Journal
JOURNAL OF THE AMERICAN HEART ASSOCIATION
Volume 5, Issue 5, Pages -Publisher
WILEY
DOI: 10.1161/JAHA.115.002907
Keywords
arterial stiffness; atherosclerosis; atrial fibrillation; carotid intima-media thickness
Categories
Funding
- National Institute on Aging [R21AG042660-01A1]
- American Heart Association [10SDG3420031, 16EIA26410001]
- ARIC
- MESA
- National Heart, Lung, and Blood Institute [RC1 HL099452, R01 HL102214, HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C]
- Netherlands Organization for Health Research and Development [ZonMw HTA 80-82500-98-10208]
- Netherlands Organization for Scientific Research [NWO Vici 918-76-619]
- National Center for Research Resources (NCRR) [UL1-RR-024156, UL1-RR-025005]
- Erasmus MC
- Erasmus University Rotterdam
- Netherlands Organization for Scientific Research (NWO)
- Netherlands Organization for Health Research and Development (ZonMw)
- Research Institute for Diseases in the Elderly (RIDE)
- Netherlands Genomics Initiative (NGI)
- Ministry of Education, Culture and Science, the Ministry of Health, Welfare and Sports
- European Commission (DG XII)
- Municipality of Rotterdam
- [HHSN268201100011C]
- [HHSN268201100012C]
- [N01-HC-95159]
- [N01-HC-95160]
- [N01-HC-95161]
- [N01-HC-95162]
- [N01-HC-95163]
- [N01-HC-95164]
- [N01-HC-95165]
- [N01-HC-95166]
- [N01-HC-95167]
- [N01-HC-95168]
- [N01-HC-95169]
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Background-We evaluated the association of carotid intima-media thickness (cIMT), carotid plaque, carotid distensibility coefficient (DC), and aortic pulse wave velocity (PWV) with incident atrial fibrillation (AF) and their role in improving AF risk prediction beyond the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE)-AF risk score. Methods and Results-We analyzed data from 3 population-based cohort studies: Atherosclerosis Risk in Communities (ARIC) Study (n= 13 907); Multi-Ethnic Study of Atherosclerosis (MESA; n= 6640), and the Rotterdam Study (RS; n= 5220). We evaluated the association of arterial indices with incident AF and computed the C-statistic, category-based net reclassification improvement (NRI), and relative integrated discrimination improvement (IDI) of incorporating arterial indices into the CHARGE-AF risk score (age, race, height weight, systolic and diastolic blood pressure, antihypertensive medication use, smoking, diabetes, previous myocardial infarction, and previous heart failure). Higher cIMT (meta-analyzed hazard ratio [95% CI] per 1-SD increment, 1.12 [1.08-1.16]) and presence of carotid plaque (1.30 [1.19-1.42]) were associated with higher AF incidence after adjustment for CHARGE-AF risk-score variables. Lower DC and higher PWV were associated with higher AF incidence only after adjustment for the CHARGE-AF risk-score variables excepting height, weight, and systolic and diastolic blood pressure. Addition of cIMT or carotid plaque marginally improved CHARGE-AF score prediction as assessed by the relative IDI (estimates, 0.025-0.051), but not when assessed with the C-statistic and NRI. Conclusions-Higher cIMT, presence of carotid plaque, and greater arterial stiffness are associated with higher AF incidence, indicating that atherosclerosis and arterial stiffness play a role in AF etiopathogenesis. However, arterial indices only modestly improve AF risk prediction.
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