; 19:67-79. [PMID: 38223136 PMCID: PMC10788061 DOI: 10.2147/cia.s437065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024] Open
Abstract
Background and Aims Non-valvular atrial fibrillation (NVAF) patients face a 3-5 times greater risk of acute ischemic stroke (AIS) compared to those without NVAF. This study aims to establish a novel clinical prediction model for AIS in elderly patients with NVAF by incorporating relevant biomarker indicators. Methods A total of 301 individuals diagnosed with NVAF were selected for this investigation at the Third Affiliated Hospital of Anhui Medical University. Based on the presence of AIS, patients were categorized into two groups: the Stroke Cohort and the Non-Stroke Cohort. Predictor screening was performed using the least absolute shrinkage and selection operation (LASSO) regression algorithm. The binary logistic regression equation was applied to fit the model, followed by internal validation using the bootstrap resampling method (1000 times). Receiver operating characteristic (ROC) curve, calibration degree curve plots, and clinical decision curve analysis (DCA) were generated, respectively. Finally, a nomogram was constructed to present the prediction model. Results The final results of this study revealed that neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), lipoprotein(a) (Lp(a)), systolic pressure, history of stroke, hyperlipidemia were independent risk factors for AIS in elderly patients with NVAF (P<0.05). And the high-density lipoprotein cholesterol (HDL-C) was an independent protective factor (P<0.05). By incorporating these indicators, a nomogram prediction model for predicting AIS in elderly patients with NVAF was constructed. Comparative analysis between the nomogram predictive model and CHA2DS2-VASc score revealed that the AUC of the nomogram predictive model surpassed that of the CHA2DS2-VASc score (AUC: 0.881vs 0.850). Conclusion NLR, RDW, Lp(a), SP, history of stroke, hyperlipidemia, and HDL-C emerge as independent prognostic factors for acute ischemic stroke in elderly patients with non-valvular atrial fibrillation. The predictive utility of the nomogram model may potentially surpass that of the CHA2DS2-VASc scoring system.
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Affiliation(s)
- Jiongchao Guo
- Department of Cardiology, the Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Yuan Zhou
- Department of Cardiology, the Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Bingfeng Zhou
- Department of Cardiology, Hefei BOE Hospital, Hefei, Anhui, People's Republic of China
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Li J, Yu Y, Sun Y, Yu B, Tan X, Wang B, Lu Y, Wang N. SGLT2 inhibition, circulating metabolites, and atrial fibrillation: a Mendelian randomization study. Cardiovasc Diabetol 2023; 22:278. [PMID: 37848934 PMCID: PMC10583416 DOI: 10.1186/s12933-023-02019-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Sodium-glucose cotransporter 2 (SGLT2) inhibitors have shown promise in reducing the risk of atrial fibrillation (AF). However, the results are controversial and the underlying metabolic mechanism remains unclear. Emerging evidence implied that SGLT2 inhibitors have extra beneficial metabolic effects on circulating metabolites beyond glucose control, which might play a role in reducing the risk of AF. Hence, our study aimed to investigate the effect of circulating metabolites mediating SGLT2 inhibition in AF by Mendelian randomization (MR). METHODS A two-sample and two-step MR study was conducted to evaluate the association of SGLT2 inhibition with AF and the mediation effects of circulating metabolites linking SGLT2 inhibition with AF. Genetic instruments for SGLT2 inhibition were identified as genetic variants, which were both associated with the expression of SLC5A2 gene and glycated hemoglobin level (HbA1c). Positive control analysis on type 2 diabetes mellitus (T2DM) was conducted to validate the selection of genetic instruments. RESULTS Genetically predicted SGLT2 inhibition (per 1 SD decrement in HbA1c) was associated with reduced risk of T2DM (odds ratio [OR] = 0.63 [95% CI 0.45, 0.88], P = 0.006) and AF (0.51 [0.27, 0.97], P = 0.039). Among 168 circulating metabolites, two metabolites were both associated with SGLT2 inhibition and AF. The effect of SGLT2 inhibition on AF through the total concentration of lipoprotein particles (0.88 [0.81, 0.96], P = 0.004) and the concentration of HDL particles (0.89 [0.82, 0.97], P = 0.005), with a mediated proportion of 8.03% (95% CI [1.20%, 14.34%], P = 0.010) and 7.59% ([1.09%, 13.34%], P = 0.011) of the total effect, respectively. CONCLUSIONS This study supported the association of SGLT2 inhibition with a reduced risk of AF. The total concentration of lipoprotein particles and particularly the concentration of HDL particles might mediate this association. Further mechanistic and clinical studies research are needed to understand the mediation effects of circulating metabolites especially blood lipids in the association between SGLT2 inhibition and AF.
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Affiliation(s)
- Jiang Li
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuefeng Yu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Sun
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bowei Yu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao Tan
- School of Public Health, Zhejiang University, Hangzhou, China
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Bin Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Hayıroğlu Mİ, Şaylık F, Çınar T, Tokgözoğlu L. Meta-analysis of the Current Research on the Relationship Between Blood Lipid Levels and the Occurrence of Atrial Fibrillation. Heart Lung Circ 2023; 32:1158-1166. [PMID: 37741751 DOI: 10.1016/j.hlc.2023.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/24/2023] [Accepted: 08/15/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND There is still debate in the literature about the relationship between lipid profile and the occurrence of atrial fibrillation (AF). In order to assess the association between blood lipid profiles and incidence of AF, this review was conducted to perform a meta-analysis of all available studies. METHODS This review analysed all studies up to 28 February 2023 in PubMed, Google Scholar, and the Cochrane Library that included data regarding blood lipid levels and incidence of AF. For the purpose of calculating pooled estimates, the hazard ratios were extracted from all studies. RESULTS Fourteen studies including 19 cohorts with 3,990,484 patients were included in this meta-analysis. An elevation of one standard deviation in total cholesterol (TC) level was associated with an 8% reduction (HR=0.92, 0.88-0.96; p<0.01) in the risk of developing AF. Although increased low-density lipoprotein cholesterol levels were associated with a 7% reduction in the development of AF (HR=0.93, 0.87-1.00; p=0.04), there was high heterogeneity in the random effects model (I2=92%). Changes in high-density lipoprotein cholesterol and triglyceride levels were not found to be associated with AF risk in the pooled analysis. Dose-response meta-analysis showed that TC was inversely linearly associated with the risk of AF (p<0.001). CONCLUSIONS Higher TC levels were shown to be independently attributed to an increased risk of AF in individuals without cardiovascular disease. There was no association between the incidence of AF and triglyceride, high-density lipoprotein cholesterol, or low-density lipoprotein cholesterol blood levels.
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Affiliation(s)
- Mert İlker Hayıroğlu
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Faysal Şaylık
- Department of Cardiology, Van Education and Research Hospital, Van, Turkey
| | - Tufan Çınar
- Department of Cardiology, Haydarpasa Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Lale Tokgözoğlu
- Department of Cardiology, Hacettepe University School of Medicine, Ankara, Turkey
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9
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Masson W, Barbagelata L, Nogueira JP, Corral P, Lavalle-Cobo A, Romeo FJ. Elevated Lipoprotein(a) Levels and Atrial Fibrillation: A Systematic Review. J Lipid Atheroscler 2023; 12:267-276. [PMID: 37800104 PMCID: PMC10548189 DOI: 10.12997/jla.2023.12.3.267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/08/2023] [Accepted: 07/17/2023] [Indexed: 10/07/2023] Open
Abstract
Objective The role of lipoprotein(a) (Lp[a]) as a possibly causal risk factor for atherosclerotic cardiovascular disease has been well established. However, the clinical evidence regarding the association between Lp(a) levels and atrial fibrillation (AF) remains limited and inconsistent. This study aimed to analyze the association between elevated Lp(a) levels or single-nucleotide polymorphisms (SNPs) related to high levels of Lp(a) and AF. Methods This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search was performed to identify studies that evaluated the association between Lp(a) levels or SNPs related to high levels of Lp(a) and AF. Observational studies with a cross-sectional, case-control, or cohort design were included in this systematic review, without limitations according to language, country, or publication type. Results Eleven observational studies including 1,246,817 patients were eligible for this systematic review. Two cross-sectional studies, 5 prospective/retrospective cohort studies, and 4 Mendelian randomization studies were analyzed. Two cross-sectional studies that compared Lp(a) levels between patients with and without AF showed conflicting results. Cohort studies that evaluated the incidence of AF according to Lp(a) levels showed different results: no association (3 studies), a positive association (1 study), and an inverse relationship (1 study). Finally, Mendelian randomization studies also showed heterogeneous results (positive association: 2 studies; inverse association: 1 study; no association: 1 study). Conclusion Although there could be an association between Lp(a) levels and AF, the results of the studies published to date are contradictory and not yet definitive. Therefore, further research should clarify this issue.
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Affiliation(s)
- Walter Masson
- Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Leandro Barbagelata
- Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan P Nogueira
- Department of Endocrinology, Nutrition and Metabolism Research Center, Faculty of Health Sciences, Universidad Nacional de Formosa, Formosa, Argentina
- International University of the Americas, San José, Costa Rica
| | - Pablo Corral
- Faculty of Medicine, FASTA University, Mar del Plata, Argentina
| | | | - Francisco J. Romeo
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside & West, New York, NY, USA
- Department of Cardiology, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
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10
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Guan B, Wang A, Xu H. Causal associations of remnant cholesterol with cardiometabolic diseases and risk factors: a mendelian randomization analysis. Cardiovasc Diabetol 2023; 22:207. [PMID: 37563569 PMCID: PMC10416527 DOI: 10.1186/s12933-023-01927-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Emerging evidence suggests that remnant cholesterol (RC) is strongly associated with an increased incidence of cardiometabolic diseases (CMD). However, the causality have not been confirmed. We aimed to evaluate the causal associations of RC with CMD and the relative risk factors using two-sample Mendelian randomization (MR) methods. METHODS Summary-level statistics of RC, CMD, and cardiometabolic risk factors were obtained from the published data from individuals with a predominantly European ancestry mainly from the UK Biobank and the FinnGen biobank. Univariable and multivariable MR analyses were used to evaluate the causal relationships between RC and CMD. A bidirectional MR analysis was performed to estimate the causality between RC and cardiometabolic risk factors. The main MR method was conducted using the inverse-variance weighted method. RESULTS Univariable MR analyses showed that genetically predicted RC was causally associated with higher risk of ischemic heart disease, myocardial infarction, atrial fibrillation and flutter, peripheral artery disease, and non-rheumatic valve diseases (all P < 0.05). Multivariable MR analyses provided compelling evidence of the harmful effects of RC on the risk of ischemic heart disease (P < 0.05). Bidirectional MR analysis demonstrated that RC was bidirectionally causally linked to total cholesterol, triglycerides, low-density lipoprotein cholesterol, hypercholesterolemia (all P < 0.05). However, no genetic association was found between RC and metabolic disorders or the other cardiometabolic risk factors. CONCLUSIONS This MR study demonstrates that genetically driven RC increases the risk of several CMD and cardiometabolic risk factors, suggesting that targeted RC-lowering therapies may be effective for the primary prevention of CMD.
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Affiliation(s)
- Baoyi Guan
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, 100091, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, 100091, Beijing, China
| | - Anlu Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, 100091, Beijing, China.
- National Clinical Research Center for Chinese Medicine Cardiology, 100091, Beijing, China.
| | - Hao Xu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, 100091, Beijing, China.
- National Clinical Research Center for Chinese Medicine Cardiology, 100091, Beijing, China.
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11
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Bai W, Liu ZQ, He PY, Muhuyati. The role of IL-6, IL-10, TNF-α and PD-1 expression on CD4 T cells in atrial fibrillation. Heliyon 2023; 9:e18818. [PMID: 37636377 PMCID: PMC10448416 DOI: 10.1016/j.heliyon.2023.e18818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 07/04/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Backgrounds While not completely understood, the electrical, structural, and communication pathways that play a role in the onset and progression of atrial fibrillation (AF) seem to be connected to the intricate interplay between neurohormones and cellular mediators. Our study's objective was to examine how the expression profiles of the inflammatory cytokines interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor (TNF), and programmed death 1 (PD-1) changed in Cluster of Differentiation 4 (CD4) T cells depending on whether atrial fibrillation was paroxysmal or permanent. This analysis would provide new diagnostic markers for the detection and management of atrial fibrillation. Methods In a cross-sectional study, 60 healthy controls, 49 patients with persistent atrial fibrillation, and 50 patients with paroxysmal atrial fibrillation were compared. Serum biomarker levels are found using the ELISA method, which uses enzyme-linked immunosorbent assay. Echocardiography was used to assess heart function. Results Patients with atrial fibrillation had serum concentrations of IL-6, TNF-a, and IL-10 that were considerably higher than but PD-1 was lower those in the non-AF control group and those in patients with persistent atrial fibrillation. According to the diameter of LA and the serum level of NT-proB-type natriuretic peptide (NT-proBNP) is greater than that of patients with paroxysmal atrial fibrillation than control group. Patients with persistent atrial fibrillation had increased serum levels of low-density lipoprotein cholesterol (LDL-C) compared with those without atrial fibrillation. While PD-1 in patients with paroxysmal atrial fibrillation is closely related to C-reactive protein (CRP), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and very low density lipoprotein cholesterol. In addition, PD-1 in patients with persistent atrial fibrillation is closely related to IL-6, TNF-a, and IL-10. Conclusion Higher blood concentrations of NT-proBNP, IL-6, IL-10, TNF-, and LDL-C but low level of PD-1 are associated with progression from paroxysmal or chronic AF.
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Affiliation(s)
- Wen Bai
- Department of Comprehensive Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
- Cardiovascular Center of the Urumqi Friendship Hospital, Urumqi, Xinjiang, China
| | - Zhi-Qiang Liu
- Department of Comprehensive Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Peng-Yi He
- Department of Comprehensive Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Muhuyati
- Department of Comprehensive Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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12
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Li J, Wang Y, Qi W, Zhang N, Tse G, Li G, Wu S, Liu T. Association of proteinuria and risk of incident atrial fibrillation in the general population: A prospective study of Kailuan study participants. Pacing Clin Electrophysiol 2023; 46:526-534. [PMID: 36636861 DOI: 10.1111/pace.14658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/08/2022] [Accepted: 12/30/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Proteinuria is a well-known cardiovascular risk factor, but whether it independently increases the risk for atrial fibrillation (AF) in Chinese population is unknown. To address this deficiency, herein, we investigated the association between proteinuria detected using urine dipstick test and the risk of AF. METHODS This was a prospective cohort study of Kailuan study participants who underwent the 2006-2007 and 2010-2011 health checkups and was free from AF. Participants were classified into four groups based on the level of proteinuria: [-, trace (±), 1+, ≥2+]. The outcome was incident AF as confirmed by 12-lead electrocardiography. RESULTS During a median of 11.90 years of follow-up, we documented 514 incident AF cases among 60,599 participants. Proteinuria was found in 6302 (10.40%) participants. Relative to participants without proteinuria at the baseline, those with proteinuria (≥2+) had an 83.9% higher risk (95% confidence interval [CI], 1.073-3.154, p = .0267) of developing AF, after adjusted for confounding variables. The result was consistent in the sensitivity analysis. Compared to consistently negative proteinuria, the risk of AF significantly increased in the aggravated proteinuria group (hazard ratio [HR] 1.552, 95% CI 1.140-2.114) and the persistent proteinuria group (HR 2.485, 95% CI 1.414-4.366). Among participants with resolved proteinuria (from positive to negative), the risk of incident AF was not significantly increased compared to those with persistently negative proteinuria (HR 1.300, 95% CI 0.743-2.276). CONCLUSIONS Proteinuria could be a modifiable risk factor for predicting AF development. Knowing the presence of proteinuria may improve risk stratification for decision-making about AF prevention.
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Affiliation(s)
- Jie Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- VIP Department, Qingdao Municipal Hospital, Shandong, China
| | - Yueying Wang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Wenwei Qi
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Nan Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- School of Nursing and Health Studies, Hong Kong, Metropolitan University, China
- Kent and Medway Medical School, Canterbury, Kent, UK
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
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Zhong X, Yu J, Zhao D, Teng J, Jiao H. Association between serum apolipoprotein A1 and atrial fibrillation in the Chinese population: a case-control study. BMC Cardiovasc Disord 2023; 23:269. [PMID: 37221493 DOI: 10.1186/s12872-023-03283-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND The relationship between serum apolipoprotein A1 (APOA1) and atrial fibrillation (AF) is not known. Therefore, we sought to investigate the associations between APOA1 and AF in the Chinese population. METHODS This case-control study included 950 patients with AF (29-83 years old, 50.42% male) who were hospitalized consecutively in China between January 2019 and September 2021. Controls with sinus rhythm and without AF were matched (1:1) to cases by sex and age. Pearson correlation analysis was performed to investigate the correlation between APOA1 and blood lipid profiles. Multivariate regression models were used to explore the association between APOA1 and AF. The receiver operator characteristic (ROC) curve was constructed to examine the performance of APOA1. RESULTS Multivariate regression analysis showed that low serum APOA1 in men and women with AF was significantly associated with AF (OR = 0.261, 95% CI: 0.162-0.422, P < 0.001). Pearson correlation analysis indicated that serum APOA1 was positively correlated with total cholesterol (TC) (r = 0.456, p < 0.001), low-density lipoprotein cholesterol (LDL-C) (r = 0.825, p < 0.001), high-density lipoprotein cholesterol (HDL-C) (r = 0.238, p < 0.001), and apolipoprotein B (APOB) (r = 0.083, p = 0.011). ROC curve analysis showed that APOA1 levels of 1.105 g/L and 1.205 g/L were the optimal cut-off values for predicting AF in males and females, respectively. CONCLUSION Low APOA1 in male and female patients is significantly associated with AF in the Chinese population of non-statin users. APOA1 may be a potential biomarker for AF and contribute to the pathological progression of AF along with low blood lipid profiles. Potential mechanisms remain to be further explored.
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Affiliation(s)
- Xia Zhong
- Department of First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Jie Yu
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Dongsheng Zhao
- Department of First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Jing Teng
- Department of First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Huachen Jiao
- Department of Cardiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, No. 42 Wenhua West Road, Lixia District, Jinan City, Shandong Province, China.
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14
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Zhang Y, Wang L, Qi J, Yu B, Zhao J, Pang L, Zhang W, Bin L. Correlation between the triglyceride-glucose index and the onset of atrial fibrillation in patients with non-alcoholic fatty liver disease. Diabetol Metab Syndr 2023; 15:94. [PMID: 37158953 PMCID: PMC10169476 DOI: 10.1186/s13098-023-01012-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/02/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is associated with atrial fibrillation (AF). Insulin resistance (IR) is the main cause of the high prevalence of AF in NAFLD patients. The triglyceride-glucose index (TyG) is a novel IR-related indicator implicated in the incidence and severity of NAFLD. However, the role of TyG in determining the risk for AF in patients with NAFLD remains unclear. METHODS A retrospective study was conducted on 912 patients diagnosed with NAFLD via ultrasonography. These patients were divided into two groups: (1) NAFLD+ AF and (2) NAFLD+ non-AF. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to assess the correlation between the TyG index and the high risk for AF. A receiver operating characteristic (ROC) curve was constructed to evaluate the predictive value for the TyG index for AF. Restricted cubic splines (RCS) were used to test the linear correlation between TyG and the risk for AF. RESULTS A total of 204 patients with AF and 708 patients without AF were included in this study. The LASSO logistic regression analysis showed that TyG was an independent risk factor for AF (odds ratio [OR] = 4.84, 95% confidence interval [CI] 2.98-7.88, P < 0.001). The RCS showed that the risk for AF increased linearly with TyG over the entire TyG range; this risk was also evident when the patients were analyzed based on sex (P for nonlinear > 0.05). In addition, the correlation between TyG and AF was a consistent finding in subgroup analysis. Furthermore, ROC curve analysis showed that TyG levels combined with traditional risk factors improved the predictive value for atrial fibrillation. CONCLUSION The TyG index is useful in assessing the risk for atrial fibrillation in patients with NAFLD. Patients with NAFLD and increased TyG indices have higher risks for atrial fibrillation. Therefore, TyG indices should be assessed when managing patients with NAFLD.
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Affiliation(s)
- Yao Zhang
- Shanxi Medical University, Taiyuan, 030000, Shanxi, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030000, Shanxi, China
| | - Leigang Wang
- Shanxi Medical University, Taiyuan, 030000, Shanxi, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030000, Shanxi, China
| | - Jiaxin Qi
- Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Bing Yu
- Shanxi Medical University, Taiyuan, 030000, Shanxi, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030000, Shanxi, China
| | - Jianqi Zhao
- Shanxi Medical University, Taiyuan, 030000, Shanxi, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030000, Shanxi, China
| | - Lin Pang
- Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Wenjing Zhang
- Shanxi Medical University, Taiyuan, 030000, Shanxi, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030000, Shanxi, China
| | - Liang Bin
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030000, Shanxi, China.
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15
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Toledo E, Wittenbecher C, Razquin C, Ruiz-Canela M, Clish CB, Liang L, Alonso A, Hernández-Alonso P, Becerra-Tomás N, Arós-Borau F, Corella D, Ros E, Estruch R, García-Rodríguez A, Fitó M, Lapetra J, Fiol M, Alonso-Gomez ÁM, Serra-Majem L, Deik A, Salas-Salvadó J, Hu FB, Martínez-González MA. Plasma lipidome and risk of atrial fibrillation: results from the PREDIMED trial. J Physiol Biochem 2023; 79:355-364. [PMID: 37004634 PMCID: PMC10300169 DOI: 10.1007/s13105-023-00958-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/16/2023] [Indexed: 04/04/2023]
Abstract
The potential role of the lipidome in atrial fibrillation (AF) development is still widely unknown. We aimed to assess the association between lipidome profiles of the Prevención con Dieta Mediterránea (PREDIMED) trial participants and incidence of AF. We conducted a nested case-control study (512 incident centrally adjudicated AF cases and 735 controls matched by age, sex, and center). Baseline plasma lipids were profiled using a Nexera X2 U-HPLC system coupled to an Exactive Plus orbitrap mass spectrometer. We estimated the association between 216 individual lipids and AF using multivariable conditional logistic regression and adjusted the p values for multiple testing. We also examined the joint association of lipid clusters with AF incidence. Hitherto, we estimated the lipidomics network, used machine learning to select important network-clusters and AF-predictive lipid patterns, and summarized the joint association of these lipid patterns weighted scores. Finally, we addressed the possible interaction by the randomized dietary intervention.Forty-one individual lipids were associated with AF at the nominal level (p < 0.05), but no longer after adjustment for multiple-testing. However, the network-based score identified with a robust data-driven lipid network showed a multivariable-adjusted ORper+1SD of 1.32 (95% confidence interval: 1.16-1.51; p < 0.001). The score included PC plasmalogens and PE plasmalogens, palmitoyl-EA, cholesterol, CE 16:0, PC 36:4;O, and TG 53:3. No interaction with the dietary intervention was found. A multilipid score, primarily made up of plasmalogens, was associated with an increased risk of AF. Future studies are needed to get further insights into the lipidome role on AF.Current Controlled Trials number, ISRCTN35739639.
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Affiliation(s)
- Estefania Toledo
- Department of Preventive Medicine and Public Health, Edificio de Investigación, University of Navarra, Planta 2, Calle Irunlarrea 1, 31008, Pamplona, Spain.
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
- CIBER Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Clemens Wittenbecher
- SciLifeLab & Division of Food and Nutrition Science, Department of Life Sciences, Chalmers University of Technology, Gothenburg, Sweden
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Cristina Razquin
- Department of Preventive Medicine and Public Health, Edificio de Investigación, University of Navarra, Planta 2, Calle Irunlarrea 1, 31008, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- CIBER Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Miguel Ruiz-Canela
- Department of Preventive Medicine and Public Health, Edificio de Investigación, University of Navarra, Planta 2, Calle Irunlarrea 1, 31008, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- CIBER Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Clary B Clish
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Liming Liang
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Pablo Hernández-Alonso
- CIBER Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Departament de Bioquímica I Biotecnologia, Universitat Rovira I Virgili, Unitat de Nutrició Humana, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari San Joan de Reus, Reus, Spain
- Unidad de Gestión Clínica de Endocrinología Y Nutrición del Hospital Virgen de La Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Nerea Becerra-Tomás
- Departament de Bioquímica I Biotecnologia, Universitat Rovira I Virgili, Unitat de Nutrició Humana, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari San Joan de Reus, Reus, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, Valencia, Spain
| | - Fernando Arós-Borau
- CIBER Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Bioaraba Health Research Institute Osakidetza Basque Health Service, Araba University Hospital University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Dolores Corella
- CIBER Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, Valencia, Spain
| | - Emilio Ros
- CIBER Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Endocrinology & Nutrition, Hospital Clinic, Barcelona, Spain
| | - Ramón Estruch
- CIBER Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Montserrat Fitó
- CIBER Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Cardiovascular Risk and Nutrition Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - José Lapetra
- CIBER Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, 41013, Seville, Spain
| | - Miquel Fiol
- CIBER Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- IdISBa. Health Research Institute of the Balearis Islands, Palma, Spain
| | - Ángel M Alonso-Gomez
- CIBER Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Bioaraba Health Research Institute Osakidetza Basque Health Service, Araba University Hospital University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Luis Serra-Majem
- CIBER Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, & Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI) del Servicio Canario de Salud, Gobierno de Canarias, Las Palmas de Gran Canaria, Spain
| | - Amy Deik
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jordi Salas-Salvadó
- CIBER Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Departament de Bioquímica I Biotecnologia, Universitat Rovira I Virgili, Unitat de Nutrició Humana, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari San Joan de Reus, Reus, Spain
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division for Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Miguel A Martínez-González
- Department of Preventive Medicine and Public Health, Edificio de Investigación, University of Navarra, Planta 2, Calle Irunlarrea 1, 31008, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- CIBER Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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16
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Lee HC, Cheng WC, Ma WL, Lin YH, Shin SJ, Lin YH. Association of lipid composition and unsaturated fatty acids of VLDL with atrial remodeling in metabolic syndrome. Sci Rep 2023; 13:6575. [PMID: 37085694 PMCID: PMC10121655 DOI: 10.1038/s41598-023-33757-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 04/18/2023] [Indexed: 04/23/2023] Open
Abstract
Subjects with metabolic syndrome (MetS) commonly have atrial remodeling, which indicates a risk for atrial fibrillation. This study determined MetS-related changes in lipid components in very-low-density lipoprotein (VLDL), which has been shown to cause atrial remodeling, the effect of statins on these changes, and the correlation between atrial remodeling and VLDL lipid compositions. Blood samples were collected from 12 non-MetS and 27 sex- and age-matched MetS subjects. Fourteen patients with MetS (MetS-off statin) discontinued statin therapy 14 days before the study, while the remaining 13 remained on it (MetS-on statin). The VLDLs were isolated and processed for mass-based lipid profiling. Lipidomic analyses were performed and associated with atrial remodeling markers measured using standard echocardiography and electrocardiography. Compared with the VLDL components of the non-MetS group, glucosyl/galactosyl ceramide, lyso-phosphatidylcholine, lyso-phosphatidylethanolamine, and triglycerides were enriched in the MetS-off statin group. Statin therapy attenuated all abnormally abundant lipid classes in MetS, except for triglycerides. In addition, lyso-phosphatidylcholine, lyso-phosphatidylethanolamine, and triglycerides were significantly correlated with atrial dilatation, and the latter two were also correlated with the PR interval. Enrichment of double bonds, which indicate unsaturated fatty acids, was also significantly correlated with atrial remodeling and P-wave duration. This study suggests that the pathological lipid payload of MetS-VLDL may contribute to atrial remodeling in patients.
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Affiliation(s)
- Hsiang-Chun Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou 1st Rd, Kaohsiung, 807, Taiwan.
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Lipid Science and Aging Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Institute/Center of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan.
- Graduate Institute of Animal Vaccine Technology, National Pingtung University of Science and Technology, Pingtung, Taiwan.
| | - Wei-Chung Cheng
- PhD Program for Cancer Molecular Biology and Drug Discovery, China Medical University and Academia Sinica, Taichung, Taiwan
- Research Center for Cancer Biology, China Medical University, Taichung, Taiwan
| | - Wen-Lung Ma
- Graduate Institute of Biomedical Sciences, and Graduate Institution of Cancer Biology, School of Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Department of Nursing, Asia University, Taichung, Taiwan
| | - Yu-Hsun Lin
- Lipid Science and Aging Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Yi-Hsiung Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou 1st Rd, Kaohsiung, 807, Taiwan
- Lipid Science and Aging Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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17
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Zhou X, Li Z, Liu H, Li Y, Zhao D, Yang Q. Antithrombotic therapy and bleeding risk in the era of aggressive lipid-lowering: current evidence, clinical implications, and future perspectives. Chin Med J (Engl) 2023; 136:645-652. [PMID: 36806078 PMCID: PMC10129148 DOI: 10.1097/cm9.0000000000002057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Indexed: 02/23/2023] Open
Abstract
ABSTRACT The clinical efficacy of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in reducing major cardiovascular adverse events related to atherosclerotic cardiovascular disease (ASCVD) has been well established in recent large randomized outcome trials. Although the cardiovascular and all-cause mortality benefit of PCSK9i remains inconclusive, current cholesterol management guidelines have been modified toward more aggressive goals for lowering low-density lipoprotein cholesterol (LDL-C). Consequently, the emerging concept of "the lower the better" has become the paradigm of ASCVD prevention. However, there is evidence from observational studies of a U-shaped association between baseline LDL-C levels and all-cause mortality in population-based cohorts. Among East Asian populations, low LDL-C was associated with an increased risk for hemorrhagic stroke in patients not on antithrombotic therapy. Accumulating evidence showed that low LDL-C was associated with an enhanced bleeding risk in patients on dual antiplatelet therapy following percutaneous coronary intervention. Additionally, low LDL-C was associated with a higher risk for incident atrial fibrillation and thereby, a possible increase in the risk for intracranial hemorrhage after initiation of anticoagulation therapy. The mechanism of low-LDL-C-related bleeding risk has not been fully elucidated. This review summarizes recent evidence of low-LDL-C-related bleeding risk in patients on antithrombotic therapy and discusses potential measures for reducing this risk, underscoring the importance of carefully weighing the pros and cons of aggressive LDL-C lowering in patients on antithrombotic therapy.
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Affiliation(s)
- Xin Zhou
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Ziping Li
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hangkuan Liu
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yongle Li
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Qing Yang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin 300052, China
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18
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Ahn HJ, Lee SR, Choi EK, Lee SW, Han KD, Kwon S, Oh S, Lip GYH. Evaluation of the Paradoxical Association Between Lipid Levels and Incident Atrial Fibrillation According to Statin Usage: A Nationwide Cohort Study. J Lipid Atheroscler 2023; 12:73-86. [PMID: 36761066 PMCID: PMC9884554 DOI: 10.12997/jla.2023.12.1.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/14/2022] [Accepted: 11/17/2022] [Indexed: 01/26/2023] Open
Abstract
Objective Higher levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) are associated with a lower risk of atrial fibrillation (AF). Statin use might exert confounding effects on the paradoxical associations; however, the relationships that distinguish statin users from non-users have not been thoroughly evaluated. Methods From the Korean National Health Insurance Database, we included 9,778,014 adults who underwent a health examination in 2009. The levels of TC and LDL-C at the health examination were categorized into quartile values of the total study population. We grouped the study population into statin users and non-users and investigated the associations between TC, LDL-C, and the risk of incident AF. Results Of the total population, 867,336 (8.9%) were taking statins. During a mean follow-up of 8.2 years, inverse associations of TC - AF and LDL-C - AF were observed; higher levels of TC and LDL-C were associated with the lower risk of AF in the total population. Overall, statin users showed higher AF incidence rate than non-users, but the inverse associations of TC - AF and LDL-C - AF were consistently observed irrespective of statin usage; adjusted hazard ratio with 95% confidence interval was 0.81 (0.79-0.84) for statin users and 0.81 (0.80-0.83) for non-users in the highest TC quartile, and 0.84 (0.82-0.87) for statin users and 0.85 (0.84-0.86) for non-users in the highest LDL-C quartile (all p<0.001). Conclusion The paradoxical relationship between lipid levels (TC and LDL-C) and the risk of AF remains consistent in both statin users and non-users.
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Affiliation(s)
- Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Woo Lee
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gregory Y. H. Lip
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest & Heart Hospital, Liverpool, United Kingdom.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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19
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Bianco HT. Analysis of Atrial Fibrillation Prevalence and Cardiovascular Health in Cohort Derived from the ELSA-Brasil Project. Arq Bras Cardiol 2022; 119:732-733. [PMID: 36453763 PMCID: PMC9750223 DOI: 10.36660/abc.20220676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Henrique Tria Bianco
- Universidade Federal de São PauloEscola Paulista de MedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina, São Paulo, SP – Brasil
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20
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Santos IS, Lotufo PA, Goulart AC, Brant LCC, Pinto MM, Pereira AC, Barreto SM, Ribeiro ALP, Thomas GN, Lip GYH, Bensenor IM. Cardiovascular Health and Atrial Fibrillation or Flutter: A Cross-Sectional Study from ELSA-Brasil. Arq Bras Cardiol 2022; 119:S0066-782X2022005016205. [PMID: 36169453 PMCID: PMC9750207 DOI: 10.36660/abc.20210970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/13/2022] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The association between ideal cardiovascular health (ICVH) status and atrial fibrillation or flutter (AFF) diagnosis has been less studied compared to other cardiovascular diseases. OBJECTIVE To analyze the association between AFF diagnosis and ICVH metrics and scores in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS This study analyzed data from 13,141 participants with complete data. Electrocardiographic tracings were coded according to the Minnesota Coding System, in a centralized reading center. ICVH metrics (diet, physical activity, body mass index, smoking, blood pressure, fasting plasma glucose, and total cholesterol) and scores were calculated as proposed by the American Heart Association. Crude and adjusted binary logistic regression models were built to analyze the association of ICVH metrics and scores with AFF diagnosis. Significance level was set at 0.05. RESULTS The sample had a median age of 55 years and 54.4% were women. In adjusted models, ICVH scores were not significantly associated with prevalent AFF diagnosis (odds ratio [OR]:0.96; 95% confidence interval [95% CI]:0.80-1.16; p=0.70). Ideal blood pressure (OR:0.33; 95% CI:0.15-0.74; p=0.007) and total cholesterol (OR:1.88; 95% CI:1.19-2.98; p=0.007) profiles were significantly associated with AFF diagnosis. CONCLUSIONS No significant associations were identified between global ICVH scores and AFF diagnosis after multivariable adjustment in our analyses, at least partially due to the antagonistic associations of AFF with blood pressure and total cholesterol ICVH metrics. Our results suggest that estimating the prevention of AFF burden using global ICVH scores may not be adequate, and ICVH metrics should be considered in separate.
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Affiliation(s)
- Itamar S. Santos
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Departamento de Clínica Médica da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Centro de Pesquisa Clínica e EpidemiológicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Paulo A. Lotufo
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Departamento de Clínica Médica da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Centro de Pesquisa Clínica e EpidemiológicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Alessandra C. Goulart
- Centro de Pesquisa Clínica e EpidemiológicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Luisa C. C. Brant
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Marcelo M Pinto
- Programa de Pós-Graduação em Infectologia e Medicina TropicalFaculdade de MedicinaUniversidade Federal de Minas Gerais,Belo HorizonteMGBrasil Programa de Pós-Graduação em Infectologia e Medicina Tropical da Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte , MG – Brasil
| | - Alexandre C. Pereira
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Laboratório de Genética e Cardiologia Molecular do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Sandhi M. Barreto
- Departamento de Medicina Preventiva e SocialFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Medicina Preventiva e Social da Faculdade de Medicina da Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Antonio L. P. Ribeiro
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - G Neil Thomas
- Institute of Applied Health ResearchCollege of Medical and Dental SciencesUniversity of BirminghamBirminghamReino Unido Institute of Applied Health Research , College of Medical and Dental Sciences , University of Birmingham , Birmingham – Reino Unido
| | - Gregory Y. H. Lip
- Chest Hospital and Aalborg Thrombosis Research UnitDepartment of Clinical MedicineAalborg UniversityLiverpoolReino Unido Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital and Aalborg Thrombosis Research Unit , Department of Clinical Medicine , Aalborg University , Liverpool – Reino Unido
| | - Isabela M. Bensenor
- Departamento de Clínica MédicaFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Departamento de Clínica Médica da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Centro de Pesquisa Clínica e EpidemiológicaHospital UniversitárioUniversidade de São PauloSão PauloSPBrasil Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo , São Paulo , SP – Brasil
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21
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Ding M, Wennberg A, Gigante B, Walldius G, Hammar N, Modig K. Lipid levels in midlife and risk of atrial fibrillation over 3 decades-Experience from the Swedish AMORIS cohort: A cohort study. PLoS Med 2022; 19:e1004044. [PMID: 35951514 PMCID: PMC9371362 DOI: 10.1371/journal.pmed.1004044] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The role of cholesterol levels in the development of atrial fibrillation (AF) is still controversial. In addition, whether and to what extent apolipoproteins are associated with the risk of AF is rarely studied. In this study, we aimed to investigate the association between blood lipid levels in midlife and subsequent risk of new-onset AF. METHODS AND FINDINGS This population-based study included 65,136 individuals aged 45 to 60 years without overt cardiovascular diseases (CVDs) from the Swedish Apolipoprotein-Related Mortality Risk (AMORIS) cohort. Lipids were measured in 1985 to 1996, and individuals were followed until December 31, 2019 for incident AF (i.e., study outcome). Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox regression, adjusting for age, sex, and socioeconomic status. Over a mean follow-up of 24.2 years (standard deviation 7.5, range 0.2 to 35.9), 13,871 (21.3%) incident AF cases occurred. Higher levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) were statistically significantly associated with a lower risk of AF during the first 5 years of follow-up (HR = 0.61, 95% CI: 0.41 to 0.99, p = 0.013; HR = 0.64, 95% CI: 0.45 to 0.92, p = 0.016), but not thereafter (HR ranging from 0.94 [95% CI: 0.89 to 1.00, p = 0.038] to 0.96 [95% CI: 0.77 to 1.19, p > 0.05]). Lower levels of high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A-I (ApoA-I) and higher triglycerides (TG)/HDL-C ratio were statistically significantly associated with a higher risk of AF during the entire follow-up (HR ranging from 1.13 [95% CI: 1.07 to 1.19, p < 0.001] to 1.53 [95% CI: 1.12 to 2.00, p = 0.007]). Apolipoprotein B (ApoB)/ApoA-I ratio was not associated with AF risk. The observed associations were similar among those who developed incident heart failure (HF)/coronary heart disease (CHD) and those who did not. The main limitations of this study include lack of adjustments for lifestyle factors and high blood pressure leading to potential residual confounding. CONCLUSIONS High TC and LDL-C in midlife was associated with a lower risk of AF, but this association was present only within 5 years from lipid measurement and not thereafter. On the contrary, low HDL-C and ApoA-I and high TG/HDL-C ratio were associated with an increased risk of AF over almost 35 years of follow-up. ApoB/ApoA-I ratio was not associated with AF risk.
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Affiliation(s)
- Mozhu Ding
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Alexandra Wennberg
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bruna Gigante
- Division of Cardiovascular Medicine, Department of Medicine, Karolinska Institutet and Division of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Göran Walldius
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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22
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Liu L, Liu X, Ding X, Chen H, Li W, Li H. Lipid Levels and New-Onset Atrial Fibrillation in Patients with Acute Myocardial Infarction. J Atheroscler Thromb 2022; 30:515-530. [PMID: 35871559 PMCID: PMC10164594 DOI: 10.5551/jat.63574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM In acute myocardial fraction (AMI) patients, the association between lipid parameters and new-onset atrial fibrillation (NOAF) remains unclear due to limited evidence. METHODS A total of 4282 participants free from atrial fibrillation (AF) at baseline were identified in Beijing Friendship Hospital. Fasting levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured at baseline. The study population was stratified based on tertiles of lipid profile and lipid ratios. Incidence of NOAF was observed at the follow-up visits. The associations between different lipid parameters and the incidence of NOAF were assessed by multivariate Cox regression analysis. RESULTS Over a median follow-up period of 42.0 months (IQR: 18.7, 67.3 months), 3.1% (N=132) AMI patients developed NOAF. After multivariable adjustment, higher TC (hazard ratios (HR): 0.205, 95% confidence intervals (CI): 0.061-0.696) levels were inversely associated with NOAF development. However, higher HDL-C (HR: 1.892, 95% CI: 1.133-3.159) levels were positively associated with NOAF development. LDL-C levels, TG levels, non-HDL-C levels, and lipid ratios showed no association with NOAF development. CONCLUSION TC levels were inversely associated with incidence of NOAF; this was mainly reflected in the subgroups of male gender and older patients (65 years or older). HDL-C levels were positively associated with incidence of NOAF; this was mainly reflected in the subgroups of male gender and younger patients (age <65 years). There was no significant association of NOAF with LDL-C, TG, or non-HDL-C levels.
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Affiliation(s)
- Lei Liu
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
| | - Xiaoyan Liu
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
| | - Xiaosong Ding
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
| | - Weiping Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University.,Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University.,Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease.,Department of Geriatrics, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University
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23
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Mackey RH, Rohatgi A. Is there a connection between HDL and atrial fibrillation? J Clin Lipidol 2022; 16:386-388. [PMID: 35988955 DOI: 10.1016/j.jacl.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Rachel H Mackey
- Assistant Professor of Epidemiology (Adjunct), University of Pittsburgh School of Public Health, Pittsburgh, PA 15261; Principal Research Scientist, Premier Applied Sciences, Premier, Inc., Charlotte, NC 28277.
| | - Anand Rohatgi
- Professor of Medicine, Cardiovascular Director of Academic Development, Preventive Cardiology, South Asian Heart Program, Division of Cardiology/Department of Internal Medicine, UT Southwestern Medical Center
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24
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Zhong X, Jiao H, Zhao D, Teng J. A case-control study to investigate association between serum uric acid levels and paroxysmal atrial fibrillation. Sci Rep 2022; 12:10380. [PMID: 35726017 PMCID: PMC9209416 DOI: 10.1038/s41598-022-14622-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/09/2022] [Indexed: 11/24/2022] Open
Abstract
The relationship between serum uric acid (SUA) levels and paroxysmal atrial fibrillation (AF) remains controversial. The objective of this case–control study was to investigate the association between serum SUA levels and paroxysmal AF by gender in 328 patients. This study included 328 hospitalized patients with newly diagnosed paroxysmal AF in China between January 2019 and September 2021. Controls with sinus rhythm were matched (2:1) to cases by age and gender. Baseline data were analyzed using ANOVA, T-test, and Chi-square test. Pearson correlation analyses were used to confirm the correlation between variables, and multivariate regression analyses were used to adjust for covariates. Elevated SUA levels in female patients were significantly associated with paroxysmal AF after adjusting for confounding factors (OR = 1.229, 95% CI 1.058–1.427, P = 0.007). Further results showed SUA levels were negatively correlated with high-density lipoprotein cholesterol (HDL-C) (r = − 0.182, p = 0.001) and apolipoprotein A1 (APOA1) (r = − 0.109, p = 0.049), were positively correlated with low-density lipoprotein cholesterol (LDL-C) (r = 0.169, p = 0.002) and prealbumin (PAB) (r = 0.161, p = 0.004) . Nevertheless, there was no significant complication difference between SUA levels and paroxysmal AF (P > 0.05). Increased SUA in female patients was significantly associated with paroxysmal AF in a Chinese population. This finding implies that it would be interesting to monitor and interfere with hyperuricemia in paroxysmal AF patients.
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Affiliation(s)
- Xia Zhong
- Department of First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People's Republic of China
| | - Huachen Jiao
- Department of Cardiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, No. 16369, Jingshi Road, Lixia District, Jinan, Shandong, People's Republic of China.
| | - Dongsheng Zhao
- Department of First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People's Republic of China
| | - Jing Teng
- Department of First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People's Republic of China
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25
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Association between serum apolipoprotein B and atrial fibrillation: a case-control study. Sci Rep 2022; 12:9597. [PMID: 35688870 PMCID: PMC9187736 DOI: 10.1038/s41598-022-13773-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 05/27/2022] [Indexed: 11/08/2022] Open
Abstract
The relationship between apolipoprotein B (APOB) and atrial fibrillation (AF) is less well-known. We aimed to investigate the association between APOB and AF by gender. We conducted a case-control study including 1913 consecutive hospitalized patients to analyze the association between APOB and AF. 950 AF patients and 963 age-, sex-matched non-AF patients with sinus rhythm were evaluated. T-test, Mann-Whitney test, ANOVA, and Chi-square analysis were performed to analyze baseline data and intergroup comparisons. Pearson's correlation tests or Spearman correlation tests were performed to determine the interrelationships. Multiple regression analysis was performed to adjust for covariables. The receiver operator characteristic (ROC) curve was constructed to examine the performance of APOB. AF patients had lower APOB (P < 0.001) and an independent negative association between APOB and AF in both genders adjusting for confounding factors (OR 0.121, 95% CI 0.067-0.220, P < 0.001), regardless of statin use. APOB was positively correlated with total cholesterol (TC) (r = 0.529, p < 0.001), low-density lipoprotein cholesterol (LDL-C) (r = 0.545, p < 0.001), apolipoprotein A1 (APOA1) (r = 0.083, p < 0.001), and albumin (ALB) (r = 0.134, p < 0.001). ROC curve analysis showed that APOB level = 0.895 g/L was the most optimal cut-off value, the area under the ROC curve was 0.722. This study shows a protective association of APOB with AF in men and women. It implies APOB may be a potential biomarker for AF with a promising cut-off point of 0.895 g/L and may involve initiating and maintaining AF along with several metabolic factors.
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Tajik B, Tuomainen TP, Jarroch R, Kauhanen J, Lip GY, Isanejad M. Lipid levels, apolipoproteins, and risk of incident atrial fibrillation in men: A report from the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD). J Clin Lipidol 2022; 16:447-454. [DOI: 10.1016/j.jacl.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 04/07/2022] [Accepted: 04/20/2022] [Indexed: 12/25/2022]
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Yang S, Pudasaini R, Zhi H, Wang L. The Relationship between Blood Lipids and Risk of Atrial Fibrillation: Univariable and Multivariable Mendelian Randomization Analysis. Nutrients 2021; 14:nu14010181. [PMID: 35011056 PMCID: PMC8746968 DOI: 10.3390/nu14010181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022] Open
Abstract
We performed univariable and multivariable Mendelian randomization (MR) analysis to evaluate the association between blood lipids and risk of atrial fibrillation (AF), including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), Apolipoprotein A1, and Apolipoprotein B. METHODS Data on the single nucleotide polymorphisms (SNPs) related to blood lipids were obtained from the UK Biobank study with more than 300,000 subjects of White British European ancestry, and data for AF were from the latest meta-analysis of Genome-wide association study (GWASs) with six independent cohorts with more than 1,000,000 subjects of European ancestry. The univariable MR analysis was conducted to explore whether genetic evidence of individual lipid-related traits was significantly associated with AF risks and multivariable MR analysis with three models was performed to assess the independent effects of lipid-related traits. RESULTS The IVW estimate showed that genetically predicted LDL-C (OR: 1.016, 95% CI: 0.962-1.073, p = 0.560), HDL-C (OR: 0.951, 95% CI: 0.895-1.010, p = 0.102), TG (OR: 0.961, 95% CI: 0.889-1.038, p = 0.313), Apolipoprotein A1 (OR: 0.978, 95% CI: 0.933-1.025, p = 0.356), and Apolipoprotein B (OR: 1.008, 95% CI: 0.959-1.070, p = 0.794) were not causally associated with the risk of AF. Sample mode (OR: 0.852, 95% CI: 0.731-0.993, p = 0.043) and weighted mode (OR: 0.907, 95% CI: 0.841-0.979, p = 0.013) showed that a 1-unit increase in TG (mmol/L) was causally associated with a 14.8% and 9.3% relative decrease in AF risk, respectively. The multivariable MR analysis with model 1, 2, and 3 indicated that TG, LDL-C, HDL-C, Apolipoprotein A1, and Apolipoprotein B were not associated with the lower risk for AF. CONCLUSIONS Our multivariable Mendelian randomization analysis (MVMR) finding suggested no genetic evidence of lipid traits was significantly associated with AF risk. Furthermore, more work is warranted to confirm the potential association between lipid traits and AF risks.
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Affiliation(s)
- Shengyi Yang
- Key Laboratory of Environmental Medicine Engineering, Department of Epidemiology & Biostatistics, School of Public Health, Southeast University, Ministry of Education, Nanjing 210009, China; (S.Y.); (R.P.)
| | - Rupak Pudasaini
- Key Laboratory of Environmental Medicine Engineering, Department of Epidemiology & Biostatistics, School of Public Health, Southeast University, Ministry of Education, Nanjing 210009, China; (S.Y.); (R.P.)
| | - Hong Zhi
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing 210009, China;
| | - Lina Wang
- Key Laboratory of Environmental Medicine Engineering, Department of Epidemiology & Biostatistics, School of Public Health, Southeast University, Ministry of Education, Nanjing 210009, China; (S.Y.); (R.P.)
- Correspondence:
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Zhang Y, Fu Y, Jiang T, Liu B, Sun H, Zhang Y, Fan B, Li X, Qin X, Zheng Q. Enhancing Fatty Acids Oxidation via L-Carnitine Attenuates Obesity-Related Atrial Fibrillation and Structural Remodeling by Activating AMPK Signaling and Alleviating Cardiac Lipotoxicity. Front Pharmacol 2021; 12:771940. [PMID: 34899326 PMCID: PMC8662783 DOI: 10.3389/fphar.2021.771940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/12/2021] [Indexed: 12/28/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical setting. Its pathogenesis was associated with metabolic disorder, especially defective fatty acids oxidation (FAO). However, whether promoting FAO could prevent AF occurrence and development remains elusive. In this study, we established a mouse model of obesity-related AF through high-fat diet (HFD) feeding, and used l-carnitine (LCA, 150 mg/kg⋅BW/d), an endogenous cofactor of carnitine palmitoyl-transferase-1B (CPT1B; the rate-limiting enzyme of FAO) to investigate whether FAO promotion can attenuate the AF susceptibility in obesity. All mice underwent electrophysiological assessment for atrial vulnerability, and echocardiography, histology and molecular evaluation for AF substrates and underlying mechanisms, which were further validated by pharmacological experiments in vitro. HFD-induced obese mice increased AF vulnerability and exhibited apparent atrial structural remodeling, including left atrial dilation, cardiomyocyte hypertrophy, connexin-43 remodeling and fibrosis. Pathologically, HFD apparently leads to defective cardiac FAO and subsequent lipotoxicity, thereby evoking a set of pathological reactions including oxidative stress, DNA damage, inflammation, and insulin resistance. Enhancing FAO via LCA attenuated lipotoxicity and lipotoxicity-induced pathological changes in the atria of obese mice, resulting in restored structural remodeling and ameliorated AF susceptibility. Mechanistically, LCA activated AMPK/PGC1α signaling both in vivo and in vitro, and pharmacological inhibition of AMPK via Compound C attenuated LCA-induced cardio-protection in palmitate-treated primary atrial cardiomyocytes. Taken together, our results demonstrated that FAO promotion via LCA attenuated obesity-mediated AF and structural remodeling by activating AMPK signaling and alleviating atrial lipotoxicity. Thus, enhancing FAO may be a potential therapeutic target for AF.
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Affiliation(s)
- Yudi Zhang
- The Second Affiliate Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuping Fu
- The Second Affiliate Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Tiannan Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Binghua Liu
- School of Life Sciences, Northwestern Polytechnical University, Xi'an, China
| | - Hongke Sun
- The Second Affiliate Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ying Zhang
- The Second Affiliate Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Boyuan Fan
- The Second Affiliate Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaoli Li
- The Second Affiliate Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xinghua Qin
- School of Life Sciences, Northwestern Polytechnical University, Xi'an, China
| | - Qiangsun Zheng
- The Second Affiliate Hospital of Xi'an Jiaotong University, Xi'an, China
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Li F, Du X, He L, Jiang C, Xia S, Ma C, Dong J. Relationship between serum lipid levels and ischemic stroke in patients with atrial fibrillation: a nested case-control study based on the China Atrial Fibrillation Registry. BMC Cardiovasc Disord 2021; 21:424. [PMID: 34496759 PMCID: PMC8425053 DOI: 10.1186/s12872-021-02237-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is an important risk factor for acute ischemic stroke. METHODS A nested case-control study was conducted among patients diagnosed with AF, whose information was acquired from the prospective China Atrial Fibrillation Registry (China-AF), from August 2011 to December 2018. RESULTS This study compared patients with stroke group (n = 145) with a matched control group (n = 577). Demographic data were similar except for body mass index (BMI), diastolic blood pressure (DBP) which were higher, and new oral anticoagulant (NOAC) treatment rate which was lower in the stroke group (all P < 0.05). Baseline median [IQR] levels of including triglyceride (TG) were higher in the stroke group (21.96 [16.74, 21.52], mg/dL) than the control group (19.62 [14.76, 27.36], mg/dL) (P = 0.012), while the total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were similar between the two groups. Elevated TG and HDL-C were positively associated with ischemic stroke (OR 1.01, 95% CI 1.00-1.02, P = 0.032; OR 1.03, 95% CI 1.00-1.05, P = 0.025), after adjustment for BMI, systolic blood pressure, DBP, CHA2DS2-VASc score, HAS-BLED score, NOAC, LDL-C and HDL-C. However, NOAC (OR 0.20, 95% CI 0.05-0.84, P = 0.029) could decrease the likelihood of ischemic stroke in patients with AF. In subgroup analysis, higher TG level remained significantly associated with ischemic stroke for AF patients without a history of smoking (OR 1.26, 95% CI 1.02-1.55, P = 0.028). CONCLUSION Higher level of TG and HDL-C were positively associated with ischemic stroke in patients with AF.
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Affiliation(s)
- Fei Li
- Department of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Chao Jiang
- Department of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Shijun Xia
- Department of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China.
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Lee H, Kim HJ, Yoo JS, Kim DJ, Yeom SY, Cho KR. Early pharmacologic conversion of atrial fibrillation after off-pump coronary artery bypass grafting. J Thorac Dis 2021; 13:4072-4082. [PMID: 34422337 PMCID: PMC8339786 DOI: 10.21037/jtd-21-466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/27/2021] [Indexed: 11/30/2022]
Abstract
Background The aim of this study was to evaluate the efficacy of early amiodarone-based pharmacological cardioversion for postoperative atrial fibrillation (POAF) following off-pump coronary bypass grafting (OPCAB). Methods A total of 507 patients who underwent OPCAB between 2015 and 2017 were categorized into POAF (n=94) and no-POAF (n=413) groups. Patients in the POAF group were treated according to the following institutional protocol: 150 mg loading dose of intravenous amiodarone, followed by oral administration with sequential maintenance doses at 600, 400, and 200 mg per day. If sinus rhythm was restored before discharge, patients were discharged without amiodarone or anticoagulants, except for dual antiplatelets. Results Before discharge at index hospitalization, 97.8% of POAF patients had restored sinus rhythm. Independent risk factors for POAF were age, unstable angina, prior percutaneous transluminal coronary angioplasty, and left atrial diameter. The mean follow-up duration was 41.1±12.8 months. Freedom from overall mortality and composite events, including mortality, major bleeding requiring admission and cerebrovascular events, were similar between the 2 groups. Results were consistent after propensity-score matching. Conclusions Amiodarone-based rapid pharmacological cardioversion of POAF resulted in a high sinus rhythm conversion rate (97.9%). Rate of late adverse cardiovascular events including stroke, were low even without anticoagulation. As optimal treatment and anticoagulation guidelines for POAF after OPCAB have not yet been established, amiodarone-based treatment protocols may be considered as a useful option.
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Affiliation(s)
- Heemoon Lee
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea
| | - Hee Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Jae Suk Yoo
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea
| | - Dong Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea
| | - Sang Youn Yeom
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea
| | - Kwang Ree Cho
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea
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Shan R, Ning Y, Ma Y, Liu S, Wu J, Fan X, Lv J, Wang B, Li S, Li L. Prevalence and risk factors of atrioventricular block among 15 million Chinese health examination participants in 2018: a nation-wide cross-sectional study. BMC Cardiovasc Disord 2021; 21:289. [PMID: 34116630 PMCID: PMC8194203 DOI: 10.1186/s12872-021-02105-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/07/2021] [Indexed: 01/01/2023] Open
Abstract
Background Nationwide data on the prevalence of atrioventricular (AV) block are currently unavailable in China. Thus, we aimed to assess the prevalence and risk factors of AV block among Chinese health examination adults. Methods A total of 15,181,402 participants aged ≥ 18 years (mean age 41.5 ± 13.4 years, 53.2% men) who underwent an electrocardiogram as a part of routine health examination in 2018 were analyzed. AV block was diagnosed by physicians using 12-lead electrocardiogram. Overall and stratified prevalence (by age, sex, and city size) of all, first-, second- and third-degree AV block were calculated. Multivariable logistic regression analyses were performed to explore risk factors associated with AV block. Results AV block was observed in 88,842 participants, including 86,153 with first-degree, 2249 with second-degree and 440 with third-degree AV block. The age- and sex-standardized prevalence rate [95% confidence interval (CI)] of all, first-, second- and third-degree AV block were 7.06‰ (7.01–7.11), 6.84‰ (6.79–6.89), 0.18‰ (0.17–0.18) and 0.04‰ (0.03–0.04) respectively. After multivariable adjustment, the risk of AV block was positively associated with older age, being male, lower heart rate, higher body mass index, hypertension, diabetes and low high-density lipoprotein cholesterol. High total cholesterol was associated with a lower risk of AV block. Conclusion First-degree AV block is relatively common while severe AV block is rare in health examination adults. Besides, AV block was highly prevalent among the elderly. The risk of AV block was associated with older age, being male and metabolic factors. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02105-3.
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Affiliation(s)
- Ruiqi Shan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China
| | - Yi Ning
- Peking University Health Science Center Meinian Public Health Institute, 35 North Huayuan Road, Beijing, 100191, China. .,Meinian Institute of Health, Beijing, China.
| | - Yuan Ma
- Meinian Institute of Health, Beijing, China
| | - Siliang Liu
- Department of Anesthesiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jing Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China
| | - Xiaohan Fan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China.,Peking University Health Science Center Meinian Public Health Institute, 35 North Huayuan Road, Beijing, 100191, China.,Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Bo Wang
- Peking University Health Science Center Meinian Public Health Institute, 35 North Huayuan Road, Beijing, 100191, China.,Meinian Institute of Health, Beijing, China
| | - Shijun Li
- Meinian Institute of Health, Beijing, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China. .,Peking University Health Science Center Meinian Public Health Institute, 35 North Huayuan Road, Beijing, 100191, China. .,Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China.
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Xia J, Guo C, Liu K, Xie Y, Cao H, Peng W, Sun Y, Liu X, Li B, Zhang L. Association of Lipoprotein (a) variants with risk of cardiovascular disease: a Mendelian randomization study. Lipids Health Dis 2021; 20:57. [PMID: 34074296 PMCID: PMC8170931 DOI: 10.1186/s12944-021-01482-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/17/2021] [Indexed: 11/15/2022] Open
Abstract
Background There is a well-documented empirical relationship between lipoprotein (a) [Lp(a)] and cardiovascular disease (CVD); however, causal evidence, especially from the Chinese population, is lacking. Therefore, this study aims to estimate the causal association between variants in genes affecting Lp(a) concentrations and CVD in people of Han Chinese ethnicity. Methods Two-sample Mendelian randomization analysis was used to assess the causal effect of Lp(a) concentrations on the risk of CVD. Summary statistics for Lp(a) variants were obtained from 1256 individuals in the Cohort Study on Chronic Disease of Communities Natural Population in Beijing, Tianjin and Hebei. Data on associations between single-nucleotide polymorphisms (SNPs) and CVD were obtained from recently published genome-wide association studies. Results Thirteen SNPs associated with Lp(a) levels in the Han Chinese population were used as instrumental variables. Genetically elevated Lp(a) was inversely associated with the risk of atrial fibrillation [odds ratio (OR), 0.94; 95% confidence interval (95%CI), 0.901–0.987; P = 0.012)], the risk of arrhythmia (OR, 0.96; 95%CI, 0.941–0.990; P = 0.005), the left ventricular mass index (OR, 0.97; 95%CI, 0.949–1.000; P = 0.048), and the left ventricular internal dimension in diastole (OR, 0.97; 95%CI, 0.950–0.997; P = 0.028) according to the inverse-variance weighted method. No significant association was observed for congestive heart failure (OR, 0.99; 95% CI, 0.950–1.038; P = 0.766), ischemic stroke (OR, 1.01; 95%CI, 0.981–1.046; P = 0.422), and left ventricular internal dimension in systole (OR, 0.98; 95%CI, 0.960–1.009; P = 0.214). Conclusions This study provided evidence that genetically elevated Lp(a) was inversely associated with atrial fibrillation, arrhythmia, the left ventricular mass index and the left ventricular internal dimension in diastole, but not with congestive heart failure, ischemic stroke, and the left ventricular internal dimension in systole in the Han Chinese population. Further research is needed to identify the mechanism underlying these results and determine whether genetically elevated Lp(a) increases the risk of coronary heart disease or other CVD subtypes. Supplementary Information The online version contains supplementary material available at 10.1186/s12944-021-01482-0.
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Affiliation(s)
- Juan Xia
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, No 10 Xitoutiao, You'anmenwai, Fengtai, Beijing, 100069, P. R. China
| | - Chunyue Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, No 10 Xitoutiao, You'anmenwai, Fengtai, Beijing, 100069, P. R. China
| | - Kuo Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, No 10 Xitoutiao, You'anmenwai, Fengtai, Beijing, 100069, P. R. China
| | - Yunyi Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, No 10 Xitoutiao, You'anmenwai, Fengtai, Beijing, 100069, P. R. China
| | - Han Cao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, No 10 Xitoutiao, You'anmenwai, Fengtai, Beijing, 100069, P. R. China
| | - Wenjuan Peng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, No 10 Xitoutiao, You'anmenwai, Fengtai, Beijing, 100069, P. R. China
| | - Yanyan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, No 10 Xitoutiao, You'anmenwai, Fengtai, Beijing, 100069, P. R. China
| | - Xiaohui Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, No 10 Xitoutiao, You'anmenwai, Fengtai, Beijing, 100069, P. R. China
| | - Bingxiao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, No 10 Xitoutiao, You'anmenwai, Fengtai, Beijing, 100069, P. R. China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University and Beijing Municipal Key Laboratory of Clinical Epidemiology, No 10 Xitoutiao, You'anmenwai, Fengtai, Beijing, 100069, P. R. China.
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Turkkolu ST, Selçuk E, Köksal C. Biochemical predictors of postoperative atrial fibrillation following cardiac surgery. BMC Cardiovasc Disord 2021; 21:167. [PMID: 33836659 PMCID: PMC8033715 DOI: 10.1186/s12872-021-01981-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/30/2021] [Indexed: 02/07/2023] Open
Abstract
Background New-onset postoperative atrial fibrillation (POAF) is common after cardiac surgery. Early identification of its risk factors during the preoperative period would help in reducing the associated morbidity, mortality, and healthcare costs. Aim of the study This study aimed to identify the predictors of POAF following open cardiac surgery, with emphasis on biochemical parameters. Methods A total of 1191 patients with no preoperative atrial fibrillation (AF) and undergoing open cardiac surgery for any reason were included in this retrospective study. Data on clinical and biochemical parameters, the occurrence of new-onset AF, and its clinical course were retrieved from the hospital database. Results During the early postoperative period 330 patients (27.7%) developed atrial fibrillation, at median third postoperative day (range 1–6 days) and 217 (65.8%) responded to treatment. Multivariate analysis identified the following as the significant independent predictors of any POAF: EF < 60% (Odds ratio (OR), 2.6), valvular intervention (OR, 2.4), liver failure (OR, 2.4), diabetes (OR, 1.6), low hematocrit (OR, 2.1), low thrombocyte (OR, 5.6), low LDL (OR, 1.6), high direct bilirubin (OR, 2.0), low GFR (OR, 1.6), and high CRP (OR, 2.0). Following parameters emerged as significant independent predictors of persistent AF: EF < 60% (OR, 1.9), diabetes (OR, 2.1), COPD (OR, 1.8), previous cardiac surgery (OR, 3.1), valvular intervention (OR, 2.4), low hematocrit (OR, 1.9), low LDL (OR, 2.1), high HbA1c (OR, 2.0), and high CRP (OR, 2.7). Conclusions Certain parameters assessed during preoperative physical and laboratory examinations have the potential to be used as markers of POAF.
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Affiliation(s)
- Sevket T Turkkolu
- Department of Cardiovascular Surgery, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı, Vatan Caddesi, Fatih/İstanbul, 34093, Istanbul, Turkey.
| | - Emre Selçuk
- Department of Cardiovascular Surgery, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı, Vatan Caddesi, Fatih/İstanbul, 34093, Istanbul, Turkey
| | - Cengiz Köksal
- Department of Cardiovascular Surgery, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı, Vatan Caddesi, Fatih/İstanbul, 34093, Istanbul, Turkey
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Anzai T, Grandinetti A, Katz AR, Hurwitz EL, Wu YY, Masaki K. Paradoxical association between atrial fibrillation/flutter and high cholesterol over age 75 years: The Kuakini Honolulu Heart Program and Honolulu-Asia Aging Study. J Electrocardiol 2021; 65:37-44. [PMID: 33482619 DOI: 10.1016/j.jelectrocard.2020.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/06/2020] [Accepted: 12/14/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Several studies have indicated high cholesterol is paradoxically associated with low prevalence of atrial fibrillation/flutter (AF). However, the etiology is uncertain. One potential explanation might be the confounding effect of age exemplifying prevalence-incidence (Neyman's) bias. However, this bias has not often been discussed in depth in the literature. Therefore, we conducted a cross-sectional analysis to test the hypothesis that there is a paradoxical association between lipid profile and AF prevalence. METHODS This is a cross-sectional study design, using data from the Kuakini Honolulu Heart Program. Participants were 3741 Japanese-American men between 71 and 93 years old living in Hawaii. Serum total cholesterol (TC) level was measured and categorized into quartiles. AF was diagnosed by 12‑lead Electrocardiogram. We categorized age into quartiles (71-74, 75-77, 78-80 and 81+ years). RESULTS We observed opposite associations between AF and TC among different age groups. For participants age ≥75, higher TC levels were paradoxically associated with lower prevalence of AF after multivariable adjustment, i.e. the odds ratios of AF comparing the highest TC quartile with the lowest TC quartile for age 75-77, 78-80 and 81+ years were 0.17 (95% confidence interval [CI], 0.06-0.52), 0.28 (95% CI, 0.07-1.09) and 0.14 (95% CI, 0.03-0.62), respectively. Conversely, for those who were 71-74 years old, the odds ratio of AF was 2.09 (95% CI, 0.76-5.75) between the highest and the lowest TC quartiles. CONCLUSIONS There is a paradoxical association of TC with AF in Japanese-American men age ≥75, but not <75 years. The paradox might be explained by Neyman's bias.
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Affiliation(s)
- Tagayasu Anzai
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Honolulu, HI, USA.
| | - Andrew Grandinetti
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Honolulu, HI, USA.
| | - Alan R Katz
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Honolulu, HI, USA.
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Honolulu, HI, USA.
| | - Yan Yan Wu
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Honolulu, HI, USA.
| | - Kamal Masaki
- Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawai'i at Mānoa, 347 N Kuakini St, Honolulu, HI, USA; Kuakini Medical Center, 347 N Kuakini St, Honolulu, HI, USA.
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Ding WY, Protty MB, Davies IG, Lip GYH. Relationship between lipoproteins, thrombosis and atrial fibrillation. Cardiovasc Res 2021; 118:716-731. [PMID: 33483737 PMCID: PMC8859639 DOI: 10.1093/cvr/cvab017] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/14/2020] [Accepted: 01/12/2021] [Indexed: 12/19/2022] Open
Abstract
The prothrombotic state in atrial fibrillation (AF) occurs as a result of multifaceted interactions, known as Virchow’s triad of hypercoagulability, structural abnormalities, and blood stasis. More recently, there is emerging evidence that lipoproteins are implicated in this process, beyond their traditional role in atherosclerosis. In this review, we provide an overview of the various lipoproteins and explore the association between lipoproteins and AF, the effects of lipoproteins on haemostasis, and the potential contribution of lipoproteins to thrombogenesis in AF. There are several types of lipoproteins based on size, lipid composition, and apolipoprotein category, namely: chylomicrons, very low-density lipoprotein, low-density lipoprotein (LDL), intermediate-density lipoprotein, and high-density lipoprotein. Each of these lipoproteins may contain numerous lipid species and proteins with a variety of different functions. Furthermore, the lipoprotein particles may be oxidized causing an alteration in their structure and content. Of note, there is a paradoxical inverse relationship between total cholesterol and LDL cholesterol (LDL-C) levels, and incident AF. The mechanism by which this occurs may be related to the stabilizing effect of cholesterol on myocardial membranes, along with its role in inflammation. Overall, specific lipoproteins may interact with haemostatic pathways to promote excess platelet activation and thrombin generation, as well as inhibiting fibrinolysis. In this regard, LDL-C has been shown to be an independent risk factor for thromboembolic events in AF. The complex relationship between lipoproteins, thrombosis and AF warrants further research with an aim to improve our knowledge base and contribute to our overall understanding of lipoprotein-mediated thrombosis.
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Affiliation(s)
- Wern Yew Ding
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Majd B Protty
- Systems Immunity University Research Institute, Cardiff University, Cardiff, United Kingdom
| | - Ian G Davies
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Harrison SL, Lane DA, Banach M, Mastej M, Kasperczyk S, Jóźwiak JJ, Lip GY, Al-Shaer B, Andrusewicz W, Andrzejczuk-Rosa M, Anusz-Gaszewska E, Bagińska A, Balawajder P, Bańka G, Barańska-Skubisz E, Barbara Przyczyna B, Bartkowiak S, Bartodziej J, Bartosiewicz M, Basałyga M, Batyra A, Bąk A, Bednarz M, Bejnar K, Bernacki W, Betiuk-Kwiatkowska M, Biegaj S, Bień M, Bilski W, Biłogan M, Biruta-Pawłowska G, Biskup A, Błaszczyk B, Błaszczyk H, Błońska-Jankowska T, Bogacka-Gancarczyk B, Bojanowska M, Bonda E, Borowik-Skwarek J, Borowska J, Bruckner J, Brzostek J, Brzuchacz M, Budzyńska M, Bulzacka-Fugiel I, Bulzak J, Bunikowski K, Cebulska A, Celka T, Cempel-Nowak E, Chechliński W, Chludzińska A, Chmiel D, Chmielewska M, Cichy M, Ciemięga A, Ciepluch A, Cieszyńska I, Czajka B, Czapla B, Czerner M, Czerwińska B, Czuryszkiewicz W, Daleka E, Dawid Z, Dąbrowska M, Dąbrowska R, Dąbrowski D, Dąbrowski M, Demczyszyn K, Dębowska-Serwińska A, Dmochowski J, Dobrzecka-Kiwior J, Dolanowska E, Dolanowski H, Dołek P, Domagała M, Domański H, Doszel A, Duda D, Dudkowska M, Dudziuk B, Dybciak P, Dymanowski M, Dziadzio-Bolek L, Eicke M, El-Hassan H, Eremus A, Fąferek-Muller M, Figura-Roguska E, Fijałkowska-Kaczmarek I, Flis M, Florczak T, Florczuk M, Foryszewska-Witan E, Frydrych W, Fugiel A, Futyma E, Gaca-Jaroszewicz A, Gajdamowicz I, Ganczarski K, Gatnar A, Gers M, Głowacki A, Głód K, Godula J, Gołąb J, Gołębiewski M, Goszczyńska E, Gościcka K, Górna-Hajduga A, Górny E, Grabowska T, Grabowski R, Graczyk-Duda A, Gromow A, Grudewicz A, Gruszecka J, Gruszka A, Gryboś J, Grzebyk J, Grzechowiak A, Grzesiak D, Grześkowiak T, Guźla A, Hachuła G, Hawel B, Hiltawska H, Honkowicz E, Ignatowicz J, Imielski K, Iwaniura A, Jagieła-Szymala A, Jalć-Sowała M, Janczylik A, Janisz E, Janiszek M, Jankiewicz-Ziobro K, Januszewska K, Jaremek A, Jaros-Urbaniak A, Jarosz J, Jarosz P, Jasiński W, Jezierska-Wasilewska M, Jędraszewski T, Jędrzejowska A, Józefowicz R, Jóźwiak J, Juźwin K, Kacprzak E, Kaczmarek-Szewczyk J, Kaczmarzyk M, Kandziora R, Kaniewski C, Karolak-Brandt L, Kasperczyk S, Kasperek-Dyląg E, Kedziora I, Kępa A, Kiciński J, Kielak-Al-Hosam J, Kiełczawa Ł, Kilimowicz P, Kitliński K, Kiwka T, Klein U, Klichowicz L, Klimowicz A, Klonowski B, Kmolek B, Kobyłko-Klepacka E, Kocoń A, Kolenda A, Kollek E, Kopeć M, Koper-Kozikowska B, Koralewska J, Korczyńska M, Korzeniewski M, Kosk A, Kotarski K, Kowalczyk E, Kowalczyk M, Kowalik I, Kozak-Błażkiewicz B, Kozik M, Kozłowska D, Kozłowska E, Kozłowska M, Kozubski T, Kózka K, Kraśnik L, Krężel T, Krochmal B, Król B, Król G, Król J, Królikowska T, Kruszewska H, Krygier-Potrykus B, Krystek W, Krzysztoń J, Kubicki T, Kuczmierczyk-El-Hassan A, Kuczyńska-Witek W, Kujda D, Kurowski A, Kurzelewska-Solarz I, Kwaczyńska M, Kwaśniak M, Kwaśniak P, Kwietniewska T, Łebek-Ordon A, Lebiedowicz A, Lejkowska-Olszewska L, Lentas M, Lesiewicz-Ksycińska A, Limanowski M, Łoniewski S, Łopata J, Łubianka B, Łukasiuk I, Łużna M, Łysiak M, Łysik B, Machowski Z, Maciaczyk-Kubiak J, Mackiewicz-Zabochnicka G, Magner-Krężel Z, Majda S, Malinowski P, Mantyka J, Marchlik E, Martyna-Ordyniec G, Marzec J, Marzec M, Matejko-Wałkiewicz R, Mazur M, Michalczak M, Michalska-Żyłka A, Michniewicz M, Mika-Staniszewska D, Mikiciuk E, Mikołajczak T, Milewski J, Miller E, Misiaszek B, Mizik-Łukowska M, Młyńczyk-Pokutycka E, Mocek M, Moczała M, Morawska-Hermanowicz M, Moryc P, Moskal A, Moskal S, Moździerz A, Moździerz P, Mrozińska M, Mrozowicz K, Mróz G, Munia T, Mura A, Muras-Skudlarska M, Murawska E, Murawski Ł, Murawski R, Musielak R, Nadaj K, Nagarnowicz W, Napierała R, Niedźwiecka M, Niemirski A, Nikiel J, Nosal M, Nowacki W, Nowak J, Nyrka M, Obst A, Ochowicz J, Ogonowska E, Oleszczyk M, Ołdakowski A, Ołowniuk-Stefaniak I, Ordowska-Rejman J, Orliński M, Osińska B, Ostańska-Burian A, Paciorkowska A, Paczkowska U, Paluch L, Pałka L, Paszko-Wojtkowska J, Paszkowska A, Pawlak-Ganczarska E, Pawlik W, Pawłowska I, Paździora M, Permiakow G, Petlic-Marendziak A, Piasecka T, Piaścińska E, Piktel A, Pilarska-Igielska A, Piotrkowska A, Piwowar-Klag K, Planer M, Plewa J, Płatkiewicz P, Płonczyńska B, Podgórska A, Polewska M, Porębska B, Porwoł P, Potakowska I, Prokop A, Przybylski J, Przybyła M, Psiuk H, Ptak K, Puzoń G, Rabiza N, Rachwalik S, Raczyńska E, Raniszewska M, Romanek-Kozik A, Rosa A, Rosa K, Rozewicz A, Rudzka-Kałwak J, Rusak J, Rutkowska D, Rybacki M, Rybińska D, Rycyk-Sadowska A, Rynda L, Rynkiewicz B, Sadowska-Krawczyk B, Sadowska-Zarzycka M, Sarnecka B, Sawalach-Tomanik E, Sidor-Drozd B, Siemieniak-Dębska M, Sieroń A, Siewniak-Zalewska B, Sikora A, Sitarska-Pawlina B, Skorupski J, Skrzypińska-Mansfeld I, Skubisz J, Skwarek R, Słodyczka M, Smentek M, Smolińska K, Solarz B, Sosnowska W, Sroka B, Stachura H, Stangreciak D, Staniak M, Stańczyk Z, Stańszczak-Ozga D, Startek E, Stefańczyk M, Stelmach R, Sternadel-Rączka E, Sternik M, Stępień J, Stocka J, Stokowska-Wojda M, Studler-Karpińska M, Suchorukow W, Sufryd W, Supłacz B, Sygacz J, Szczepański Ł, Szkandera J, Szłapa-Zellner J, Szydlarska D, Śliwa T, Śliwka J, Śmiejkowski Ł, Targońska A, Tesarska E, Tobiasz M, Tomaka J, Tomalska-Bywalec K, Tomiak E, Topczewski S, Trawińska A, Trela-Mucha L, Trojanowski D, Trzaskowska M, Trzcińska-Larska B, Trznadel-Mozul A, Ulanicka-Liwoch K, Urbanowicz M, Uthke-Kluzek A, Waczyński J, Walczak J, Warsz L, Wasyńczuk M, Wąchała-Jędras U, Wąsowicz D, Wczysła J, Wenda F, Werner-Kubicka E, Weryszko E, Węgrzynowska B, Wiaksa M, Wiankowski M, Wicherek A, Wieczorek R, Wiencek R, Wienzek-Tatara G, Wierzbicka B, Wierzbicki M, Wilczyńska B, Wilmańska D, Winiarski P, Wiszniewska-Pabiszczak A, Witkowska M, Witzling J, Wlaź A, Wojtkowiak I, Woydyłło J, Woźniak K, Wójtowicz A, Wrona J, Wrońska M, Wujkowska H, Wyrąbek J, Wysokiński O, Zakrzewski R, Zaleska-Zatkalik J, Zaleski J, Zalewska- Dybciak M, Zalewska E, Zalewska-Uchimiak B, Zawadzka-Krajewska J, Zawadzki J, Zieliński A, Zubrycka E, Żybort I, Żymełka M. Lipid levels, atrial fibrillation and the impact of age: Results from the LIPIDOGRAM2015 study. Atherosclerosis 2020; 312:16-22. [DOI: 10.1016/j.atherosclerosis.2020.08.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/04/2020] [Accepted: 08/13/2020] [Indexed: 12/22/2022]
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From hemorrhagic stroke to lipid paradox: a double-hit hypothesis underlying low low-density lipoprotein cholesterol related cardiovascular risk—a narrative review. JOURNAL OF BIO-X RESEARCH 2020. [DOI: 10.1097/jbr.0000000000000067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Garg PK, Guan W, Karger AB, Steffen BT, O'Neal W, Heckbert SR, Michos ED, Tsai MY. Lp(a) (Lipoprotein [a]) and Risk for Incident Atrial Fibrillation: Multi-Ethnic Study of Atherosclerosis. Circ Arrhythm Electrophysiol 2020; 13:e008401. [PMID: 32302223 DOI: 10.1161/circep.120.008401] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Parveen K Garg
- Division of Cardiology, University of Southern California, Los Angeles (P.K.G.)
| | - Weihua Guan
- Division of Biostatistics, School of Public Health (W.G.), University of Minnesota, Minneapolis
| | - Amy B Karger
- Department of Laboratory Medicine and Pathology (A.B.K., B.T.S., M.Y.T.), University of Minnesota, Minneapolis
| | - Brian T Steffen
- Department of Laboratory Medicine and Pathology (A.B.K., B.T.S., M.Y.T.), University of Minnesota, Minneapolis
| | - Wesley O'Neal
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (W.O.)
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle (S.R.H.)
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (E.D.M.)
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology (A.B.K., B.T.S., M.Y.T.), University of Minnesota, Minneapolis
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