1
|
Murphy R, Damasceno A, Reddin C, Hankey GJ, Iversen HK, Oveisgharan S, Lanas F, Czlonkowska A, Langhorne P, Ogunniyi A, Wasay M, Rumboldt Z, Judge C, Oguz A, Mondo C, Winter Y, Rosengren A, Pogosova N, Avezum A, Nilanont Y, Penaherrera E, Xavier D, Lopez-Jaramillo P, Wang X, Yusuf S, O'Donnell M. Variations in the prevalence of atrial fibrillation, and in the strength of its association with ischemic stroke, in countries with different income levels: INTERSTROKE case-control study. Int J Stroke 2024; 19:559-568. [PMID: 38204182 DOI: 10.1177/17474930241227783] [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] [Indexed: 01/12/2024]
Abstract
BACKGROUND The contribution of atrial fibrillation (AF) to the etiology and burden of stroke may vary by country income level. AIMS We examined differences in the prevalence of AF and described variations in the magnitude of the association between AF and ischemic stroke by country income level. METHODS In the INTERSTROKE case-control study, participants with acute first ischemic stroke were recruited across 32 countries. We included 10,363 ischemic stroke cases and 10,333 community or hospital controls who were matched for age, sex, and center. Participants were grouped into high-income (HIC), upper-middle-income (subdivided into two groups-UMIC-1 and UMIC-2), and lower-middle-income (LMIC) countries, based on gross national income. We evaluated the risk factors for AF overall and by country income level, and evaluated the association of AF with ischemic stroke. RESULTS AF was documented in 11.9% (n = 1235) of cases and 3.2% (n = 328) of controls. Compared to HIC, the prevalence of AF was significantly lower in UMIC-2 (aOR 0.35, 95% CI 0.29-0.41) and LMIC (aOR 0.50, 95% CI 0.41-0.60) on multivariable analysis. Hypertension, female sex, valvular heart disease, and alcohol intake were stronger risk factors for AF in lower-income countries, and obesity a stronger risk factor in higher-income countries. The magnitude of association between AF and ischemic stroke was significantly higher in lower-income countries compared to higher-income countries. The population attributable fraction for AF and stroke varied by region and was 15.7% (95% CI 13.7-17.8) in HIC, 14.6% (95% CI 12.3-17.1) in UMIC-1, 5.7% (95% CI 4.9-6.7) in UMIC-2, and 6.3% (95% CI 5.3-7.3) in LMIC. CONCLUSION Risk factors for AF vary by country income level. AF contributes to stroke burden to a greater extent in higher-income countries than in lower-income countries, due to a higher prevalence and despite a lower magnitude of odds ratio.
Collapse
Affiliation(s)
- Robert Murphy
- HRB Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
| | | | - Catriona Reddin
- HRB Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
| | - Graeme J Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia
| | - Helle K Iversen
- Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Shahram Oveisgharan
- Rush Alzheimer's Disease Research Center, Rush University Medical Center, Chicago, IL, USA
| | - Fernando Lanas
- Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | | | - Peter Langhorne
- Academic Section of Geriatric Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
| | - Adesola Ogunniyi
- Division of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | | | - Conor Judge
- HRB Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
| | - Aytekin Oguz
- Metabolic Syndrome Association, Istanbul, Turkey
| | - Charles Mondo
- Department of Cardiology, Kiruddu National Referral Hospital, Kampala, Uganda
| | - Yaroslav Winter
- Department of Neurology, Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Annika Rosengren
- Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nana Pogosova
- National Medical Research Center of Cardiology Named After Academician E.I. Chazov, Moscow, Russia
| | - Alvaro Avezum
- Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Yongchai Nilanont
- Neurology Division, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Denis Xavier
- St. John's Research Institute, St. John's Medical College, Bangalore, India
| | - Patricio Lopez-Jaramillo
- Fundacion Oftalmologica de Santander-Clinica Carlos Ardila Lulle (FOSCAL), Bucaramanga, Colombia
| | - Xingyu Wang
- Laboratory of Human Genetics, Beijing Hypertension League Institute, Beijing, China
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Martin O'Donnell
- HRB Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
2
|
Ayinde H, Markson F, Ogbenna UK, Jackson L. Addressing racial differences in the management of atrial fibrillation: Focus on black patients. J Natl Med Assoc 2023:S0027-9684(23)00142-6. [PMID: 38114334 DOI: 10.1016/j.jnma.2023.11.007] [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: 10/11/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia, affecting between 3 and 6 million people in the United States. It is associated with a reduced quality of life and increased risk of stroke, cognitive decline, heart failure and death. Black patients have a lower prevalence of AF than White patients but are more likely to suffer worse outcomes with the disease. It is important that stakeholders understand the disproportionate burden of disease and management gaps that exists among Black patients living with AF. Appropriate treatments, including aggressive risk factor control, early referral to cardiovascular specialists and improving healthcare access may bridge some of the gaps in management and improve outcomes.
Collapse
Affiliation(s)
- Hakeem Ayinde
- Cardiology Associates of Fredericksburg, Fredericksburg, VA, USA.
| | - Favour Markson
- Department of Medicine, Lincoln Medical Center, Bronx, NY, USA
| | - Ugonna Kevin Ogbenna
- Department of Medicine, Michigan State University College of Osteopathic Medicine, Lansing, MI, USA
| | - Larry Jackson
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
3
|
Thomas KL, Garg J, Velagapudi P, Gopinathannair R, Chung MK, Kusumoto F, Ajijola O, Jackson LR, Turagam MK, Joglar JA, Sogade FO, Fontaine JM, Krahn AD, Russo AM, Albert C, Lakkireddy DR. Racial and ethnic disparities in arrhythmia care: A call for action. Heart Rhythm 2022; 19:1577-1593. [PMID: 35842408 PMCID: PMC10124949 DOI: 10.1016/j.hrthm.2022.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Kevin L Thomas
- Division of Cardiac Electrophysiology, Duke University School of Medicine, Durham, North Carolina
| | - Jalaj Garg
- Cardiac Arrhythmia Service, Loma Linda University Hospital, Loma Linda, California
| | - Poonam Velagapudi
- Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Mina K Chung
- Cardiac Pacing and Electrophysiology, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Fred Kusumoto
- Heart Rhythm Services, Mayo Clinic, Jacksonville, Florida
| | - Olujimi Ajijola
- Ronald Reagan University of California Los Angeles Cardiac Arrhythmia Center, Los Angeles, California
| | - Larry R Jackson
- Division of Cardiac Electrophysiology, Duke University School of Medicine, Durham, North Carolina
| | - Mohit K Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jose A Joglar
- Division of Cardiology, Clinical Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - Felix O Sogade
- Clinical Cardiac Electrophysiology, Georgia Arrhythmia Consultants, Macon, Georgia
| | - John M Fontaine
- Clinical Cardiac Electrophysiology Service, University of Pittsburgh Medical Center Williamsport, Williamsport, Pennsylvania
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Division of Cardiovascular Disease, Cooper University Hospital, Camden, New Jersey
| | - Christine Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | |
Collapse
|
4
|
Haruta D, Landes RD, Hida A, Imaizumi M, Ohishi W, Akahoshi M, Maemura K. Relationship Between Radiation Exposure and Incident Atrial Fibrillation Among Atomic Bomb Survivors. Circ Rep 2021; 3:381-387. [PMID: 34250279 PMCID: PMC8258179 DOI: 10.1253/circrep.cr-21-0059] [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: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Atrial fibrillation (AF) is a common arrhythmia. Although radiation exposure is associated with an elevated risk of cardiovascular disease, the effects of radiation on arrhythmia, especially AF, are unclear. We evaluated the relationship between radiation and AF in a cohort of atomic bomb survivors. Methods and Results: From a baseline enrollment period (1967-1969) to 2009, 7,379 Hiroshima and Nagasaki atomic bomb survivors (mean baseline age 50.6 years, 65.8% women, 72.9% from Hiroshima) without AF and who had been exposed to estimated radiation doses between 0 and 3.614 Gy were followed-up once every 2 years. AF was identified by 12-lead electrocardiograms and medical records. Treating age as the time scale, AF incidence was modeled with Cox proportional hazards models adjusting for demographics, AF risk factors, and radiation. We modeled radiation as both a continuous variable and categorized according to radiation dose (Control [<0.005 Gy] and 5 equal-sized groups based on radiation dose quintiles in the cohort). Over 4 decades of follow-up, we identified 276 AF cases in 176,687 person-years, for an incidence rate of 1.56 per 1,000 person-years. After adjusting for sex and city, neither categorized, linear, nor linear-quadratic models showed substantive evidence of radiation effects. Similar results were obtained after adjusting for AF risk factors. Conclusions: There were no clear positive associations between radiation dose and AF risk, rather null or non-significant inverse associations.
Collapse
Affiliation(s)
- Daisuke Haruta
- Department of Clinical Studies, Radiation Effects Research Foundation Nagasaki and Hiroshima Japan.,Saikakai Shibata Chokodo Hospital Shimabara Japan
| | - Reid D Landes
- Department of Statistics, Radiation Effects Research Foundation Hiroshima Japan.,Department of Biostatistics, University of Arkansas for Medical Sciences Little Rock, AR USA
| | - Ayumi Hida
- Department of Clinical Studies, Radiation Effects Research Foundation Nagasaki and Hiroshima Japan
| | - Misa Imaizumi
- Department of Clinical Studies, Radiation Effects Research Foundation Nagasaki and Hiroshima Japan
| | - Waka Ohishi
- Department of Clinical Studies, Radiation Effects Research Foundation Nagasaki and Hiroshima Japan
| | - Masazumi Akahoshi
- Department of Clinical Studies, Radiation Effects Research Foundation Nagasaki and Hiroshima Japan.,Wakokai Keiju Hospital Isahaya Japan
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| |
Collapse
|
5
|
Glycolysis Metabolites and Risk of Atrial Fibrillation and Heart Failure in the PREDIMED Trial. Metabolites 2021; 11:metabo11050306. [PMID: 34064960 PMCID: PMC8151758 DOI: 10.3390/metabo11050306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023] Open
Abstract
The increased prevalence of atrial fibrillation (AF) and heart failure (HF) highlights the need to better understand the mechanisms underlying these cardiovascular diseases (CVDs). In the present study, we aimed to evaluate the association between glycolysis-related metabolites and the risk of AF and HF in a Mediterranean population at high risk of CVD. We used two case-control studies nested within the PREDIMED trial. A total of 512 incident AF cases matched to 734 controls, and 334 incident HF cases matched to 508 controls, were included. Plasma metabolites were quantified by using hydrophilic interaction liquid chromatography coupled with high-resolution negative ion mode MS detection. Conditional logistic regression analyses were performed. The results showed no association between baseline plasma glycolysis intermediates and other related metabolites with AF. Only phosphoglycerate was associated with a higher risk of HF (OR for 1 SD increase: 1.28; 95% CI: 1.06, 1.53). The present findings do not support a role of the glycolysis pathway in the pathogenesis of AF. However, the increased risk of HF associated with phosphoglycerate requires further studies.
Collapse
|
6
|
Biersteker TE, Schalij MJ, Treskes RW. Impact of Mobile Health Devices for the Detection of Atrial Fibrillation: Systematic Review. JMIR Mhealth Uhealth 2021; 9:e26161. [PMID: 33908885 PMCID: PMC8116993 DOI: 10.2196/26161] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/25/2021] [Accepted: 03/22/2021] [Indexed: 12/11/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common arrhythmia, and its prevalence is increasing. Early diagnosis is important to reduce the risk of stroke. Mobile health (mHealth) devices, such as single-lead electrocardiogram (ECG) devices, have been introduced to the worldwide consumer market over the past decade. Recent studies have assessed the usability of these devices for detection of AF, but it remains unclear if the use of mHealth devices leads to a higher AF detection rate. Objective The goal of the research was to conduct a systematic review of the diagnostic detection rate of AF by mHealth devices compared with traditional outpatient follow-up. Study participants were aged 16 years or older and had an increased risk for an arrhythmia and an indication for ECG follow-up—for instance, after catheter ablation or presentation to the emergency department with palpitations or (near) syncope. The intervention was the use of an mHealth device, defined as a novel device for the diagnosis of rhythm disturbances, either a handheld electronic device or a patch-like device worn on the patient’s chest. Control was standard (traditional) outpatient care, defined as follow-up via general practitioner or regular outpatient clinic visits with a standard 12-lead ECG or Holter monitoring. The main outcome measures were the odds ratio (OR) of AF detection rates. Methods Two reviewers screened the search results, extracted data, and performed a risk of bias assessment. A heterogeneity analysis was performed, forest plot made to summarize the results of the individual studies, and albatross plot made to allow the P values to be interpreted in the context of the study sample size. Results A total of 3384 articles were identified after a database search, and 14 studies with a 4617 study participants were selected. All studies but one showed a higher AF detection rate in the mHealth group compared with the control group (OR 1.00-35.71), with all RCTs showing statistically significant increases of AF detection (OR 1.54-19.16). Statistical heterogeneity between studies was considerable, with a Q of 34.1 and an I2 of 61.9, and therefore it was decided to not pool the results into a meta-analysis. Conclusions Although the results of 13 of 14 studies support the effectiveness of mHealth interventions compared with standard care, study results could not be pooled due to considerable clinical and statistical heterogeneity. However, smartphone-connectable ECG devices provide patients with the ability to document a rhythm disturbance more easily than with standard care, which may increase empowerment and engagement with regard to their illness. Clinicians must beware of overdiagnosis of AF, as it is not yet clear when an mHealth-detected episode of AF must be deemed significant.
Collapse
|
7
|
Mascolo A, Urbanek K, De Angelis A, Sessa M, Scavone C, Berrino L, Rosano GMC, Capuano A, Rossi F. Angiotensin II and angiotensin 1-7: which is their role in atrial fibrillation? Heart Fail Rev 2021; 25:367-380. [PMID: 31375968 DOI: 10.1007/s10741-019-09837-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Atrial fibrillation (AF) is a significant cause of morbidity and mortality as well as a public health burden considering the high costs of AF-related hospitalizations. Pre-clinical and clinical evidence showed a potential role of the renin angiotensin system (RAS) in the etiopathogenesis of AF. Among RAS mediators, angiotensin II (AII) and angiotensin 1-7 (A1-7) have been mostly investigated in AF. Specifically, the stimulation of the pathway mediated by AII or the inhibition of the pathway mediated by A1-7 may participate in inducing and sustaining AF. In this review, we summarize the evidence showing that both RAS pathways may balance the onset of AF through different biological mechanisms involving inflammation, epicardial adipose tissue (EAT) accumulation, and electrical cardiac remodeling. EAT is a predictor for AF as it may induce its onset through direct (infiltration of epicardial adipocytes into the underlying atrial myocardium) and indirect (release of inflammatory adipokines, the stimulation of oxidative stress, macrophage phenotype switching, and AF triggers) mechanisms. Classic RAS blockers such as angiotensin converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) may prevent AF by affecting the accumulation of the EAT, representing a useful therapeutic strategy for preventing AF especially in patients with heart failure and known left ventricular dysfunction. Further studies are necessary to prove this benefit in patients with other cardiovascular diseases. Finally, the possibility of using the A1-7 or ACE2 analogues, to enlarge current therapeutic options for AF, may represent an important field of research.
Collapse
Affiliation(s)
- Annamaria Mascolo
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania "Luigi Vanvitelli", Via Santa Maria di Costantinopoli 16, 80138, Naples, Italy.
| | - Konrad Urbanek
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania "Luigi Vanvitelli", Via Santa Maria di Costantinopoli 16, 80138, Naples, Italy
| | - Antonella De Angelis
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania "Luigi Vanvitelli", Via Santa Maria di Costantinopoli 16, 80138, Naples, Italy
| | - Maurizio Sessa
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania "Luigi Vanvitelli", Via Santa Maria di Costantinopoli 16, 80138, Naples, Italy
| | - Cristina Scavone
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania "Luigi Vanvitelli", Via Santa Maria di Costantinopoli 16, 80138, Naples, Italy
| | - Liberato Berrino
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania "Luigi Vanvitelli", Via Santa Maria di Costantinopoli 16, 80138, Naples, Italy
| | - Giuseppe Massimo Claudio Rosano
- IRCCS San Raffaele Pisana, Rome, Italy.,Cardiovascular and Cell Sciences Research Institute, St. George's, University of London, London, UK
| | - Annalisa Capuano
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania "Luigi Vanvitelli", Via Santa Maria di Costantinopoli 16, 80138, Naples, Italy
| | - Francesco Rossi
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania "Luigi Vanvitelli", Via Santa Maria di Costantinopoli 16, 80138, Naples, Italy
| |
Collapse
|
8
|
Wodschow K, Bihrmann K, Larsen ML, Gislason G, Ersbøll AK. Geographical variation and clustering are found in atrial fibrillation beyond socioeconomic differences: a Danish cohort study, 1987-2015. Int J Health Geogr 2021; 20:11. [PMID: 33648527 PMCID: PMC7923319 DOI: 10.1186/s12942-021-00264-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/09/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The prevalence and incidence rate of atrial fibrillation (AF) increase worldwide and AF is a risk factor for more adverse cardiovascular diseases including stroke. Approximately 44% of AF cases cannot be explained by common individual risk factors and risk might therefore also be related to the environment. By studying geographical variation and clustering in risk of incident AF adjusted for socioeconomic position at an individual level, potential neighbourhood risk factors could be revealed. METHODS Initially, yearly AF incidence rates 1987-2015 were estimated overall and stratified by income in a register-based cohort study. To examine geographical variation and clustering in AF, we used both spatial scan statistics and a hierarchical Bayesian Poisson regression analysis of AF incidence rates with random effect of municipalities (n = 98) in Denmark in 2011-2015. RESULTS The 1987-2015 cohort included 5,453,639 individuals whereof 369,800 were diagnosed with an incident AF. AF incidence rate increased from 174 to 576 per 100,000 person-years from 1987 to 2015. Inequality in AF incidence rate ratio between highest and lowest income groups increased from 23% in 1987 to 38% in 2015. We found clustering and geographical variation in AF incidence rates, with incidence rates at municipality level being up to 34% higher than the country mean after adjusting for socioeconomic position. CONCLUSIONS Geographical variations and clustering in AF incidence rates exist. Compared to previous studies from Alberta, Canada and the United States, we show that geographical variations exist in a country with free access to healthcare and even when accounting for socioeconomic differences at an individual level. An increasing social inequality in AF was seen from 1987 to 2015. Therefore, when planning prevention strategies, attention to individuals with low income should be given. Further studies focusing on identification of neighbourhood risk factors for AF are needed.
Collapse
Affiliation(s)
- Kirstine Wodschow
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark.
| | - Kristine Bihrmann
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
| | | | - Gunnar Gislason
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark.,Department of Cardiology, Herlev and Gentofte Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
| |
Collapse
|
9
|
Comparison of Frequency of Atrial Fibrillation in Blacks Versus Whites and the Utilization of Race in a Novel Risk Score. Am J Cardiol 2020; 135:68-76. [PMID: 32866451 DOI: 10.1016/j.amjcard.2020.08.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 01/14/2023]
Abstract
Blacks have a lower prevalence of atrial fibrillation (AF) compared with Whites. We sought to confirm previously reported ethnic trends in AF in Blacks and Whites in a large database, and develop a prediction score for AF. Over 330 million hospital discharges between the years 2003 to 2013 from the National Inpatient Sample database were analyzed. All hospitalizations with a diagnosis of AF formed the study cohort. Traditional risk factors for the development of AF were compared between Blacks and Whites. Univariate and multiple logistic regression analyses were used to formulate a risk score to predict AF-CHADSAVES (Congestive heart failure, Hypertension, Age>65 years, Diabetes Mellitus, prior Stroke, Age>75 years, Vascular disease, White Ethnicity, and previous cardiothoracic Surgery). AF prevalence in Whites was 11.3% vs 4.6% in Blacks (p < 0.001). Blacks were younger (33.8% vs 14.4% patients <65 years, p < 0.01) and had less males (46.3% vs 49.4%, p < 0.01). Blacks had more hypertension (71.3% vs 64.1%, p < 0.01), congestive heart failure (24.8% vs 22.6%, p < 0.01), diabetes mellitus with (7.5% vs 4.7%, p < 0.01) or without complications (30.3% vs 23.1%, p < 0.01), renal failure (29.7% vs 17.1%, p < 0.01), and obesity (13.1% vs 8.7%, p < 0.01). CHADSAVES predicted AF in the study population (NIS 2003 to 2013) with an AUC of 0.82 and verified in a validation cohort (NIS 2014) with an AUC of 0.85. In conclusion, our data confirm a significant AF ethnicity paradox. Despite a higher prevalence of traditional risk factors for AF, Blacks had >2-fold lower prevalence of AF compared with Whites. CHADSAVES can be used effectively to predict AF in inpatients.
Collapse
|
10
|
Papandreou C, Hernández-Alonso P, Bulló M, Ruiz-Canela M, Li J, Guasch-Ferré M, Toledo E, Clish C, Corella D, Estruch R, Cofán M, Fitó M, Razquin C, Arós F, Fiol M, Santos-Lozano JM, Serra-Majem L, Liang L, Martínez-González MA, Hu FB, Salas-Salvadó J. High Plasma Glutamate and a Low Glutamine-to-Glutamate Ratio Are Associated with Increased Risk of Heart Failure but Not Atrial Fibrillation in the Prevención con Dieta Mediterránea (PREDIMED) Study. J Nutr 2020; 150:2882-2889. [PMID: 32939552 PMCID: PMC7675032 DOI: 10.1093/jn/nxaa273] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/26/2020] [Accepted: 08/13/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although the association between glutamate and glutamine in relation to cardiometabolic disorders has been evaluated, the role of these metabolites in the development of atrial fibrillation (AF) and heart failure (HF) remains unknown. OBJECTIVES We examined associations of glutamate, glutamine, and the glutamine-to-glutamate ratio with AF and HF incidence in a Mediterranean population at high cardiovascular disease (CVD) risk. METHODS The present study used 2 nested case-control studies within the PREDIMED (Prevención con Dieta Mediterránea) study. During ∼10 y of follow-up, there were 509 AF incident cases matched to 618 controls and 326 HF incident cases matched to 426 controls. Plasma concentrations of glutamate and glutamine were semiquantitatively profiled with LC-tandem MS. ORs were estimated with multivariable conditional logistic regression models. RESULTS In fully adjusted models, per 1-SD increment, glutamate was associated with a 29% (95% CI: 1.08, 1.54) increased risk of HF and glutamine-to-glutamate ratio with a 20% (95% CI: 0.67, 0.94) decreased risk. Glutamine-to-glutamate ratio was also inversely associated with HF risk (OR per 1-SD increment: 0.80; 95% CI: 0.67, 0.94) when comparing extreme quartiles. Higher glutamate concentrations were associated with a worse cardiometabolic risk profile, whereas a higher glutamine-to-glutamate ratio was associated with a better cardiometabolic risk profile. No associations between the concentrations of these metabolites and AF were observed. CONCLUSIONS Our findings suggest that high plasma glutamate concentrations possibly resulting from alterations in the glutamate-glutamine cycle may contribute to the development of HF in Mediterranean individuals at high CVD risk.This trial was registered at www.isrctn.com as ISRCTN35739639.
Collapse
Affiliation(s)
- Christopher Papandreou
- Biochemistry and Biotechnology Department, Human Nutrition Unit, Rovira i Virgili University, Reus, Spain,Pere i Virgili Health Research Institute (IISPV), Reus, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Human Nutrition Unit, University Hospital of Sant Joan de Reus, Reus, Spain
| | - Pablo Hernández-Alonso
- Biochemistry and Biotechnology Department, Human Nutrition Unit, Rovira i Virgili University, Reus, Spain,Pere i Virgili Health Research Institute (IISPV), Reus, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Human Nutrition Unit, University Hospital of Sant Joan de Reus, Reus, Spain
| | - Mònica Bulló
- Biochemistry and Biotechnology Department, Human Nutrition Unit, Rovira i Virgili University, Reus, Spain,Pere i Virgili Health Research Institute (IISPV), Reus, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Human Nutrition Unit, University Hospital of Sant Joan de Reus, Reus, Spain
| | - Miguel Ruiz-Canela
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Jun Li
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Marta Guasch-Ferré
- Biochemistry and Biotechnology Department, Human Nutrition Unit, Rovira i Virgili University, Reus, Spain,Pere i Virgili Health Research Institute (IISPV), Reus, Spain,Department of Nutrition, Harvard TH 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
| | - Estefanía Toledo
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Clary Clish
- Broad Institute of MIT and Harvard University, Cambridge, MA, USA
| | - Dolores Corella
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Ramon Estruch
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Department of Internal Medicine, Hospital Clinic, University of Barcelona,, Barcelona, Spain,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Montserrat Cofán
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain,Lipid Clinic, Department of Endocrinology and Nutrition, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Montserrat Fitó
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Cardiovascular and Nutrition Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Cristina Razquin
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Fernando Arós
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Department of Cardiology, University Hospital of Alava, Vitoria, Spain
| | - Miquel Fiol
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Institute of Health Sciences IUNICS, Health Research Institute of the Balearic Islands, Son Espases Hospital, Palma de Mallorca, Spain
| | - José M Santos-Lozano
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Department of Family Medicine, Seville Primary Care Health District, San Pablo Health Center, Seville, Spain
| | - Lluís Serra-Majem
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Research Institute of Biomedical and Health Sciences IUIBS, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Liming Liang
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Statistics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Miguel A Martínez-González
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard TH 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,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | | |
Collapse
|
11
|
Environmental factors, serum biomarkers and risk of atrial fibrillation: an exposure-wide umbrella review of meta-analyses. Eur J Epidemiol 2020; 35:223-239. [PMID: 32180061 DOI: 10.1007/s10654-020-00618-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 02/24/2020] [Indexed: 01/05/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia. We designed an umbrella review to systematically assess the epidemiological credibility of the associations of non-genetic factors with risk of AF. We searched PubMed and EMBASE from inception to December 31, 2018 to identify systematic reviews and meta-analyses of observational studies for the association of non-genetic factors with risk of AF. For each meta-analysis, we used the random-effects model, and we estimated the 95% confidence and prediction intervals. We also assessed between-study heterogeneity, small-study effects and excess significance bias. We identified 34 eligible papers that examined 51 associations of 42 unique non-genetic factors with risk of AF. Eighteen associations remained statistically significant at P value < 1 × 10-6. Thirty-one associations presented large or very large between-study heterogeneity. Eight associations presented evidence for small-study effects and 13 associations had evidence for excess significance bias. Ten associations, i.e. corrected QT interval, alcohol consumption (highest vs. lowest category, per 1 drink/day increase), body mass index (> 30 units vs. < 30 units, per 5 units increase), waist circumference, body weight, type 2 diabetes mellitus, and smoking (ever vs. never, per 10 cigarettes/day increase) were supported by convincing or highly suggestive evidence in meta-analyses of prospective cohort studies. Type 2 diabetes mellitus, markers of adiposity, alcohol consumption, smoking, and corrected QT interval constitute credible risk factors of AF. Our proposed grading may guide the design of future studies, including Mendelian randomization studies, to assess whether these associations are causal.
Collapse
|
12
|
McAlister FA, Yan L, Roos LL, Lix LM. Parental Atrial Fibrillation and Stroke or Atrial Fibrillation in Young Adults. Stroke 2019; 50:2322-2328. [PMID: 31337299 DOI: 10.1161/strokeaha.119.025124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background and Purpose- Cryptogenic strokes are often the first clinical manifestation of undiagnosed atrial fibrillation (AF). We designed this study to test whether parental AF is a risk factor for stroke in young adults. Methods- Population-based cohort study using linked administrative databases from April 1, 1972 to March 31, 2016 in Manitoba, Canada for 325 333 offspring (age ≥18 years) with at least 1 linked parent (total 582 195 parents). We examined the association between parental history of AF and stroke or transient ischemic attack (TIA) in the offspring using multivariable Cox proportional hazards models. Results- Offspring median age at study entry was 18 years. During 5.533 million person-years of follow-up (mean 17 years), 8678 offspring had an incident stroke or TIA (5.2% of the 24 583 offspring with a parental history of AF compared with 2.5% of the 300 750 offspring with no parental history of AF), and 1430 were diagnosed with AF (1.9% versus 0.3%). Incidence rates for stroke/TIA were higher in offspring with a parental history of AF (195.0 versus 156.6 per 100 000 person-years). Parental AF was associated with elevated risk in offspring of stroke/TIA (hazard ratio 1.11; 95% CI, 1.04-1.18) or AF (hazard ratio 1.75; 95% CI, 1.55-1.97) and a higher frequency of other cardiovascular risk factors. After adjusting for demographics, region of residence, socioeconomic status, and other stroke risk factors in offspring, parental AF was associated with AF in their offspring in young adulthood (adjusted hazard ratio 1.61; 95% CI, 1.43-1.82); the association of parental AF with offspring stroke/TIA was attenuated (adjusted hazard ratio 1.05; 95% CI, 0.99-1.12) after adjusting for the other cardiovascular risk factors. Conclusions- Parental AF is associated with increased risk of AF and other cardiovascular risk factors in their offspring during early adulthood, resulting in increased stroke risk.
Collapse
Affiliation(s)
- Finlay A McAlister
- From the Division of General Internal Medicine, University of Alberta, Edmonton, Canada (F.A.M.)
| | - Lin Yan
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada (L.Y., L.L.R., L.M.L.)
| | - Leslie L Roos
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada (L.Y., L.L.R., L.M.L.)
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada (L.Y., L.L.R., L.M.L.)
| |
Collapse
|
13
|
Nakagawa T, Hara H, Yamamoto M, Matsushita Y, Hiroi Y. Transmitral inflow wave and progression from paroxysmal to permanent atrial fibrillation in Asian people. HEART ASIA 2019; 11:e011166. [PMID: 31320938 DOI: 10.1136/heartasia-2018-011166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/30/2019] [Accepted: 05/22/2019] [Indexed: 11/04/2022]
Abstract
Objective Paroxysmal atrial fibrillation could progress to permanent atrial fibrillation. Whether the transmitral inflow waves could be used to predict progression from paroxysmal atrial fibrillation to permanent atrial fibrillation is unknown. Therefore, we investigated the association between the transmitral inflow waves and progression of paroxysmal atrial fibrillation. Method We performed a retrospective study by analysing clinical and echocardiographic data from 88 patients with paroxysmal atrial fibrillation. We excluded patients who had structural heart disease, significant valvular disease, cardiomyopathy, cardiac device implantation or a left ventricular ejection fraction <50%. Result The patients with progression to permanent atrial fibrillation were more likely to be male and had lower peak A velocity than those without progression. After adjusting for covariates, lower peak A velocity remained the independent predictor of progression to permanent atrial fibrillation (p=0.025). Conclusion The A velocity could be useful for predicting progression to permanent atrial fibrillation in Asian people.
Collapse
Affiliation(s)
- Takashi Nakagawa
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan.,Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hisao Hara
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masaya Yamamoto
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yumi Matsushita
- Department of Clinical Research, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukio Hiroi
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| |
Collapse
|
14
|
Cortese F, Giordano P, Scicchitano P, Faienza MF, De Pergola G, Calculli G, Meliota G, Ciccone MM. Uric acid: from a biological advantage to a potential danger. A focus on cardiovascular effects. Vascul Pharmacol 2019; 120:106565. [PMID: 31152976 DOI: 10.1016/j.vph.2019.106565] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/26/2019] [Accepted: 05/27/2019] [Indexed: 02/07/2023]
Abstract
Non-communicable diseases represent nowadays the most common cause of death worldwide, having largely overcome infectious diseases. Among them, cardiovascular diseases constitute the majority. Given these premise, great efforts have been made by scientific societies to emphasize the fundamental role of cardiovascular prevention and risk factors control. In addition to classical cardiovascular risk factors such as smoking, arterial hypertension, hypercholesterolemia and male gender, new risk factors are emerging from international literature. Among them, uric acid is the protagonist. Several evidences show a direct role of hyperuricemia in the determinism of metabolic and vascular disorders. From the other hand, some researchers have demonstrated that uric acid is only a marker of cardiovascular damage and not a risk factor for its development. Aim of this review is to evaluate the scientific evidences on the role of uric acid in cardiovascular diseases in order to shed light on this confusing topic.
Collapse
Affiliation(s)
- Francesca Cortese
- Cardiological Unit, Cardiovascular Disease Section, Department of Organ Transplantation, University of Bari, Italy.
| | - Paola Giordano
- Department of Biomedicine and Human Oncology, Pediatric Section, University "A.Moro" of Bari, Bari, Italy
| | | | - Maria Felicia Faienza
- Department of Biomedicine and Human Oncology, Pediatric Section, University "A.Moro" of Bari, Bari, Italy
| | - Giovanni De Pergola
- Departmentof Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, Bari, Italy
| | | | - Giovanni Meliota
- Cardiological Unit, Cardiovascular Disease Section, Department of Organ Transplantation, University of Bari, Italy
| | - Marco Matteo Ciccone
- Cardiological Unit, Cardiovascular Disease Section, Department of Organ Transplantation, University of Bari, Italy
| |
Collapse
|
15
|
Honarpisheh P, McCullough LD. Sex as a biological variable in the pathology and pharmacology of neurodegenerative and neurovascular diseases. Br J Pharmacol 2019; 176:4173-4192. [PMID: 30950038 DOI: 10.1111/bph.14675] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/19/2019] [Accepted: 02/24/2019] [Indexed: 12/14/2022] Open
Abstract
The incidence of dementia, most commonly caused by cerebrovascular and neurodegenerative diseases, continues to grow as our population ages. Alzheimer disease (AD) and vascular cognitive impairment (VCI) are responsible for more than 80% of all cases of dementia. There are few effective, long-term treatments for AD and VCI-related conditions (e.g., stroke and cerebral amyloid angiopathy (CAA)). This review focuses on AD (as the most common "neurodegenerative" cause of dementia), CAA (as an "emerging" cause of dementia), and stroke (as the most common cause of "vascular" dementia). We will discuss the available literature on the pharmacological therapies that demonstrate sex differences, which refer to any combination of structural, chromosomal, gonadal, or hormonal differences between males and females. We will emphasize the importance of considering sex as a biological variable in the design of preclinical and clinical studies that investigate underlying pathologies or response to pharmacological interventions in dementia. LINKED ARTICLES: This article is part of a themed section on The Importance of Sex Differences in Pharmacology Research. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.21/issuetoc.
Collapse
Affiliation(s)
- Pedram Honarpisheh
- Department of Neurology, University of Texas McGovern Medical School, Houston, Texas
| | - Louise D McCullough
- Department of Neurology, University of Texas McGovern Medical School, Houston, Texas
| |
Collapse
|
16
|
Zhao SX, Ziegler PD, Crawford MH, Kwong C, Koehler JL, Passman RS. Evaluation of a clinical score for predicting atrial fibrillation in cryptogenic stroke patients with insertable cardiac monitors: results from the CRYSTAL AF study. Ther Adv Neurol Disord 2019; 12:1756286419842698. [PMID: 31007721 PMCID: PMC6460885 DOI: 10.1177/1756286419842698] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 03/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background The HAVOC score was previously developed to predict the risk of atrial fibrillation (AF) after cryptogenic stroke (CS) or transient ischemic attack (TIA). The purpose of this study was to apply the HAVOC score to patients who received insertable cardiac monitors (ICMs) in the CRYSTAL AF study. Methods All patients from the CRYSTAL AF study who received an ICM were included. HAVOC score (one point each for peripheral vascular disease and obesity with body mass index >30, two points each for hypertension, age ⩾ 75, valvular heart disease, and coronary artery disease, 4 points for congestive heart failure) was computed for all patients. The primary endpoint was AF detection by 12 months of ICM monitoring. Results A total of 214 patients who received ICM were included. AF was detected in 40 patients while the remaining 174 patients were AF negative. The HAVOC score was significantly higher among patients with AF [median 3.0 with interquartile range (IQR) 2-4] than those without AF [median 2.0 (IQR 0-3)], p = 0.01. AF increased significantly across the three HAVOC score groups: 11% in Group A (score 0-1), 18% in Group B (score 2-3), and 32 % in Group C (score ⩾ 4) with p = 0.02. Conclusions The HAVOC score was shown in this post hoc analysis of CRYSTAL AF to successfully stratify AF risk post CS or TIA. The 11% AF rate in the lowest HAVOC score group highlights the significance of nontraditional contributors to AF and ischemic stroke.
Collapse
Affiliation(s)
- Susan X Zhao
- Division of Cardiology, Santa Clara Valley Medical Center, 751 S. Bascom Avenue, Suite # 340, San Jose, CA 95128, USA
| | | | - Michael H Crawford
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Rod S Passman
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
17
|
Dewan P, Jhund PS, Shen L, Petrie MC, Abraham WT, Atif Ali M, Chen CH, Desai AS, Dickstein K, Huang J, Kiatchoosakun S, Kim KS, Køber L, Lai WT, Liao Y, Mogensen UM, Oh BH, Packer M, Rouleau JL, Shi V, Sibulo AS, Solomon SD, Sritara P, Swedberg K, Tsutsui H, Zile MR, McMurray JJV. Heart failure with reduced ejection fraction: comparison of patient characteristics and clinical outcomes within Asia and between Asia, Europe and the Americas. Eur J Heart Fail 2018; 21:577-587. [PMID: 30536678 PMCID: PMC6607486 DOI: 10.1002/ejhf.1347] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/23/2018] [Accepted: 08/23/2018] [Indexed: 12/11/2022] Open
Abstract
Aims Nearly 60% of the world's population lives in Asia but little is known about the characteristics and outcomes of Asian patients with heart failure with reduced ejection fraction (HFrEF) compared to other areas of the world. Methods and results We pooled two, large, global trials, with similar design, in 13 174 patients with HFrEF (patient distribution: China 833, India 1390, Japan 209, Korea 223, Philippines 223, Taiwan 199 and Thailand 95, Western Europe 3521, Eastern Europe 4758, North America 613, and Latin America 1110). Asian patients were younger (55.0–63.9 years) than in Western Europe (67.9 years) and North America (66.6 years). Diuretics and devices were used less, and digoxin used more, in Asia. Mineralocorticoid receptor antagonist use was higher in China (66.3%), the Philippines (64.1%) and Latin America (62.8%) compared to Europe and North America (range 32.8% to 49.6%). The rate of cardiovascular death/heart failure hospitalization was higher in Asia (e.g. Taiwan 17.2, China 14.9 per 100 patient‐years) than in Western Europe (10.4) and North America (12.8). However, the adjusted risk of cardiovascular death was higher in many Asian countries than in Western Europe (except Japan) and the risk of heart failure hospitalization was lower in India and in the Philippines than in Western Europe, but significantly higher in China, Japan, and Taiwan. Conclusion Patient characteristics and outcomes vary between Asia and other regions and between Asian countries. These variations may reflect several factors, including geography, climate and environment, diet and lifestyle, health care systems, genetics and socioeconomic influences.
Collapse
Affiliation(s)
- Pooja Dewan
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Li Shen
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Mark C Petrie
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - William T Abraham
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, USA
| | - M Atif Ali
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Chen-Huan Chen
- Department of Medicine, National Yang-Ming University School of Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Akshay S Desai
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kenneth Dickstein
- University of Bergen, Stavanger University Hospital, Stavanger, Norway
| | - Jun Huang
- Department of Cardiology, First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | | | - Kee-Sik Kim
- Daegu Catholic University Medical Centre, Daegu, South Korea
| | - Lars Køber
- Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Wen-Ter Lai
- Division of Cardiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yuhua Liao
- Institute of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ulrik M Mogensen
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Byung-Hee Oh
- Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Centre, Dallas, TX, USA
| | - Jean L Rouleau
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Canada
| | - Victor Shi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Scott D Solomon
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Piyamitr Sritara
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.,National Heart and Lung Institute, Imperial College, London, UK
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Michael R Zile
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Centre, Charleston, SC, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| |
Collapse
|
18
|
High-sensitivity cardiac troponin I and risk of incident atrial fibrillation hospitalisation in an Australian community-based cohort: The Busselton health study. Clin Biochem 2018; 58:20-25. [DOI: 10.1016/j.clinbiochem.2018.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/17/2018] [Accepted: 05/06/2018] [Indexed: 01/13/2023]
|
19
|
Ugowe FE, Jackson LR, Thomas KL. Racial and ethnic differences in the prevalence, management, and outcomes in patients with atrial fibrillation: A systematic review. Heart Rhythm 2018; 15:1337-1345. [PMID: 29803022 DOI: 10.1016/j.hrthm.2018.05.019] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Indexed: 01/26/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia in the United States and is associated with increased morbidity, mortality, and health care expenditures. In this review, our aim was to assess the racial and ethnic differences in the epidemiology, management, and outcomes of patients with AF. A search of relevant studies from January 1, 2007, to December 30, 2017, was conducted in PubMed, EMBASE, and Web of Science and supplemented by manual searches of the bibliographies of retrieved articles. We identified 152 studies of which 64 were subsequently included. We found that underrepresented racial and ethnic groups have a higher prevalence of established risk factors associated with the development of AF but an overall lower incidence and prevalence of AF as compared with non-Hispanic whites. Moreover, racial and ethnic differences exist in detection, awareness, and AF-associated symptoms. Nonwhite populations also experience decreased use of rhythm control modalities and anticoagulation for stroke prevention. Lastly, among those with AF, underrepresented racial and ethnic groups had increased morbidity and mortality relative to white groups. Racial and ethnic differences exist in the prevalence, quality of life, management, and outcomes of individuals with AF; however, the mechanisms for these differences have yet to be fully elucidated. Racial and ethnic differences in AF warrant further analysis to understand the factors contributing to the differences in prevalence and management to ensure the delivery of high quality care that prevents stroke, reduces deaths, and decreases expenses associated with caring for underrepresented populations with AF.
Collapse
Affiliation(s)
| | - Larry R Jackson
- Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Kevin L Thomas
- Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| |
Collapse
|
20
|
Zuo H, Svingen GFT, Tell GS, Ueland PM, Vollset SE, Pedersen ER, Ulvik A, Meyer K, Nordrehaug JE, Nilsen DWT, Bønaa KH, Nygård O. Plasma Concentrations and Dietary Intakes of Choline and Betaine in Association With Atrial Fibrillation Risk: Results From 3 Prospective Cohorts With Different Health Profiles. J Am Heart Assoc 2018; 7:JAHA.117.008190. [PMID: 29650710 PMCID: PMC6015426 DOI: 10.1161/jaha.117.008190] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Although choline metabolism has been associated with atherosclerotic heart disease, less research attention has been paid to the associations of choline and its oxidative metabolite betaine with cardiac arrhythmias. Methods and Results We evaluated associations of plasma concentrations and dietary intakes of choline and betaine with long‐term atrial fibrillation (AF) risk in a community‐based cohort, HUSK ([the Hordaland Health Study] n=6949), and validated the findings in 2 patient cohorts: the Western Norway Coronary Angiography Cohort (n=4164) and the NORVIT (Norwegian B‐Vitamin) Trial (n=3733). Information on AF was obtained from the CVDNOR (Cardiovascular Disease in Norway) project. In HUSK, WECAC (Western Norway Coronary Angiography Cohort), and NORVIT, 552, 411, and 663 AF cases were identified during a median follow‐up time of 10.9, 7.3, and, 8.7 years, respectively. Plasma concentrations of choline and betaine were significantly positively associated with later AF risk after multivariable adjustments in HUSK. Such associations were independently replicated in the 2 external prospective patient cohorts. The pooled hazard ratio was 1.13 (95% confidence interval 1.08‐1.19, P<0.001) and 1.16 (95% confidence interval 1.10‐1.22, P<0.001) per SD increment for log‐transformed choline and betaine, respectively. Moreover, dietary intake of choline was marginally associated with AF risk (pooled hazard ratio 1.29, 95% confidence interval 1.01‐1.66, fifth versus first quintile), whereas no significant association was observed between dietary betaine and AF risk. Conclusions Our findings indicate that plasma concentrations as well as dietary intake of choline, but not betaine, are associated with subsequent risk of AF, suggesting a potential role of choline metabolism in the pathogenesis of AF. Clinical Trial Registration URL: https://www.clinicaltrials.gov.Unique identifier: NCT00671346.
Collapse
Affiliation(s)
- Hui Zuo
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Gard F T Svingen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Norway.,Division of Mental and Physical Health, Department of Noncommunicable Diseases, Norwegian Institute of Public Health, Bergen, Norway
| | - Per M Ueland
- Department of Clinical Science, University of Bergen, Norway.,Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Stein E Vollset
- Department of Global Public Health and Primary Care, University of Bergen, Norway.,Centre for Burden of Disease, Norwegian Institute of Public Health, Bergen, Norway
| | - Eva R Pedersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | | | - Jan E Nordrehaug
- Department of Clinical Science, University of Bergen, Norway.,Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Dennis W T Nilsen
- Department of Clinical Science, University of Bergen, Norway.,Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Kaare H Bønaa
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway.,Clinic for Heart Disease, St. Olav's University Hospital, Trondheim, Norway
| | - Ottar Nygård
- Department of Clinical Science, University of Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
21
|
Cardiovascular outcomes in diabetic kidney disease: insights from recent clinical trials. Kidney Int Suppl (2011) 2017; 8:8-17. [PMID: 30675434 DOI: 10.1016/j.kisu.2017.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The prevalence of type 2 diabetes is catalyzing a pandemic in kidney disease, with ensuing cardiovascular complications. The effort to identify antidiabetic agents capable of promoting benefits that go beyond the bounds of glucose control has produced remarkable outcomes in recent cardiovascular outcomes trials in patients with type 2 diabetes mellitus, many of whom have diabetic kidney disease. Two novel antidiabetic drug classes, sodium-glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs), improve cardiovascular outcomes in different ways, with SGLT2is reducing the risk of heart failure and cardiovascular death and GLP-1 RAs being associated with reduced risk of myocardial infarction and cardiovascular death. Further mechanistic studies and additional cardiovascular outcome trials are ongoing and are expected to determine whether these benefits are a result of class effect, as well as to delineate optimum timing for intervention and population target.
Collapse
|
22
|
Abstract
BACKGROUND Atrial fibrillation (AF) represents a significant health concern, due to the increased prevalence, morbidity, and mortality. METHODS AND RESULTS There is a growing body of evidence correlating serum uric acid (SUA) with cardiovascular diseases such as arterial hypertension and AF. CONCLUSION Thus, a question arises as to whether SUA levels have a role in the pathophysiology of AF development.
Collapse
|
23
|
Kumarathurai P, Mouridsen MR, Mattsson N, Larsen BS, Nielsen OW, Gerds TA, Sajadieh A. Atrial ectopy and N-terminal pro-B-type natriuretic peptide as predictors of atrial fibrillation: a population-based cohort study. Europace 2017; 19:364-370. [PMID: 27194537 DOI: 10.1093/europace/euw017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/17/2016] [Indexed: 11/15/2022] Open
Abstract
Aims The risk of incident atrial fibrillation (AF) can be estimated by clinical parameters in the Framingham AF risk model. Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) and increased rate of premature atrial contractions (PACs) have been shown to be associated with AF, but the additive value of both of these biomarkers in the Framingham AF risk model has not been fully examined. Methods and results A total of 646 subjects from the Copenhagen Holter Study (mean age 64.4 ± 6.8 years, 41.6% women) with no history of prior AF, stroke or cardiovascular disease were followed for the diagnosis of incident AF or death (median follow-up time 14.4 years). Median NT-proBNP was 6.7 pmol/L (IQR: 3.6-13.5), median PAC count was 1.4 beats/h (IQR: 0.6-4.5), 71 (11.0%) subjects developed AF, and 244 (37.8%) died. Multiple Cox regression including Framingham AF risk score, log-transformed NT-proBNP, and log-transformed PAC showed a significant increase in AF hazard risk [hazard ratio (HR) 1.45, 95% confidence interval (CI) 1.14-1.85, P = 0.002; HR 1.23, 95% CI 1.09-1.39, P = 0.001]. The addition of PAC to the Framingham AF risk model significantly improved the time-dependent area under the receiver operating characteristic curve (AUC 65.6 vs. 72.6; P = 0.008), while the addition of NT-proBNP did not. Conclusion Atrial fibrillation risk discrimination was significantly improved by the addition of PAC to the Framingham AF risk model, but not by the addition of NT-proBNP.
Collapse
Affiliation(s)
- Preman Kumarathurai
- Department of Cardiology, University Hospital of Bispebjerg, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, Copenhagen DK-2400, Denmark
| | - Mette R Mouridsen
- Department of Cardiology, University Hospital of Bispebjerg, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, Copenhagen DK-2400, Denmark
| | - Nick Mattsson
- Department of Cardiology, University Hospital of Bispebjerg, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, Copenhagen DK-2400, Denmark
| | - Bjørn S Larsen
- Department of Cardiology, University Hospital of Bispebjerg, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, Copenhagen DK-2400, Denmark
| | - Olav W Nielsen
- Department of Cardiology, University Hospital of Bispebjerg, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, Copenhagen DK-2400, Denmark
| | - Thomas A Gerds
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Ahmad Sajadieh
- Department of Cardiology, University Hospital of Bispebjerg, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, Copenhagen DK-2400, Denmark
| |
Collapse
|
24
|
Liao KM, Chen CY. Incidence and risk factors of atrial fibrillation in Asian COPD patients. Int J Chron Obstruct Pulmon Dis 2017; 12:2523-2530. [PMID: 28883719 PMCID: PMC5574688 DOI: 10.2147/copd.s143691] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the incidence and risk factors of atrial fibrillation (AF) in Asian chronic obstructive pulmonary disease (COPD) patients. Patients and methods We selected a study population older than 40 years with a COPD diagnosis and who had used at least one inhaled bronchodilator medication between 1998 and 2012. The date of the index COPD diagnosis was defined as the index date. We excluded patients with a history of AF, significant mitral valve disease, disorders of the thyroid gland, or ischemic heart disease before the index date. We followed all patients from the index date to the day of AF occurrence, the day of death, or the date of December 31, 2013. The baseline of comorbidities was identified before the index date. Comorbidities included hypertension, diabetes mellitus, end-stage renal disease, congenital heart failure, stroke, peripheral arterial occlusive disease, and malignancy. Results We included 6,208 COPD patients and 12,409 patients without COPD. The incidence of AF was higher in COPD patients than in those without COPD. The adjusted hazard ratio (HR) for AF among those with COPD was 2.23 with a 95% confidence interval (CI) of 1.98–2.51 compared to those without COPD. After multiple analyses, patients with hypertension (HR 1.43 [95% CI =1.26–1.62]) or heart failure (HR 2.36 [95% CI =1.81–3.08]) were found to have a significantly higher incidence of AF than those without these conditions. Conclusion It is important for physicians to monitor, prevent, and provide early intervention for AF in COPD patients with hypertension or heart failure.
Collapse
Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center Chiali, Tainan
| | - Chung-Yu Chen
- Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University.,Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Republic of China
| |
Collapse
|
25
|
High-Sensitivity Troponin as a Biomarker in Heart Rhythm Disease. Am J Cardiol 2017; 119:1407-1413. [PMID: 28256250 DOI: 10.1016/j.amjcard.2017.01.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 11/23/2022]
Abstract
Biomarkers are important prognostic tools in various cardiovascular conditions, including coronary artery disease and heart failure. Although their utility in cardiac electrophysiology (EP) is less established, biomarkers may guide EP clinical practice by identifying patients at risk for developing arrhythmias and their complications, in addition to augmenting therapeutic decisions by targeting appropriate pharmacologic and interventional therapies to patients who may benefit most. In this review, we focus on the prognostic role of high-sensitivity cardiac troponin (hs-cTn) assays-which detect subclinical cardiac myocyte damage-in cardiac arrhythmias and their sequelae. We review the current literature on hs-cTn and its impact on various arrhythmia disease states and also provide suggestions for future research in this field. In conclusion, although the utility of hs-cTn assays remains at an investigational stage in cardiac EP, studies to date have suggested value as a prognostic biomarker in atrial fibrillation and as a screening marker for patients at high risk of sudden cardiac death (both in the general population and among those with hypertrophic cardiomyopathy).
Collapse
|
26
|
Hijazi Z, Oldgren J, Siegbahn A, Wallentin L. Application of Biomarkers for Risk Stratification in Patients with Atrial Fibrillation. Clin Chem 2017; 63:152-164. [DOI: 10.1373/clinchem.2016.255182] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/01/2016] [Indexed: 12/13/2022]
Abstract
Abstract
BACKGROUND
Atrial fibrillation is the most common sustained arrhythmia and an important contributor to cardiovascular morbidity and mortality. Several strategies have been proposed for prediction of outcomes and individualization of treatments to better balance the benefits of stroke prevention and risks of bleeding during anticoagulation.
CONTENT
The availability of analytically more specific and sensitive methods to measure circulating biomarkers of cellular and organ stress and dysfunction has led to testing of their utility in several cardiovascular conditions. In patients with atrial fibrillation, biomarkers of myocardial injury (troponin) and cardiovascular stress and dysfunction (natriuretic peptides, growth differentiation factor 15), myocardial fibrosis (galectin-3), renal dysfunction (creatinine, cystatin C), inflammation (C-reactive protein, cytokines) and coagulation activity (d-dimer) have been found associated with underlying pathophysiology, clinical outcomes and effects of treatment. Measurements of these markers might therefore expand the understanding of the pathophysiology, improve risk assessment and optimize treatment in individual patients with atrial fibrillation.
SUMMARY
Biomarkers for risk stratification have potential roles as tools for evaluation of patients with atrial fibrillation and for selection of the best treatment strategies to prevent stroke, major bleeding, and mortality.
Collapse
Affiliation(s)
- Ziad Hijazi
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center (UCR), Uppsala University, Uppsala, Sweden
| | - Jonas Oldgren
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center (UCR), Uppsala University, Uppsala, Sweden
| | - Agneta Siegbahn
- Uppsala Clinical Research Center (UCR), Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center (UCR), Uppsala University, Uppsala, Sweden
| |
Collapse
|
27
|
The risk of atrial fibrillation in patients with gout: a nationwide population-based study. Sci Rep 2016; 6:32220. [PMID: 27599578 PMCID: PMC5013274 DOI: 10.1038/srep32220] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/25/2016] [Indexed: 12/17/2022] Open
Abstract
Many studies have found that systemic inflammation plays an important role in the pathogenesis of atrial fibrillation (AF). Gout is a chronic systemic inflammatory disorder, but little evidence exists regarding whether the risk of AF is increased in patients with gout. The National Health Insurance Research Database in Taiwan was used in this study, and gout was defined as the occurrence of at least one episode of an acute gout attack requiring medical treatment. A total of 63264 gout and 63264 age- and gender-matched patients were included as the study population. The Cox model was used to evaluate the risk of AF in patients with gout. Patients with gout experienced a greater frequency of co-morbidities compared to patients without gout. The cumulative incidences of AF were 4.61% and 3.04% in patients with and without gout, respectively (log-rank test, P < 0.001). After adjusting for co-morbidities and prescription medication use, gout was found to be associated with AF [hazard ratio (HR), 1.38]. Moreover, the HR for AF decreased with increasing age in our study. Gout was found to be associated with an increased risk of developing AF after adjusting for potential confounders.
Collapse
|
28
|
Bhatia S, Qazi M, Erande A, Shah K, Amin A, Patel P, Malik S. Racial Differences in the Prevalence and Outcomes of Atrial Fibrillation in Patients Hospitalized With Heart Failure. Am J Cardiol 2016; 117:1468-73. [PMID: 26970814 DOI: 10.1016/j.amjcard.2016.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 02/08/2016] [Accepted: 02/08/2016] [Indexed: 11/19/2022]
Abstract
Previous research has shown that roughly 15% to 30% of those with heart failure (HF) develop atrial fibrillation (AF). Although studies have shown variations in the incidence of AF in patients with HF, there has been no evidence of mortality differences by race. The purpose of this study was to assess AF prevalence and inhospital mortality in patients with HF among different racial groups in the United States. Using the National Inpatient Sample registry, the largest publicly available all-payer inpatient care database representing >95% of the US inpatient population, we analyzed subjects hospitalized with a primary diagnosis of HF from 2001 to 2011 (n = 11,485,673) using the International Classification of Diseases, Ninth Edition (ICD 9) codes 428.0-0.1, 428.20-0.23, 428.30-0.33, 428.40-0.43, and 428.9; patients with AF were identified using the ICD 9 code 427.31. We assessed prevalence and mortality among racial groups. Using logistic regression, we examined odds of mortality adjusted for demographics and co-morbidity using Elixhauser co-morbidity index. We also examined utilization of procedures by race. Of the 11,485,673 patients hospitalized with HF in our study, 3,939,129 (34%) had AF. Patients with HF and AF had greater inhospital mortality compared with those without AF (4.6% vs 3.3% respectively, p <0.0001). Additionally, black, Hispanic, Asian, and white patients with HF and AF had a 24%, 17%, 13%, and 6% higher mortality, respectively, than if they did not have AF. Among patients with HF and AF, minority racial groups had underutilization of catheter ablation and cardioversion compared with white patients. In conclusion, minority patients with HF and AF had a disproportionately higher risk of inpatient death compared with white patients with HF. We also found a significant underutilization of cardioversion and catheter ablation in minority racial groups compared with white patients.
Collapse
Affiliation(s)
- Subir Bhatia
- School of Medicine, University of California, Irvine, California
| | - Mohammad Qazi
- Division of Cardiology, Department of Medicine, University of California, Irvine, California
| | - Ashwini Erande
- Division of Cardiology, Department of Medicine, University of California, Irvine, California
| | - Kunjan Shah
- Division of Cardiology, Department of Medicine, University of California, Irvine, California
| | - Alpesh Amin
- Division of Cardiology, Department of Medicine, University of California, Irvine, California
| | - Pranav Patel
- Division of Cardiology, Department of Medicine, University of California, Irvine, California
| | - Shaista Malik
- Division of Cardiology, Department of Medicine, University of California, Irvine, California.
| |
Collapse
|
29
|
Alonso A, Yu B, Qureshi WT, Grams ME, Selvin E, Soliman EZ, Loehr LR, Chen LY, Agarwal SK, Alexander D, Boerwinkle E. Metabolomics and Incidence of Atrial Fibrillation in African Americans: The Atherosclerosis Risk in Communities (ARIC) Study. PLoS One 2015; 10:e0142610. [PMID: 26544570 PMCID: PMC4636390 DOI: 10.1371/journal.pone.0142610] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/23/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a common arrhythmia. Application of metabolomic approaches, which may identify novel pathways and biomarkers of disease risk, to a longitudinal epidemiologic study of AF has been limited. METHODS We determined the prospective association of 118 serum metabolites identified through untargeted metabolomics profiling with the incidence of newly-diagnosed AF in 1919 African-American men and women from the Atherosclerosis Risk in Communities study without AF at baseline (1987-1989). Incident AF cases through 2011 were ascertained from study electrocardiograms, hospital discharge codes, and death certificates. RESULTS During a median follow-up of 22 years, we identified 183 incident AF cases. In Cox proportional hazards models adjusted for age, sex, smoking, body mass index, systolic blood pressure, use of antihypertensive medication, diabetes, prevalent heart failure, prevalent coronary heart disease, and kidney function, two conjugated bile acids (glycolithocholate sulfate and glycocholenate sulfate) were significantly associated with AF risk after correcting for multiple comparisons (p<0.0004). Multivariable-adjusted hazard ratios (95% confidence intervals) of AF were 1.22 (1.12-1.32) for glycolithocholate sulfate and 1.22 (1.10-1.35) for glycocholenate sulfate per 1-standard deviation higher levels. Associations were not appreciably different after additional adjustment for alcohol consumption or concentrations of circulating albumin and liver enzymes. CONCLUSION We found an association of higher levels of two bile acids with an increased risk of AF, pointing to a potential novel pathway in AF pathogenesis. Replication of results in independent studies is warranted.
Collapse
Affiliation(s)
- Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Bing Yu
- Human Genetics Center, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Waqas T. Qureshi
- Division of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Morgan E. Grams
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
- Department of Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Laura R. Loehr
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Lin Y. Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Sunil K. Agarwal
- Mount Sinai Heart Hospital, New York, New York, United States of America
| | - Danny Alexander
- Metabolon, Inc., Durham, North Carolina, United States of America
| | - Eric Boerwinkle
- Human Genetics Center, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas, United States of America
| |
Collapse
|
30
|
Schotten U, Hatem S, Ravens U, Jaïs P, Müller FU, Goette A, Rohr S, Antoons G, Pieske B, Scherr D, Oto A, Casadei B, Verheule S, Cartlidge D, Steinmeyer K, Götsche T, Dobrev D, Kockskämper J, Lendeckel U, Fabritz L, Kirchhof P, Camm AJ. The European Network for Translational Research in Atrial Fibrillation (EUTRAF): objectives and initial results. Europace 2015; 17:1457-66. [DOI: 10.1093/europace/euv252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 06/29/2015] [Indexed: 01/25/2023] Open
|
31
|
Hoit BD. Refining the Risk for Atrial Fibrillation. Circ Cardiovasc Imaging 2015; 8:e003807. [DOI: 10.1161/circimaging.115.003807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brian D. Hoit
- From the Case Western Reserve University, Cleveland, OH; and Harrington Heart and Vascular Institute, University Hospital Case Medical Center, Cleveland, OH
| |
Collapse
|
32
|
Lippi G, Cervellin G, Sanchis-Gomar F. Galectin-3 in atrial fibrillation: Simple bystander, player or both? Clin Biochem 2015; 48:818-22. [DOI: 10.1016/j.clinbiochem.2015.04.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 01/29/2023]
|
33
|
Coronary atherosclerosis and adverse outcomes in patients with recent-onset atrial fibrillation and troponin rise. Am J Emerg Med 2015; 33:1407-13. [PMID: 26272437 DOI: 10.1016/j.ajem.2015.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/05/2015] [Accepted: 07/06/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The relationship between troponin and atrial fibrillation (AF) without acute coronary syndrome is still unclear. We sought to investigate the presence of coronary atherosclerosis and adverse outcomes in patients with AF. METHODS Consecutive patients with recent-onset AF and without severe comorbidities were enrolled between 2004 and 2013. Patients with a troponin rise or with adverse outcomes were considered for coronary angiography and revascularization when "critical" stenosis (≥70%) was recognized. Propensity score matching was performed to adjust for baseline characteristics; after matching, no differences existed between the groups of patients with or without troponin rise. The primary end point was the composite of acute coronary syndrome, revascularization, and cardiac death at 1- and 12-month follow-ups. RESULTS Of 3627 patients enrolled, 3541 completed the study; 202 (6%) showed troponin rise; and 91 (3%), an adverse outcome. In the entire cohort, on multivariate analysis, the odds ratio for the occurrence of the primary end point of troponin rise was 14 (95% confidence interval [CI], 10-23; P<.001), and that of known coronary artery disease was 3 (CI, 2-5; P=.001). In the matching cohort, the odds ratio of troponin rise was 10 (CI, 4-22; P<.001), and that of TIMI score greater than 2 was 4 (CI, 2-9; P≤.001). In the entire cohort, patients with or without troponin rise achieved the primary end point in 38 (19%) and 43 (1%) patients, respectively (P<.001). Stroke occurred in 4 (2%) and 20 (1%), respectively (P=.018). Critical stenosis and revascularization account for 23 (12%) and 15 (1%), respectively (P<.001). In the matching cohort, results were confirmed, but incidence of stroke was comparable. CONCLUSIONS Patients with recent-onset AF and troponin rise showed higher prevalence of coronary atherosclerosis and adverse cardiac events. Stroke per se did not succeed in justifying the high morbidity. Thus, beyond stroke, coronary atherosclerosis might have a pivotal role in poor outcomes.
Collapse
|
34
|
Affiliation(s)
- Advay G Bhatt
- From Boston University School of Medicine, Boston, MA
| | | |
Collapse
|
35
|
Incremental Value of Left Atrial Structural and Functional Characteristics for Prediction of Atrial Fibrillation in Patients Receiving Cardiac Pacing. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002942. [DOI: 10.1161/circimaging.114.002942] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
36
|
Progress toward the prevention and treatment of atrial fibrillation: A summary of the Heart Rhythm Society Research Forum on the Treatment and Prevention of Atrial Fibrillation, Washington, DC, December 9-10, 2013. Heart Rhythm 2014; 12:e5-e29. [PMID: 25460864 DOI: 10.1016/j.hrthm.2014.11.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Indexed: 02/07/2023]
|
37
|
Abstract
Atrial fibrillation (AF) is a major public health burden worldwide, and its prevalence is set to increase owing to widespread population ageing, especially in rapidly developing countries such as Brazil, China, India, and Indonesia. Despite the availability of epidemiological data on the prevalence of AF in North America and Western Europe, corresponding data are limited in Africa, Asia, and South America. Moreover, other observations suggest that the prevalence of AF might be underestimated-not only in low-income and middle-income countries, but also in their high-income counterparts. Future studies are required to provide precise estimations of the global AF burden, identify important risk factors in various regions worldwide, and take into consideration regional and ethnic variations in AF. Furthermore, in response to the increasing prevalence of AF, additional resources will need to be allocated globally for prevention and treatment of AF and its associated complications. In this Review, we discuss the available data on the global prevalence, risk factors, management, financial costs, and clinical burden of AF, and highlight the current worldwide inadequacy of its treatment.
Collapse
|
38
|
Sareh S, Toppen W, Mukdad L, Satou N, Shemin R, Buch E, Benharash P. CHADS2 score predicts atrial fibrillation following cardiac surgery. J Surg Res 2014; 190:407-12. [DOI: 10.1016/j.jss.2014.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 02/02/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
|
39
|
Tamariz L, Hernandez F, Bush A, Palacio A, Hare JM. Association between serum uric acid and atrial fibrillation: A systematic review and meta-analysis. Heart Rhythm 2014; 11:1102-8. [DOI: 10.1016/j.hrthm.2014.04.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Indexed: 02/07/2023]
|
40
|
van Peet PG, de Craen AJM, Gussekloo J, de Ruijter W. Plasma NT-proBNP as predictor of change in functional status, cardiovascular morbidity and mortality in the oldest old: the Leiden 85-plus study. AGE (DORDRECHT, NETHERLANDS) 2014; 36:9660. [PMID: 24807464 PMCID: PMC4082596 DOI: 10.1007/s11357-014-9660-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 04/21/2014] [Indexed: 06/03/2023]
Abstract
In the aging society, it is important to identify very old persons at high risk of functional decline, cardiovascular disease and mortality. However, traditional risk markers lose their predictive value with age. We investigated whether plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels predict change in functional status, cardiovascular morbidity and mortality in very old age. Here we present an observational prospective cohort study (Leiden 85-plus Study, 1997-2004) in a population-based sample of 560 individuals aged 85 years with a 5-year complete follow-up for functional status, cardiovascular morbidity and cause-specific mortality. Median NT-proBNP for men was 351 pg/ml (cutoff values for low-medium tertiles 201 pg/ml and medium-high tertiles 649 pg/ml) and, for women, 297 pg/ml (cutoffs 204 and 519 pg/ml, respectively). During the 5-year follow-up, participants with high NT-proBNP had an accelerated cognitive decline and increase of activities of daily living (ADL) disability over time (all at p < 0.01) and an increased risk of incident heart failure [hazard ratio (HR) 3.3 (95 % confidence interval (CI) 1.8-6.1)], atrial fibrillation [HR 4.1 (2.0-8.7)], myocardial infarction [HR 2.1 (1.2-3.7)], stroke [HR 3.4 (1.9-6.3)], cardiovascular mortality [HR 5.5 (3.1-10)], non-cardiovascular mortality [HR 2.0 (1.4-3.0)] and all-cause mortality [HR 2.9 (2.1-4.0)], independent of other known risk markers. All results remained similar after exclusion of participants with heart failure at baseline. In very old age, high-NT-proBNP levels predict accelerated cognitive and functional decline, as well as cardiovascular morbidity and mortality. Results suggest that NT-proBNP can help clinicians to identify very old people at high risk of functional impairment and incident cardiovascular morbidity.
Collapse
Affiliation(s)
- Petra G van Peet
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands,
| | | | | | | |
Collapse
|
41
|
Abstract
Atrial fibrillation (AF) sometimes develops in younger individuals without any evident cardiac or other disease. To refer to these patients who were considered to have a very favourable prognosis compared with other AF patients, the term 'lone' AF was introduced in 1953. However, there are numerous uncertainties associated with 'lone' AF, including inconsistent entity definitions, considerable variations in the reported prevalence and outcomes, etc. Indeed, increasing evidence suggests a number of often subtle cardiac alterations associated with apparently 'lone' AF, which may have relevant prognostic implications. Hence, 'lone' AF patients comprise a rather heterogeneous cohort, and may have largely variable risk profiles based on the presence (or absence) of overlooked subclinical cardiovascular risk factors or genetically determined subtle alterations at the cellular or molecular level. Whether the implementation of various cardiac imaging techniques, biomarkers and genetic information could improve the prediction of risk for incident AF and risk assessment of 'lone' AF patients, and influence the treatment decisions needs further research. In this review, we summarise the current knowledge on 'lone' AF, highlight the existing inconsistencies in the field and discuss the prognostic and treatment implications of recent insights in 'lone' AF pathophysiology.
Collapse
Affiliation(s)
- T S Potpara
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | |
Collapse
|
42
|
Anderson EJ, Efird JT, Davies SW, O'Neal WT, Darden TM, Thayne KA, Katunga LA, Kindell LC, Ferguson TB, Anderson CA, Chitwood WR, Koutlas TC, Williams JM, Rodriguez E, Kypson AP. Monoamine oxidase is a major determinant of redox balance in human atrial myocardium and is associated with postoperative atrial fibrillation. J Am Heart Assoc 2014; 3:e000713. [PMID: 24572256 PMCID: PMC3959694 DOI: 10.1161/jaha.113.000713] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Onset of postoperative atrial fibrillation (POAF) is a common and costly complication of heart surgery despite major improvements in surgical technique and quality of patient care. The etiology of POAF, and the ability of clinicians to identify and therapeutically target high‐risk patients, remains elusive. Methods and Results Myocardial tissue dissected from right atrial appendage (RAA) was obtained from 244 patients undergoing cardiac surgery. Reactive oxygen species (ROS) generation from multiple sources was assessed in this tissue, along with total glutathione (GSHt) and its related enzymes GSH‐peroxidase (GPx) and GSH‐reductase (GR). Monoamine oxidase (MAO) and NADPH oxidase were observed to generate ROS at rates 10‐fold greater than intact, coupled mitochondria. POAF risk was significantly associated with MAO activity (Quartile 1 [Q1]: adjusted relative risk [ARR]=1.0; Q2: ARR=1.8, 95% confidence interval [CI]=0.84 to 4.0; Q3: ARR=2.1, 95% CI=0.99 to 4.3; Q4: ARR=3.8, 95% CI=1.9 to 7.5; adjusted Ptrend=0.009). In contrast, myocardial GSHt was inversely associated with POAF (Quartile 1 [Q1]: adjusted relative risk [ARR]=1.0; Q2: ARR=0.93, 95% confidence interval [CI]=0.60 to 1.4; Q3: ARR=0.62, 95% CI=0.36 to 1.1; Q4: ARR=0.56, 95% CI=0.34 to 0.93; adjusted Ptrend=0.014). GPx also was significantly associated with POAF; however, a linear trend for risk was not observed across increasing levels of the enzyme. GR was not associated with POAF risk. Conclusions Our results show that MAO is an important determinant of redox balance in human atrial myocardium, and that this enzyme, in addition to GSHt and GPx, is associated with an increased risk for POAF. Further investigation is needed to validate MAO as a predictive biomarker for POAF, and to explore this enzyme's potential role in arrhythmogenesis.
Collapse
Affiliation(s)
- Ethan J Anderson
- Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Mena-Villalba AÁ, Lendínez-de la Cruz JM, Cubero-Gómez CM, Monsalvo-Moro M, Gutiérrez-Ruíz RC, García-Alfonsín A. [Relationship between antihypertensive drug use and development of atrial fibrillation in hypertensive patients in a Primary Care center]. Semergen 2014; 40:247-53. [PMID: 24485970 DOI: 10.1016/j.semerg.2013.10.006] [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: 06/30/2013] [Revised: 10/05/2013] [Accepted: 10/07/2013] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Although antihypertensive treatment can reduce the risk of cardiovascular morbimortality, studies aimed at evaluating the association between antihypertensive drug use and incidence of atrial fibrillation (AF) yield mixed results. This study aimed to determine the possible relationship between antihypertensive drug use and development of AF. MATERIAL AND METHODS Case control study. CASES Hypertensive patients with AF diagnosed at least one year after the start of drug treatment for hypertension. CONTROLS Hypertensive patients without AF with pharmacological antihypertensive treatment for at least one year, matching by sex, age and duration of antihypertensive therapy at diagnosis of AF cases. The study included 136 cases and 132 controls. VARIABLES AF, antihypertensive drugs, control of hypertension, duration of treatment with antihypertensive drugs, number of antihypertensive drugs. ANALYSIS Crude OR were calculated, with logistic regression being used to calculate the adjusted odds ratios. RESULTS Overall, diuretics was close to statistical significance: OR 0.616 (95% CI 0.365 to 1.040), as a protective factor for development of AF. Calcium channel blockers behaved as a protective factor against development of AF at 75 years or older (OR 0.366; 95% CI 0.173 to 0.772), and within this age in women (OR 0.343; 95% CI 0.145-0.811). CONCLUSIONS Calcium channel blockers in the group of 75 years or more, especially in women, worked statistically significant as a drug protecting against the appearance of AF. Diuretics may have a protective role in AF incidence in all hypertensive patients.
Collapse
Affiliation(s)
- A Á Mena-Villalba
- Unidad de Gestión Clínica, Centro de Salud Puerto Real, Distrito de Atención Primaria Cádiz, Bahía, La Janda, Servicio Andaluz de Salud, Puerto Real, Cádiz, España
| | - J M Lendínez-de la Cruz
- Unidad de Gestión Clínica, Centro de Salud Puerto Real, Distrito de Atención Primaria Cádiz, Bahía, La Janda, Servicio Andaluz de Salud, Puerto Real, Cádiz, España.
| | - C M Cubero-Gómez
- Unidad de Gestión Clínica, Centro de Salud Puerto Real, Distrito de Atención Primaria Cádiz, Bahía, La Janda, Servicio Andaluz de Salud, Puerto Real, Cádiz, España
| | - M Monsalvo-Moro
- Unidad de Gestión Clínica, Centro de Salud Puerto Real, Distrito de Atención Primaria Cádiz, Bahía, La Janda, Servicio Andaluz de Salud, Puerto Real, Cádiz, España
| | - R C Gutiérrez-Ruíz
- Unidad de Gestión Clínica, Centro de Salud Puerto Real, Distrito de Atención Primaria Cádiz, Bahía, La Janda, Servicio Andaluz de Salud, Puerto Real, Cádiz, España
| | - A García-Alfonsín
- Unidad de Gestión Clínica, Centro de Salud Puerto Real, Distrito de Atención Primaria Cádiz, Bahía, La Janda, Servicio Andaluz de Salud, Puerto Real, Cádiz, España
| |
Collapse
|
44
|
Knerr M, Bertog S, Vaskelyte L, Hofmann I, Sievert H. Results of percutaneous closure of patent foramen ovale with the GORE®septal occluder. Catheter Cardiovasc Interv 2014; 83:1144-51. [DOI: 10.1002/ccd.25336] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 11/11/2013] [Accepted: 11/27/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Meike Knerr
- CardioVascular Center, Seckbacher Landstraße 65, 60389; Frankfurt Germany
| | - Stefan Bertog
- CardioVascular Center, Seckbacher Landstraße 65, 60389; Frankfurt Germany
| | - Laura Vaskelyte
- CardioVascular Center, Seckbacher Landstraße 65, 60389; Frankfurt Germany
| | - Ilona Hofmann
- CardioVascular Center, Seckbacher Landstraße 65, 60389; Frankfurt Germany
| | - Horst Sievert
- CardioVascular Center, Seckbacher Landstraße 65, 60389; Frankfurt Germany
| |
Collapse
|
45
|
Rienstra M, Yin X, Larson MG, Fontes JD, Magnani JW, McManus DD, McCabe EL, Coglianese EE, Amponsah M, Ho JE, Januzzi JL, Wollert KC, Fradley MG, Vasan RS, Ellinor PT, Wang TJ, Benjamin EJ. Relation between soluble ST2, growth differentiation factor-15, and high-sensitivity troponin I and incident atrial fibrillation. Am Heart J 2014; 167:109-115.e2. [PMID: 24332149 DOI: 10.1016/j.ahj.2013.10.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 10/02/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND We investigated whether circulating concentrations of soluble ST2, growth differentiation factor-15 (GDF-15), and high-sensitivity troponin I (hsTnI) are associated with incident atrial fibrillation (AF) and whether these biomarkers improve current risk prediction models including AF risk factors, B-type natriuretic peptide (BNP), and C-reactive protein (CRP). METHODS We studied the relation between soluble ST2, GDF-15, and hsTnI and development of AF in Framingham Heart Study participants without prevalent AF. We used Cox proportional hazard regression analysis to examine the relation of incident AF during a 10-year follow-up period with each biomarker. We adjusted for standard AF clinical risk factors, BNP, and CRP. RESULTS The mean age of the 3,217 participants was 59 ± 10 years, and 54% were women. During a 10-year follow-up, 242 participants developed AF. In age- and sex-adjusted models, GDF-15 and hsTnI were associated with risk of incident AF; however, after including the AF risk factors and BNP and CRP, only hsTnI was significantly associated with AF (hazard ratio per 1 SD of loge hsTnI, 1.12, 95% CI 1.00-1.26, P = .045). The c statistic of the base model including AF risk factors, BNP, and CRP was 0.803 (95% CI 0.777-0.830) and did not improve by adding individual or all 3 biomarkers. None of the discrimination and reclassification statistics were significant compared with the base model. CONCLUSION In a community-based cohort, circulating hsTnI concentrations were associated with incident AF. None of the novel biomarkers evaluated improved AF risk discrimination or reclassification beyond standard clinical AF risk factors and biomarkers.
Collapse
|
46
|
Jeff JM, Donahue BS, Brown-Gentry K, Roden DM, Crawford DC, Stein CM, Kurnik D. Genetic variation in the β1-adrenergic receptor is associated with the risk of atrial fibrillation after cardiac surgery. Am Heart J 2014; 167:101-108.e1. [PMID: 24332148 DOI: 10.1016/j.ahj.2013.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 09/29/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Postoperative atrial fibrillation (PoAF) after cardiac surgery is common and associated with increased morbidity and mortality. Increased sympathetic activation after surgery contributes to PoAF, and β-blockers are the first-line recommendation for its prevention. We examined the hypothesis that common functional genetic variants in the β1-adrenoreceptor, the mediator of cardiac sympathetic activation and drug target of β-blockers, are associated with the risk for PoAF and with the protective effect of β-blockers. METHODS In a prospective cohort study, we studied 947 adult European Americans who underwent cardiac surgery at Vanderbilt University between 1999 and 2005. We genotyped 2 variants in the β1-adrenoreceptor, rs1801253 (Arg389Gly) and rs1801252 (Ser49Gly), and used logistic regression to examine the association between genotypes and PoAF occurring within 14 days after surgery, before and after adjustment for demographic and clinical covariates. RESULTS Postoperative atrial fibrillation occurred in 239 patients (25.2%) and was associated with rs1801253 genotype (adjusted P = .008), with Gly389Gly having an odds ratio of 2.63 (95% CI 1.42-4.89) for PoAF compared to the common Arg389Arg (P = .002). In a predefined subgroup analysis, this association appeared to be stronger among patients without β-blocker prophylaxis (adjusted odds ratio 7.00, 95% CI 1.82-26.96, P = .005) compared to patients with β-blocker prophylaxis, among whom the association between rs1801253 genotype and PoAF was not statistically significant (adjusted P = .11). CONCLUSION The Gly389 variant in the β1-adrenoreceptor is associated with PoAF, and this association appears to be modulated by β-blocker therapy. Future studies of the association of other adrenergic pathway genes with PoAF will be of interest.
Collapse
Affiliation(s)
- Janina M Jeff
- Center for Human Genetics Research, Vanderbilt University, Nashville, TN
| | - Brian S Donahue
- Department of Anesthesiology, Vanderbilt University, Nashville, TN
| | | | - Dan M Roden
- Division of Clinical Pharmacology, Departments of Medicine and Pharmacology, Vanderbilt University, Nashville, TN
| | - Dana C Crawford
- Center for Human Genetics Research, Vanderbilt University, Nashville, TN; Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN
| | - C Michael Stein
- Division of Clinical Pharmacology, Departments of Medicine and Pharmacology, Vanderbilt University, Nashville, TN
| | - Daniel Kurnik
- Division of Clinical Pharmacology, Departments of Medicine and Pharmacology, Vanderbilt University, Nashville, TN; Institute of Clinical Pharmacology and Toxicology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
47
|
Soliman EZ. More or less irregularity in understanding an irregular rhythm: atrial fibrillation classification and racial differences. J Am Heart Assoc 2013; 2:e000482. [PMID: 24113328 PMCID: PMC3835266 DOI: 10.1161/jaha.113.000482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
48
|
Arasaratnam P, Lee E. Prognostic value of the E/e′ ratio among octogenarians in Singapore. HEART ASIA 2013; 5:176-80. [DOI: 10.1136/heartasia-2013-010361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/11/2013] [Accepted: 07/21/2013] [Indexed: 11/03/2022]
|
49
|
Ferrero-de Loma-Osorio Á, Izquierdo-de Francisco M, Martínez-Brotons A, Sánchez-Gómez JM, Mascarell-Gregori B, Ruiz-Ros V, Cuenca-Romero I, García-Civera R, Chorro-Gascó FJ, Ruiz-Granell R. Medium-term results of cryoballoon ablation of the pulmonary veins in patients with paroxysmal and persistent atrial fibrillation. First experience of a Spanish center. J Interv Card Electrophysiol 2013; 37:189-96. [DOI: 10.1007/s10840-013-9797-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 02/25/2013] [Indexed: 01/05/2023]
|
50
|
|