Inflammation as a risk factor for atrial fibrillation

Background - The presence of systemic inflammation determined by elevations in C-reactive protein (CRP) has been associated with persistence of atrial fibrillation (AF). The relationship between CRP and prediction of AF has not been studied in a large population-based cohort. Methods and Results - CRP measurement and cardiovascular assessment were performed at baseline in 5806 subjects enrolled in the Cardiovascular Health Study. Patients were followed up for a mean of 6.9 +/- 1.6 ( median 7.8) years. AF was identified by self-reported history and ECGs at baseline and by ECGs and hospital discharge diagnoses at follow-up. Univariate and multivariate analyses were used to assess CRP as a predictor of baseline and future development of AF. At baseline, 315 subjects (5%) had AF. Compared with subjects in the first CRP quartile ( < 0.97 mg/L), subjects in the fourth quartile ( > 3.41 mg/L) had more AF (7.4% versus 3.7%, adjusted OR 1.8, 95% CI 1.2 to 2.5; P = 0.002). Of 5491 subjects without AF at baseline, 897 ( 16%) developed AF during follow-up. Baseline CRP predicted higher risk for developing future AF ( fourth versus first quartile adjusted hazard ratio 1.31, 95% CI 1.08 to 1.58; P = 0.005). When treated as a continuous variable, elevated CRP predicted increased risk for developing future AF ( adjusted hazard ratio for 1-SD increase, 1.24; 95% CI 1.11 to 1.40; P < 0.001). Conclusions - CRP is not only associated with the presence of AF but may also predict patients at increased risk for future development of AF.