1
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Siland JE, Geelhoed B, Roselli C, Wang B, Lin HJ, Weiss S, Trompet S, van den Berg ME, Soliman EZ, Chen LY, Ford I, Jukema JW, Macfarlane PW, Kornej J, Lin H, Lunetta KL, Kavousi M, Kors JA, Ikram MA, Guo X, Yao J, Dörr M, Felix SB, Völker U, Sotoodehnia N, Arking DE, Stricker BH, Heckbert SR, Lubitz SA, Benjamin EJ, Alonso A, Ellinor PT, van der Harst P, Rienstra M. Resting heart rate and incident atrial fibrillation: A stratified Mendelian randomization in the AFGen consortium. PLoS One 2022; 17:e0268768. [PMID: 35594314 PMCID: PMC9122202 DOI: 10.1371/journal.pone.0268768] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Both elevated and low resting heart rates are associated with atrial fibrillation (AF), suggesting a U-shaped relationship. However, evidence for a U-shaped causal association between genetically-determined resting heart rate and incident AF is limited. We investigated potential directional changes of the causal association between genetically-determined resting heart rate and incident AF. Method and results Seven cohorts of the AFGen consortium contributed data to this meta-analysis. All participants were of European ancestry with known AF status, genotype information, and a heart rate measurement from a baseline electrocardiogram (ECG). Three strata of instrumental variable-free resting heart rate were used to assess possible non-linear associations between genetically-determined resting heart rate and the logarithm of the incident AF hazard rate: <65; 65–75; and >75 beats per minute (bpm). Mendelian randomization analyses using a weighted resting heart rate polygenic risk score were performed for each stratum. We studied 38,981 individuals (mean age 59±10 years, 54% women) with a mean resting heart rate of 67±11 bpm. During a mean follow-up of 13±5 years, 4,779 (12%) individuals developed AF. A U-shaped association between the resting heart rate and the incident AF-hazard ratio was observed. Genetically-determined resting heart rate was inversely associated with incident AF for instrumental variable-free resting heart rates below 65 bpm (hazard ratio for genetically-determined resting heart rate, 0.96; 95% confidence interval, 0.94–0.99; p = 0.01). Genetically-determined resting heart rate was not associated with incident AF in the other two strata. Conclusions For resting heart rates below 65 bpm, our results support an inverse causal association between genetically-determined resting heart rate and incident AF.
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Affiliation(s)
- J. E. Siland
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B. Geelhoed
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C. Roselli
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, United States of America
| | - B. Wang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - H. J. Lin
- Institute for Translational Genomics and Population Sciences, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States of America
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - S. Weiss
- Interfaculty Institute for Genetics and Functional Genomics; Department of Functional Genomics; University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research); partner site Greifswald, Greifswald, Germany
| | - S. Trompet
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - M. E. van den Berg
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - E. Z. Soliman
- Division of Public Health Sciences and Department of Medicine, Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - L. Y. Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - I. Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - J. W. Jukema
- DZHK (German Centre for Cardiovascular Research); partner site Greifswald, Greifswald, Germany
- Einthoven Laboratory for Experimental Vascular Medicine, LUMC, Leiden, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - P. W. Macfarlane
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - J. Kornej
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA, United States of America
| | - H. Lin
- National Heart Lung and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA, United States of America
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, Unites States of America
| | - K. L. Lunetta
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, MA, United States of America
| | - M. Kavousi
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J. A. Kors
- Department of Medical Informatics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M. A. Ikram
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - X. Guo
- Institute for Translational Genomics and Population Sciences, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States of America
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - J. Yao
- Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States of America
| | - M. Dörr
- DZHK (German Centre for Cardiovascular Research); partner site Greifswald, Greifswald, Germany
- Department of Internal Medicine B-Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, Greifswald, Germany
| | - S. B. Felix
- DZHK (German Centre for Cardiovascular Research); partner site Greifswald, Greifswald, Germany
- Department of Internal Medicine B-Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, Greifswald, Germany
| | - U. Völker
- Interfaculty Institute for Genetics and Functional Genomics; Department of Functional Genomics; University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research); partner site Greifswald, Greifswald, Germany
| | - N. Sotoodehnia
- Cardiovascular Health Research Unit, Division of Cardiology, Departments of Medicine and Epidemiology, University of Washington, Seattle, WA, Unites States of America
| | - D. E. Arking
- McKusick-Nathans Institute, Department of Genetic Medicine, Johns Hopkins University SOM, Baltimore, MD, Unites States of America
| | - B. H. Stricker
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - S. R. Heckbert
- Cardiovascular Health Research Unit and the Department of Epidemiology, University of Washington, Seattle, WA, Unites States of America
| | - S. A. Lubitz
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, United States of America
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, Unites States of America
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, Unites States of America
| | - E. J. Benjamin
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- Department of Medicine, Boston University School of Medicine, Boston, MA, Unites States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, Unites States of America
| | - A. Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, Unites States of America
| | - P. T. Ellinor
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, United States of America
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, Unites States of America
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, Unites States of America
| | - P. van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands
- University Medical Center Utrecht, Department of Heart and Lungs, University of Utrecht, Utrecht, The Netherlands
| | - M. Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
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2
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Artola V, Geelhoed B, Van Lande M, Khalilian Ekrami N, De With R, Weberndorfer V, Linz D, Ten Cate H, Spronk H, Koldenhof T, Tieleman RG, Schotten U, Crijns HJG, Van Gelder I, Rienstra M. The 3S-AF scheme, rather than the 4S-AF scheme, predicts progression in patients with paroxysmal atrial fibrillation: data from RACE V study. Europace 2022. [DOI: 10.1093/europace/euac053.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): support from the Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation, CVON 2014-9: Reappraisal of Atrial Fibrillation: interaction between hyperCoagulability, Electrical remodelling, and Vascular destabilisation in the progression of AF (RACE V).
Purpose
To assess whether the 4S-AF scheme predicts AF progression, cardiovascular hospitalizations and mortality in patients with self-terminating paroxysmal AF.
Methods
We analysed well-phenotyped patients with paroxysmal AF from the Reappraisal of Atrial Fibrillation: Interaction between HyperCoagulability, Electrical remodelling, and Vascular Destabilisation in the Progression of AF (RACE V study). From the 417 patients included in RACE V, 341 (82%) had echocardiography available. Patient had continuous monitoring with implantable loop recorders or pacemakers. Primary endpoint of RACE V was AF progression, defined as (1) progression to persistent or permanent AF, or (2) progression of PAF with >3% burden increase. Median follow-up was 2.2 (1.6-2.8) years. Patients were given a score based on the components of the 4S-AF scheme (St, stroke=1; Sy, symptoms=2; Sb, Severity of burden=2; Su, Substrate=5) to a total maximum of 10 points (table 1). Left atrial fibrosis was not evaluated in our patients and therefore not included into the score. A score of zero (0) in the AF burden domain was given to all patients due to the presence of paroxysmal AF in all. A modified 4S-AF scheme was designed by eliminating the symptom domain, resulting in a 3S-AF scheme. Logistic regression was performed to assess AF progression and the composite endpoint of cardiovascular hospitalizations and mortality, C-statistic to assess prediction of the score, for both using the 4S-AF and the modified 3S-AF scheme.
Results
Mean age was 65 (IQR 58-71) years, 149 (44%) were women, 103 (48%) had heart failure (HFrEF 6 [2%]; HFpEF 97 [46%]), 276 (81%) had hypertension, 38(11%) had coronary artery disease and 162(48%) atherosclerosis (Table 2, Panel A). Based on the 4S-AF scheme, patients had an average score of 4.5±1.3, the majority had a score under 5 (n=272, 80%), 20% of the score was explained by the S1 domain (stroke), 16% of the score was explained by the Sy domain (symptoms), and 64% of the score was explained by the Su domain (substrate). The score points from the 4S-AF scheme did not predict the risk of AF progression (OR 1.08 95%CI 0.84 – 1.39, C-statistic 0.53) nor the composite endpoint (OR 0.79 95%CI 0.53 – 1.20, C-statistic 0.42, Table 2, Panel B). However, when excluding the Sy domain (symptoms) from the scheme, the 3S-AF scheme, it predicted the risk of progression (OR 1.54 95%CI 1.12 – 2.18, C-statistic 0.61, Table 2, Panel B).
Conclusion
In paroxysmal AF patients the 4S-AF scheme does not predict AF progression nor the composite endpoint cardiovascular hospitalizations and mortality. Although symptoms are important for choosing the treatment strategy, they may be less relevant to determine AF progression, cardiovascular hospitalization and mortality. To assess progression, the 3S-AF scheme may be more appropriate.
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Affiliation(s)
- V Artola
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - B Geelhoed
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - M Van Lande
- University Medical Center Groningen, Groningen, Netherlands (The)
| | | | - R De With
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - V Weberndorfer
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - D Linz
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - H Ten Cate
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - H Spronk
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - T Koldenhof
- Martini Hospital, Groningen, Netherlands (The)
| | - RG Tieleman
- Martini Hospital, Groningen, Netherlands (The)
| | - U Schotten
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - HJG Crijns
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - I Van Gelder
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - M Rienstra
- University Medical Center Groningen, Groningen, Netherlands (The)
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3
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Camen S, Csengeri D, Geelhoed B, Gianfagna F, Soderberg S, Kee F, Blankenberg S, Lochen ML, Iacoviello L, Tunstall-Pedoe H, Joergensen T, Salomaa V, Linneberg A, Kuulasmaa K, Schnabel RB. Risk factors, subsequent disease onset and prognostic impact of myocardial infarction and atrial fibrillation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Myocardial infarction (MI) is a known risk factor for incident atrial fibrillation (AF), while AF frequently complicates acute MI. Although both diseases share common cardiovascular risk factors, the direction and strength of the association of the risk factors with disease onset, subsequent disease incidence and mortality are not completely understood.
Purpose
Our goal was to define the temporal relationship of MI and AF and the association of cardiovascular risk factors with disease incidence in order to determine whether common clinical risk factors show different associations with incident MI or AF. We further aimed to investigate predictors of subsequent disease onset and the impact of subsequent disease diagnosis on mortality.
Methods
In pooled multivariable Cox regression analyses we examined temporal relations of disease onset and identified predictors of MI, AF and subsequent all-cause mortality in 108,363 individuals (median age 46.0 years, 48.2% men) free of MI and AF at baseline from six European population-based cohorts.
Results
Over a maximum follow-up of 10.0 years 3558 (3.3%) individuals were diagnosed exclusively with MI, 1922 (1.8%) with AF but no MI, and 491 (0.5%) individuals developed both MI and AF. Association of male sex, systolic blood pressure, antihypertensive treatment and diabetes mellitus appeared to be stronger with incident MI than with AF, whereas increasing age and body mass index showed a higher risk for incident AF. Total cholesterol and daily smoking were significantly related to incident MI but not AF. The combined population attributable fraction of the cardiovascular risk factors was over 70% for incident MI, whereas it was only about one quarter for incident AF. Subsequent MI after incident AF (hazard ratio1.68, 95% CI 1.03–2.74) and subsequent AF after MI (hazard ratio 1.75, 95% CI 1.31–2.34) both significantly increased overall mortality risk.
Conclusions
Subsequent diagnosis of MI and AF was associated with a significant increase in mortality, irrespective of the first event. We found different associations of common cardiovascular risk factors with incident MI and AF indicating distinct pathophysiological pathways in disease development.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020 research and innovation programme (grant agreement No 847770, AFFECT-EU) European Union's Horizon 2020 research and innovation programme (grant agreement No 648131)
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Affiliation(s)
- S Camen
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - D Csengeri
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - B Geelhoed
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | | | - S Soderberg
- Umea University, Department of Public Health and Clinical Medicine, and Heart Centre, Umea, Sweden
| | - F Kee
- Queen's University of Belfast, Belfast, United Kingdom
| | - S Blankenberg
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - M L Lochen
- UiT The Arctic University of Norway, Department of Community Medicine, Tromso, Norway
| | | | | | - T Joergensen
- Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - V Salomaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - A Linneberg
- Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - K Kuulasmaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - R B Schnabel
- University Heart & Vascular Center Hamburg, Hamburg, Germany
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4
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Boerschel C, Geelhoed B, Niiranen T, Camen S, Donati M, Den Ruijterg H, Linneberg A, Lochenl M, Kuulasmaa K, Blankenberg S, Iacoviello L, Zeller T, Soederberg S, Salomaa V, Schnabel R. Risk prediction of atrial fibrillation and its complications in the community using high-sensitivity cardiac troponin I: results from the BiomarCaRE Consortium. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Atrial fibrillation (AF) is becoming increasingly common and is associated with serious complications. Traditional cardiovascular risk factors (CVRF) do not explain all AF cases. Blood-based biomarkers reflecting cardiac injury may help close this gap. High-sensitivity troponin I (hsTnI) has emerged as a potential predictor.
Methods
We investigated the predictive ability of hsTnI for incident AF in 29,227 participants (median age 52.6 years, 51.2% men) across four different European community cohorts of the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) consortium in comparison to CVRF and established biomarkers (high-sensitive C-reactive protein (hsCRP), N-terminal pro B-type natriuretic peptide (NT-proBNP)).
Results
During a median follow-up of 13.8 (lower and upper quartiles 4.5, 21.3) years, 1,509 (5.2%) participants developed AF. Those in the highest fourth of hsTnI values at baseline (≥5.1 ng/L) had a 2.71-fold (95% confidence interval (CI) 2.31, 3.17; P<0.01) risk for developing AF compared to those in the lowest fourth (≤2.1 ng/L). In multivariable-adjusted Cox proportional hazard models no statistically significant association was seen between hsTnI and AF, whereas NT-proBNP (hazard ratio (HR) per two-fold increase in NT-proBNP 1.64; 95% CI 1.56, 1.72; P<0.001) as well as hsCRP (HR ratio per two-fold increase in hsCRP 1.05; 95% CI 1.01, 1.10; P=0.01) were statistically significantly related to incident AF. Inclusion of hsTnI did not improve model discrimination over CVRFs (C-index CVRF 0.7914 vs. C-index CVRF, hsTnI 0.7927; 95% CI −0.0004, 0.0031; P=0.130). Higher hsTnI concentrations were associated with AF complications such as stroke (HR 1.25; 95% CI 1.03, 1.51; P=0.02), heart failure (HR 1.27; 95% CI 1.12, 1.44; P<0.001) and cardiovascular events (HR 1.24; 95% CI 1.08, 1.42; P<0.001) as well as overall mortality (HR 1.15; 95% CI 1.05, 1.25; P<0.001) in those who were diagnosed with AF.
Conclusion
hsTnI as a biomarker of myocardial injury does not improve prediction of AF incidence beyond classical CVRFs. However, it is associated with AF complications and mortality after AF onset probably reflecting underlying subclinical cardiovascular impairment.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union Seventh Framework Programme (FP7/2007-2013
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Affiliation(s)
- C.S Boerschel
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany
| | - B Geelhoed
- University Medical Center of Schleswig-Holstein, Institute of Medical Biometry and Statistics, Luebeck, Germany
| | - T Niiranen
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - S Camen
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany
| | - M.B Donati
- Irccs I.N.M. Neuromed, Epidemiology and Prevention, Pozzilli, Italy
| | - H.M Den Ruijterg
- University Medical Center Utrecht, Laboratory for Experimental Cardiology, Utrecht, Netherlands (The)
| | - A Linneberg
- University of Copenhagen, Clinical Medicine, Copenhagen, Denmark
| | - M.L Lochenl
- UiT The Arctic University of Norway, Community Medicine, Tromso, Norway
| | - K Kuulasmaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - S Blankenberg
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany
| | - L Iacoviello
- Irccs I.N.M. Neuromed, Epidemiology and Prevention, Pozzilli, Italy
| | - T Zeller
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany
| | - S Soederberg
- Umea University, Public Health and Clinical Medicine, Umea, Sweden
| | - V Salomaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - R.B Schnabel
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany
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5
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Zwartkruis VW, Geelhoed B, Suthahar N, Gansevoort RT, Bakker SJL, Van Gelder IC, De Boer RA, Rienstra M. Atrial fibrillation detected at screening is not a benign condition - a comparison of clinical outcomes in screen-detected vs. hospital-detected atrial fibrillation. Europace 2021. [DOI: 10.1093/europace/euab116.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dutch Heart Foundation
Background
Screening for atrial fibrillation (AF) improves detection of AF. However, it is unknown whether AF detected at screening carries risks similar to clinically detected AF, and if it should be treated similarly.
Purpose
We aimed to compare clinical outcomes in individuals with screen-detected vs. hospital-detected incident AF.
Methods
We studied 8265 individuals (mean age 49 ± 13 years, 50% women) without prevalent AF from the population-based PREVEND (Prevention of Renal and Vascular End-Stage Disease) cohort study. By design, 70% of PREVEND participants had urinary albumin concentration ≥10 mg/l. AF was considered screen-detected when first detected on a 12-lead electrocardiogram (ECG) during one of the PREVEND study visits, and hospital-detected when first detected on a hospital ECG. Using Cox regression models with screen-detected and hospital-detected AF as time-varying covariates, we studied the association of screen-detected vs. hospital-detected AF with mortality, incident heart failure (HF), and incident cardiovascular (CV) events.
Results
During a mean follow-up of 9.7 years, 265 participants (3.2%) developed incident AF (mean age 62 ± 9 years, 30% women, 65% hypertension, 23% obesity, 9% diabetes, 15% history of myocardial infarction, 3% history of stroke, 2% prevalent HF). Of all incident AF cases, 60 (23%) were screen-detected and 205 (77%) hospital-detected. Baseline characteristics were generally comparable between participants with screen-detected and hospital-detected AF. A larger proportion of incident AF was screen-detected in men (26%) compared to women (15%). In univariabe analysis, both screen-detected and hospital-detected AF were strongly associated with death, incident HF, and incident CV events. After multivariable adjustment, hospital-detected AF was significantly associated with death (HR 2.95, 95% CI 2.18-4.00), incident HF (HR 3.98, 95% CI 2.49-6.34), and incident CV events (HR 1.92, 95% CI 1.21-3.06). Screen-detected AF was significantly associated with death (HR 2.21, 95% CI 1.09-4.47) and incident HF (HR 4.90, 95% CI 2.28-10.57), but not with incident CV events (HR 1.12, 95% CI 0.46-2.71).
Conclusions
In a population-based cohort enriched for microalbuminuria, almost a quarter of incident AF cases was first detected through ECG screening. Compared to hospital-detected AF, screen-detected AF was similarly associated with adverse outcomes. Although randomised trials are needed, this study highlights that AF screening may help decrease the general burden of CV disease.
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Affiliation(s)
- VW Zwartkruis
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands (The)
| | - B Geelhoed
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands (The)
| | - N Suthahar
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands (The)
| | - RT Gansevoort
- University Medical Center Groningen, Department of Internal Medicine, Division of Nephrology, Groningen, Netherlands (The)
| | - SJL Bakker
- University Medical Center Groningen, Department of Internal Medicine, Division of Nephrology, Groningen, Netherlands (The)
| | - IC Van Gelder
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands (The)
| | - RA De Boer
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands (The)
| | - M Rienstra
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands (The)
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6
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Boerschel C, Geelhoed B, Conradi L, Girdauskas E, Mueller C, Reichenspurner H, Blankenberg S, Zeller T, Schnabel R. Multi-omics approach to post-CABG renal impairment. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Renal impairment is a common complication after CABG (coronary artery bypass graft) surgery associated with an adverse outcome.
Purpose
To further characterize the molecular framework of the disease through omics analyses.
Methods
In N=165 CABG patients we performed multi-omics-analyses in preoperatively collected blood and tissue samples as well as 991 creatinine measurements. We used multivariable mixed-model regression analyses to analyse post-operative creatinine increase and to find common genetic polymorphisms, transcripts, metabolites and/or proteins associated with changes in postoperative creatinine increase. Multiple testing was accounted for by setting a 5%-limit on the false discovery rate (FDR) using the Benjamini-Hochberg procedure.
Results
Post-operative increase of log transformed creatinine was 0.035 (8%); 95% confidence interval (CI) 0.025, 0.045; P<0.001. We identified 55 gene expressions and two proteins associated with post-CABG renal impairment. On the metabolomic and single nucleotide point mutation (SNP) level, no relevant targets were found. The three most important identified gene expressions were MIR3202.1 (beta of log transformed creatinine increase per standard deviation gene expression increase −0.034; 95% CI: −0.048, 0.020; P<0.001), LOC105374386 (−0.032; 95% CI: −0.046, 0.019; P<0.001) and maternal embryonic leucine zipper kinase (MELK) (−0.022; 95% CI: −0.032, 0.013; P<0.001). Expression of all three was associated with a lower risk of post-CABG renal impairment. The same applies to the identified protein CAPRIN2 (−0.042; 95% CI: −0.062, 0.022; P<0.001), while expression of the protein TUBB6 was associated with a higher risk (0.033; 95% CI: 0.017, 0.048; P<0.001).
Conclusions
In an integrated approach we identified omics-biomarkers for the prediction of renal impairment after CABG surgery. The underlying pathophysiological associations of these genes and proteins are not fully understood. MELK might be an interesting target for further investigations, as it plays a prominent role in cell cycle control, cell proliferation, apoptosis, cell migration and cell renewal. Our results may help to better identify individuals at risk and lay the methodological groundwork for further omics analyses.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Boerschel
- University Heart Center Hamburg, Hamburg, Germany
| | - B Geelhoed
- University Heart Center Hamburg, Hamburg, Germany
| | - L Conradi
- University Heart Center Hamburg, Hamburg, Germany
| | - E Girdauskas
- University Heart Center Hamburg, Hamburg, Germany
| | - C Mueller
- University Heart Center Hamburg, Hamburg, Germany
| | | | | | - T Zeller
- University Heart Center Hamburg, Hamburg, Germany
| | - R.B Schnabel
- University Heart Center Hamburg, Hamburg, Germany
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7
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Morseth B, Geelhoed B, Linneberg A, Soderberg S, Johansson L, Kuulasmaa K, Salomaa V, Niiranen T, Iacoviello L, Loechen M, Schnabel R. Atrial fibrillation risk factor burden and disease onset across age decades. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although a number of risk factors have been associated with the progression of atrial fibrillation (AF), there is limited knowledge of their relevance for AF in relation to age.
Purpose
We examined whether the association between modifiable risk factors and AF differed between age decades.
Methods
Data were derived from five European cohorts from Denmark, Finland, Italy, Sweden, and Norway. In total, 66 951 individuals (49.1% men) aged ≥40 years (mean baseline age 53.5 years) and without prevalent AF were followed for incident AF, with the follow-up truncated at 10 years. Data on risk factors (body mass index [BMI], hypertension [systolic blood pressure ≥140 mmHg and/or use of antihypertensive medication], diabetes mellitus, myocardial infarction [MI] event before baseline examinations, daily smoking, and alcohol consumption) were available from the baseline examinations. Stratification into age decades was based on age at baseline examination. Furthermore, the participants were followed for events of stroke or mortality after AF diagnosis. Mortality, stroke, and AF outcomes were derived from national registers and hospital discharge registers. All analyses were adjusted for AF risk factors.
Results
The incidence of AF increased from 0.9 per 1000 person-years at the age of 40 to <50, to 17.7 at the age of ≥70 years. Multivariable-adjusted Cox models showed that BMI, hypertension, alcohol consumption, and history of MI were associated with increased risk of AF across age decades (p<0.05). Of these, the risk of AF associated with BMI and an MI event before baseline examinations differed across age decades. For each 5 units increase in BMI, risk of AF increased with 40% (95% confidence interval 17–68%) at the age of 40 to <50, falling to 17% (6–29%) at the age of ≥70 years (p=0.08 for difference between age decades 40 to <50 and ≥70). Participants with a history of MI showed decreased risk of AF with ageing, from a hazard ratio (HR) of 5.53 (2.85–10.73) in the 40 to <50 age group to a HR of 1.41 (1.11–1.79) at the age of ≥70 (p<0.001). Daily smoking and prevalent diabetes mellitus were in general not associated with AF. The multivariable-adjusted associations between new-onset AF and the succeeding risk of stroke and mortality increased with age, showing a 1.6 to 2.6-fold increase in risk of death at ages ≥60 years and two-fold increased risk of stroke in participants aged ≥70 years (p≤0.001).
Conclusion
The relative importance of modifiable risk factors on incident AF do not vary across age decades, with a few exceptions; BMI and a history of MI were stronger risk factors for AF at younger ages. Thus, preventive measures should target risk factors rigorously, in particular obesity. New-onset AF was associated with increased risk of stroke and mortality only at older ages, emphasizing the importance of adequate patient management in the older and oldest old.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- B Morseth
- UiT The Arctic University of Norway, School of Sport Sciences, Faculty of Health Sciences, Tromso, Norway
| | - B Geelhoed
- University Heart Center Hamburg, Hamburg, Germany
| | - A Linneberg
- Frederiksberg University Hospital, Center for Clinical Research and Prevention, Frederiksberg, Denmark
| | - S Soderberg
- Umea University, Department of Public Health and Clinical Medicine, and Heart Centre, Umea, Sweden
| | - L Johansson
- Umea University, Department of Public Health and Clinical Medicine, and Heart Centre, Umea, Sweden
| | - K Kuulasmaa
- National Institute for Health and Welfare (THL), Department of Public Health Solutions, Helsinki, Finland
| | - V Salomaa
- National Institute for Health and Welfare (THL), Department of Public Health Solutions, Helsinki, Finland
| | - T Niiranen
- National Institute for Health and Welfare (THL), Department of Public Health Solutions, Helsinki, Finland
| | - L Iacoviello
- University of Insubria, Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, Varese, Italy
| | - M.L Loechen
- UiT The Arctic University of Norway, Department of Community Medicine, Faculty of Health Sciences, Tromso, Norway
| | - R.B Schnabel
- University Heart Center Hamburg, Hamburg, Germany
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8
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Boerschel C, Geelhoed B, Niiranen T, Havulinna A, Fouodo C, Scheinhardt M, Blankenberg S, Jousilahti P, Kuulasmaa K, Zeller T, Salomaa V, Schnabel R. Assessment of causality of natriuretic peptides and atrial fibrillation and heart failure – a Mendelian randomization study in the FINRISK cohort. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Natriuretic peptides are extensively studied biomarkers for atrial fibrillation (AF) and heart failure (HF). Their role in the pathogenesis of both diseases is not entirely understood and in previous studies several single nucleotide polymorphisms (SNPs) at the NPPA-NPPB locus associated with natriuretic peptides have been identified.
Purpose
We investigated whether a causal relationship exists between natriuretic peptides and AF as well as HF using a Mendelian randomization approach.
Methods
N-terminal pro B-type natriuretic peptide (NT-proBNP) (N=6669), B-type natriuretic peptide (BNP) (N=6674) and mid-regional pro atrial natriuretic peptide (MR-proANP) (N=6813) were measured in the FINRISK 1997 cohort. Thirty common SNPs related to NT-proBNP, BNP and MR-proANP were selected from prior studies. We performed six Mendelian randomizations for all three natriuretic peptide biomarkers and for both outcomes, AF and HF separately. Polygenic risk scores (PRS) based on multiple SNPs were used as the genetic instrumental variable in Mendelian randomizations.
Results
PRS were significantly associated with the three natriuretic peptides. PRS were not significantly associated with incident AF nor HF. Most cardiovascular risk factors showed significant confounding percentages, but no association with PRS. A causal relation, other than a weak one, is unlikely.
Conclusion
In our Mendelian randomization approach, based on common genetic variation at the NPPA-NPPB locus, associations of the common polymorphisms with natriuretic peptides and the protein biomarkers themselves with incident disease could be confirmed. A strong causal relationship between natriuretic peptides and incidence of AF as well as HF was ruled out. Therapeutic approaches targeting natriuretic peptides will therefore very likely work through indirect mechanisms.
Comparison of hazard ratios
Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme, German Ministry of Research and Education
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Affiliation(s)
- C Boerschel
- University Heart Center Hamburg, Hamburg, Germany
| | - B Geelhoed
- University Heart Center Hamburg, Hamburg, Germany
| | - T Niiranen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - A.S Havulinna
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - C.J.K Fouodo
- University Medical Center of Schleswig-Holstein, Institute of Medical Biometry and Statistics, Luebeck, Germany
| | - M.O Scheinhardt
- University Medical Center of Schleswig-Holstein, Institute of Medical Biometry and Statistics, Luebeck, Germany
| | | | - P Jousilahti
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - K Kuulasmaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - T Zeller
- University Heart Center Hamburg, Hamburg, Germany
| | - V Salomaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - R.B Schnabel
- University Heart Center Hamburg, Hamburg, Germany
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9
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Fluschnik N, Geelhoed B, Becher PM, Brunner FJ, Schrage B, Knappe D, Bernhardt A, Blankenberg S, Kobashigawa J, Reichenspurner H, Schnabel RB, Magnussen C. P6310Risk predictors of cardiac allograft vasculopathy after heart transplantation: results from the United States Organ Procurement and Transplantation Network. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cardiac allograft vasculopathy (CAV) is a major long-term complication after heart transplantation leading to chronic graft failure and increased mortality.
Purpose
The aim of this study was to determine recipient- and donor-related risk factors for the development of CAV in patients after heart transplantation.
Methods
Overall, data from 34,994 heart transplant recipients prospectively enrolled from July 2004 to March 2015 in the Organ Procurement and Transplantation Network (OPTN) were analyzed. Patients aged <18 years and those without information about CAV and re-transplantation were excluded. Multivariable-adjusted analyses were performed to identify recipient- and donor-related risk factors for new-onset CAV. The mean follow-up time was 66.8 months. Analyses are based on OPTN data as of March 6, 2017.
Results
Of 34,994 patients after heart transplantation, 12,668 (36.2%) patients developed CAV. Mean age was 52±12 years for the recipients (76.1% men) and 31±12 years for the donors (71.0% men), respectively.
In recipients, male sex (hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.09–1.19, p<0.001), African American ethnicity (HR 1.11, 95% CI 1.06–1.17, p<0.001), body mass index (BMI) (HR per 5 kg/m2 increase 1.08, 95% CI 1.06–1.11, p<0.001) and smoking (HR 1.07, 95% CI 1.01–1.13, p=0.03) were associated with incident CAV. Moreover, recipients with ischemic (HR 1.30, 95% CI 1.09–1.55, p=0.003) and hypertrophic cardiomyopathy (HR 1.26, 95% CI 1.02–1.57, p=0.03) had a higher risk for new-onset CAV than patients with other cardiomyopathies.
In donors, age (HR 1.11, 95% CI 1.10–1.11, p<0.001), male sex (HR 1.28 95% CI 1.22–1.34, p<0.001), BMI (HR per 5 kg/m2 increase 1.04, 95% CI 1.02–1.05, p<0.001), smoking (HR 1.09, 95% CI 1.04–1.13, p<0.001), diabetes (HR 1.21 95% CI 1.09–1.36, p<0.001) and arterial hypertension (HR 1.13, 95% CI 1.07–1.20, p<0.001) were associated with new-onset CAV. Contrarily, African American (HR 0.93, 95% CI 0.88–0.98, p=0.007) and Hispanic ethnicity (HR 0.94, 95% CI 0.89–0.99, p=0.03) seemed to be protective.
Conclusion
Both recipient and donor male sex as well as the classical cardiovascular risk factors BMI and smoking were associated with incident CAV. On the donor side, additionally, diabetes and arterial hypertension were related to new-onset CAV. Diverse ethnicities were differentially related to new-onset CAV. Further studies are needed to clarify whether modification of cardiovascular risk factors as well as improved donor selection will reduce CAV burden.
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Affiliation(s)
- N Fluschnik
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - B Geelhoed
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - P M Becher
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - F J Brunner
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - B Schrage
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - D Knappe
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - A Bernhardt
- University Heart Center Hamburg, Department of Cardiovascular Surgery, Hamburg, Germany
| | - S Blankenberg
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - J Kobashigawa
- Cedars-Sinai Medical Center, Department of Cardiology, Los Angeles, United States of America
| | - H Reichenspurner
- University Heart Center Hamburg, Department of Cardiovascular Surgery, Hamburg, Germany
| | - R B Schnabel
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - C Magnussen
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
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10
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Schrage B, Geelhoed B, Niiranen T, Vishram-Nielsen J, Soederberg S, Vartiainen E, Di Castelnuovo A, Kontto J, Koenig W, Blankenberg S, Linneberg A, Kuulasmaa K, Iacoviello L, Salomaa V, Schnabel R. P3820Differential associations of common risk factors and biomarkers with atrial fibrillation and heart failure and their ability to predict sequential disease onset and mortality. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although atrial fibrillation (AF) and heart failure (HF) have a similar cardiovascular risk profile, the differential associations of the risk factors with both disease are incompletely understood.
Aim
The aim of this study was to understand whether common clinical risk factors and cardiovascular biomarkers show different associations with incident AF and HF, and to investigate predictors of sequential disease onset and mortality.
Methods
In 58693 individuals free of AF and HF from European population-based cohorts, pooled multivariable Cox regression analysis was used to find predictors for AF, HF and all-cause mortality. P-values for differences between Hazard Ratios (HR) of risk factors for AF and HF were estimated using bootstrapping with 5,000 replications. When AF and/or HF were used in Cox regressions as explanatory variables, they were included as time-dependent variables.
Results
Median age was 50.5 years, 49.3% were men. Median follow-up time was 13.8 years with an all-cause mortality rate of 15.7%. Incident AF and HF was present in 5.0% and 5.4% of the participants, with 1.8% showing a sequential disease onset.
In multivariable-adjusted models we observed stronger associations of body mass index (HR of 1.32 (95% CI 1.25–1.39) vs. 1.42 (95% CI 1.36–1.49), p=0.02), smoking (HR of 1.21 (95% CI 1.08–1.33) vs. 2.11 (95% CI 1.90–2.32), p<0.01) and antihypertensive medication (HR of 1.21 (95% CI 1.10–1.35) vs. 1.43 (95% CI 1.27–1.59), p<0.01) with incident HF than with incident AF.
Total serum cholesterol (HR of 1.10 (95% CI 1.06–1.15), prevalent diabetes (HR of 3.46 (95% CI 2.60–4.32), high-sensitive C-reactive protein (HR of 1.12 (95% CI 1.08–1.16)) and glomerular filtration rate (HR of 0.92 (95% CI 0.85–1.00) were significantly related to incident HF but not AF.
Age (HR of 1.54 (95% CI 1.47–1.61) vs. 1.54 (95% CI 1.47–1.62), p=0.95), male sex (HR of 2.87 (95% CI 2.42–3.33), p=0.13), prevalent myocardial infarction (HR of 1.65 (95% CI 1.26–2.04) vs. 1.75 (95% CI 1.36–2.11), p=0.73) and NT-proBNP (HR of 1.59 (95% CI 1.50–1.68) vs. 1.60 (95% CI 1.51–1.69), p=0.86) showed comparable associations with both diseases.
Age, male sex, body mass index, total serum cholesterol, prevalent diabetes and NT-proBNP were all predictors of sequential disease onset after multivariable adjustment.
In models including cardiovascular risk factors and NT-proBNP, the time-varying covariates incident AF and HF showed a strong association with all-cause mortality, with HR of 2.2 (95% CI 1.9–2.5) and 10.7 (95% CI 9.1–12.6), respectively. Sequential disease onset further increased the hazard ratio to 15.1 (95% CI 11.6–19.5).
Conclusion
In our pooled analysis of population-based cohorts, new-onset AF and HF showed different associations with common cardiovascular risk factors and biomarkers. Although both diseases significantly increased mortality, the highest risk was observed in individuals with sequential disease onset.
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Affiliation(s)
- B Schrage
- University Heart Center Hamburg, Department for General and Interventional Cardiology, Hamburg, Germany
| | - B Geelhoed
- University Heart Center Hamburg, Department for General and Interventional Cardiology, Hamburg, Germany
| | - T Niiranen
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - J Vishram-Nielsen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | | | - E Vartiainen
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | | | - J Kontto
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - W Koenig
- Deutsches Herzzentrum Muenchen Technical University of Munich, Munich, Germany
| | - S Blankenberg
- University Heart Center Hamburg, Department for General and Interventional Cardiology, Hamburg, Germany
| | - A Linneberg
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - K Kuulasmaa
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | | | - V Salomaa
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - R Schnabel
- University Heart Center Hamburg, Department for General and Interventional Cardiology, Hamburg, Germany
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11
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Boerschel C, Ohlrogge A, Geelhoed B, Niiranen T, Havulinna AS, Palosaari T, Blankenberg S, Zeller T, Salomaa V, Schnabel RB. P4796Risk prediction of atrial fibrillation in the community combining biomarkers and genetics. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Classical cardiovascular risk factors (CVRF), biomarkers and genetic variation have been suggested for risk assessment of atrial fibrillation (AF).
Purpose
To evaluate their clinical potential, we analysed their individual and combined effectiveness in AF prediction.
Methods
In N=6945 individuals of the FINRISK 1997 cohort, we assessed the predictive value of CVRF, N-terminal pro B-type natriuretic peptide (NT-proBNP) and 145 recently identified single nucleotide polymorphisms (SNPs) for incident AF.
Results
Over a median follow-up of 17.8 years, N=551 participants (7.9%) developed AF. In multivariable-adjusted Cox proportional hazard models, NT-proBNP (hazard ratio (HR) per standard deviation (SD) 1.90, 95% confidence interval (CI): 1.71–2.11, P<0.001) and the polygenic risk score (PRS) (HR per SD 1.66, 95% CI: 1.51–1.84, P<0.001) were significantly related to incident AF. The discriminatory ability improved asymptotically with increasing numbers of SNPs. Compared to a clinical model, AF risk prediction was significantly improved by addition of NT-proBNP and the PRS. The C-statistic for the combination of all CVRF, NT-proBNP and the PRS reached 0.82 compared to 0.77 for CVRF only (P<0.001). Comparing the highest versus lowest quartile, age remained the strongest risk factor with a 15-fold increased risk of AF. The highest quartiles of NT-proBNP and the PRS both showed an approximately 3-fold increased AF risk compared to the lowest quartiles.
C-Index for AF prediction
Conclusions
The PRS and the established biomarker NT-proBNP predicted incident AF comparably. Both provided incremental predictive value over standard clinical variables. Further improvements for the PRS are likely with the discovery of additional SNPs.
Acknowledgement/Funding
European Research Council, German Ministry of Research and Education, DZHK, European Union Seventh Framework Programme, CHANCES, THL
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Affiliation(s)
- C Boerschel
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - A Ohlrogge
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - B Geelhoed
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - T Niiranen
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - A S Havulinna
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - T Palosaari
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - S Blankenberg
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - T Zeller
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - V Salomaa
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - R B Schnabel
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
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12
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Nguyen BO, Rienstra M, Hobbelt AH, Alings M, Tijssen JGP, Smit MD, Brugemann J, Geelhoed B, Tieleman RG, Hillege HL, Tukkie R, Van Veldhuisen DJ, Crijns HJGM, Van Gelder IC. P2294Four targeted therapies and less than four targeted therapies of underlying conditions against conventional therapy in atrial fibrillation - data from the RACE 3 study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B O Nguyen
- University Medical Center Groningen, Cardiology, Groningen, Netherlands
| | - M Rienstra
- University Medical Center Groningen, Cardiology, Groningen, Netherlands
| | - A H Hobbelt
- University Medical Center Groningen, Cardiology, Groningen, Netherlands
| | - M Alings
- Amphia Hospital, Cardiology, Breda, Netherlands
| | - J G P Tijssen
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - M D Smit
- University Medical Center Groningen, Cardiology, Groningen, Netherlands
| | - J Brugemann
- University Medical Center Groningen, Cardiology, Groningen, Netherlands
| | - B Geelhoed
- University Medical Center Groningen, Cardiology, Groningen, Netherlands
| | - R G Tieleman
- Martini Hospital, Cardiology, Groningen, Netherlands
| | - H L Hillege
- University Medical Center Groningen, Cardiology, Groningen, Netherlands
| | - R Tukkie
- Spaarne Hospital, Cardiology, Haarlem, Netherlands
| | | | - H J G M Crijns
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands
| | - I C Van Gelder
- University Medical Center Groningen, Cardiology, Groningen, Netherlands
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13
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Zweerink A, Van Everdingen WM, Nijveldt R, Salden OAE, Meine M, Maass AH, Vernooy K, De Lange FJ, Vos MA, Geelhoed B, Rienstra M, Van Gelder IC, Van Rossum AC, Cramer MJ, Allaart CP. P320End-systolic septum strain: a multi-modality strain parameter that accurately predicts cardiac resynchronization therapy response. Europace 2018. [DOI: 10.1093/europace/euy015.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Zweerink
- VU University Medical Center, Cardiology, Amsterdam, Netherlands
| | | | - R Nijveldt
- VU University Medical Center, Cardiology, Amsterdam, Netherlands
| | - OAE Salden
- University Medical Center Utrecht, Utrecht, Netherlands
| | - M Meine
- University Medical Center Utrecht, Utrecht, Netherlands
| | - A H Maass
- University Medical Center Groningen, Groningen, Netherlands
| | - K Vernooy
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
| | - F J De Lange
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - M A Vos
- University Medical Center Utrecht, Utrecht, Netherlands
| | - B Geelhoed
- University Medical Center Groningen, Groningen, Netherlands
| | - M Rienstra
- University Medical Center Groningen, Groningen, Netherlands
| | - I C Van Gelder
- University Medical Center Groningen, Groningen, Netherlands
| | - A C Van Rossum
- VU University Medical Center, Cardiology, Amsterdam, Netherlands
| | - M J Cramer
- University Medical Center Utrecht, Utrecht, Netherlands
| | - C P Allaart
- VU University Medical Center, Cardiology, Amsterdam, Netherlands
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14
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De With RR, Rienstra M, Geelhoed B, Hobbelt AH, Nguyen BO, Alings M, Tijssen JGP, Smit MD, Brugemann J, Tieleman RG, Hillege HL, Tukkie R, Van Veldhuisen DJ, Crijns HJGM, Van Gelder IC. P1175Determinants of progression of persistent to permanent atrial fibrillation - data from the RACE 3 study. Europace 2018. [DOI: 10.1093/europace/euy015.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R R De With
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - M Rienstra
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - B Geelhoed
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - A H Hobbelt
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - B O Nguyen
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - M Alings
- Amphia Hospital, Cardiology, Breda, Netherlands
| | - JGP Tijssen
- Academic Medical Center of Amsterdam, Clinical epidemiology and biostatistics, Amsterdam, Netherlands
| | - M D Smit
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - J Brugemann
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - R G Tieleman
- Martini Hospital, Cardiology, Groningen, Netherlands
| | - H L Hillege
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - R Tukkie
- Hospital Kennemer Gasthuis, Cardiology, Haarlem, Netherlands
| | - D J Van Veldhuisen
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - HJGM Crijns
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands
| | - I C Van Gelder
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
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De With RR, Rienstra M, Nguyen BO, Zwartkruis VW, Hobbelt AH, Alings M, Tijssen JGP, Smit MD, Brugemann J, Geelhoed B, Tieleman RG, Hillege HL, Van Veldhuisen DJ, Crijns HJGM, Van Gelder IC. 54Treating underlying conditions improves quality of life in patients with persistent atrial fibrillation and heart failure - data from the RACE 3 study. Europace 2018. [DOI: 10.1093/europace/euy015.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R R De With
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - M Rienstra
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - B O Nguyen
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - V W Zwartkruis
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - A H Hobbelt
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - M Alings
- Amphia Hospital, Cardiology, Breda, Netherlands
| | - JGP Tijssen
- Academic Medical Center of Amsterdam, Clinical epidemiology and biostatistics, Amsterdam, Netherlands
| | - M D Smit
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - J Brugemann
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - B Geelhoed
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - R G Tieleman
- Martini Hospital, Cardiology, Groningen, Netherlands
| | - H L Hillege
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - D J Van Veldhuisen
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - HJGM Crijns
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands
| | - I C Van Gelder
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
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Wijers SC, Ter Horst I, Vernooy K, Maass AH, De Lange FJ, Allaart CP, Rienstra M, Geelhoed B, Ritsema Van Eck HJ, Vos MA, Meine M. 235QRS vector amplitude in the transversal plane quantifies the electrical substrate favorable for response to cardiac resynchronization therapy. Europace 2017. [DOI: 10.1093/ehjci/eux139.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Geelhoed B. Comment on 'Empirical versus modelling approaches to the estimation of measurement uncertainty caused by primary sampling' by J. A. Lyn, M. H. Ramsey, A. P. Damant and R. Wood. Analyst 2009; 134:1934-5; discussion 1936. [PMID: 19684922 DOI: 10.1039/b812422a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Recently, Lyn et al. (Analyst, 2007, 132, 1231) compared two ways of estimating the standard uncertainty of sampling pistachio nuts for aflatoxins--a modelling method and an empirical method. Their case study used robust analysis of variance (RANOVA) to derive the uncertainty estimates, highlighting a substantial difference between the two: the estimate of sampling uncertainty derived from the modelling method was six-fold greater than that using the empirical approach (cf. 136% and 22.5%, respectively, when expressed as relative standard deviations (RSDs) at 68% confidence). A further analysis of this case study is reported here and suggests that the estimation uncertainty during RANOVA in the empirical approach could account for this difference.
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Affiliation(s)
- B Geelhoed
- Delft University of Technology, Mekelweg 15, 2629 JB, Delft, The Netherlands.
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