Aims Classical cardiovascular risk factors (CVRFs), biomarkers, and common genetic variation have been suggested for risk assessment of atrial fibrillation (AF). To evaluate their clinical potential, we analysed their individual and combined ability of AF prediction. Methods and results 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) combined in a developed polygenic risk score (PRS) for incident AF. 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) of log transformed values 4.77; 95% confidence interval (CI) 3.66–6.22; P < 0.001] and the PRS (HR 2.18; 95% CI 1.88–2.53; P < 0.001) were significantly related to incident AF. The discriminatory ability improved asymptotically with increasing numbers of SNPs. Compared with a clinical model, AF risk prediction was significantly improved by addition of NT-proBNP and the PRS. The C-statistic for the combination of CVRF, NT-proBNP, and the PRS reached 0.83 compared with 0.79 for CVRF only (P < 0.001). A replication in the Dutch Prevention of REnal and Vascular ENd-stage Disease (PREVEND) cohort revealed similar results. Comparing the highest vs. lowest quartile, NT-proBNP and the PRS both showed a more than three-fold increased AF risk. Age remained the strongest risk factor with a 16.7-fold increased risk of AF in the highest quartile. Conclusion The PRS and the established biomarker NT-proBNP showed comparable predictive ability. Both provided incremental predictive value over standard clinical variables. Further improvements for the PRS are likely with the discovery of additional SNPs.
Background and AimsThe relationship between postoperative atrial fibrillation (POAF) and 25-hydroxyvitamin D [25(OH)D] concentration as well as vitamin D supplementation has been discussed controversially. The relation of pre-operative vitamin D status and POAF remains unclear.Methods and ResultsWe analysed the risk of POAF in a prospective, observational cohort study of n = 201 patients undergoing coronary artery bypass graft surgery (CABG) with 25(OH)D concentration. The median age was 66.6 years, 15.4% were women. The median (25th/75th percentile) vitamin D concentration at baseline was 17.7 (12.6/23.7) ng/ml. During follow-up we observed 48 cases of POAF. In age, sex, and creatinine-adjusted analyses, 25(OH)D was associated with an increased risk of POAF, though with borderline statistical significance [odds ratio (OR) 1.85, 95% confidence interval (CI) 0.87–3.92, p-value 0.107], in further risk factor-adjusted analyses the results remained stable (OR 1.99, 95% CI 0.90–4.39, p-value 0.087). The subgroup with vitamin D supplementation at baseline showed an increased risk of POAF (OR 5.03, 95% CI 1.13–22.33, p-value 0.034).ConclusionIn our contemporary mid-European cohort, higher 25(OH)D concentration did not show a benefit for POAF in CABG patients and may even be harmful, though with borderline statistical significance. Our data are in line with a recent randomised study in community-based adults and call for further research to determine both, the clinical impact of elevated 25(OH)D concentration and vitamin D supplementation as well as the possible underlying pathophysiological mechanisms.
Tobacco smoking and alcohol consumption are widespread exposures that are legal and socially accepted in many societies. Both have been widely recognized as important risk factors for diseases in all vital organ systems including cardiovascular diseases, and with clinical manifestations that are associated with atrial dysfunction, so-called atrial cardiomyopathy, especially atrial fibrillation and stroke. The pathogenesis of atrial cardiomyopathy, atrial fibrillation, and stroke in context with smoking and alcohol consumption is complex and multifactorial, involving pathophysiological mechanisms, environmental, and societal aspects. This narrative review summarizes the current literature regarding alterations in the atrial myocardium that is associated with smoking and alcohol.
ZUSAMMENFASSUNGVorhofflimmern (VHF) ist mit dem Auftreten von ischämischen Schlaganfällen assoziiert. Orale Antikoagulation kann das Auftreten von Schlaganfällen verhindern. Das Screening auf ein bislang nicht entdecktes VHF erscheint daher ein vielversprechender Ansatz, um das Auftreten von Schlaganfällen zu verhindern. Neben zahlreichen anderen wissenschaftlichen Studien liegen seit August 2021 die Ergebnisse von 2 Studien mit klinischen Endpunkten vor, die STROKESTOP- und die LOOP-Studie. Weitere wissenschaftliche Untersuchungen zu dieser Fragestellung befinden sich in der Durchführung.
Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): H2020-SC1-BHC-30-2019- 847770 Background Disease awareness is key for the uptake of preventive measures and positively affects self-management of atrial fibrillation patients (AF pat) or those at increased risk of AF. Less evidence exists about pat subjective risk awareness. We aims to identify the predictors of incorrect subjective risk estimation to guide future information of AF pat and stakeholders. Method In a prospective cardiology practice cohort (N=1200; age= 59.6 years; 34.4% women) with a median FU of 2.7 years we assessed the subjective estimation of: 1) the risk of stroke and AF in pat with an increased risk of AF (N=292) and 2) the stroke risk of AF pat (N=447). We used a 4-point Likert scale to measure the subjective risk estimation and matched the results with established risk scores and classified pat as "over", "under" and "correct" estimators. For non-AF cases we calculated the risk of incident AF using the CHARGE-AF- and the risk of stroke using a revised Framingham risk score to predict the 10-year probability of stroke. In AF pat we assessed their self-estimated risk of stroke compared to the CHA2DS2-VASc Score. We performed univariable association analyses of risk factors for over- or underestimation for stroke and AF with reference to correct estimators at baseline and FU and performed non-parametric tests for trend. Results At baseline N=52 AF pat, 10.6% and N=53 non-AF pat, 17.6% indicated that they are not able to estimate their stroke risk. This also applied for N=97 non-AF pat, 27.8% who were unable to estimate their AF risk. AF pat who underestimated their stroke risk were: significantly older (65.2 vs 59.8 years; p <.001), less frequently men (33.3% vs 44.4 %; p=0.023), had lower body weight (85.3 kg vs 82.5 kg p=0.023), fewer previous strokes (15.1% vs 8.3% p= 0.002) and had a higher chronic disease burden such as diabetes, hypertension, heart failure and coronary heart disease compared to AF pat with correct estimation. Non-AF cases at baseline estimated their AF risk (score value (vs): 1.0 vs 1.5; r= 0.216; p < 0.001) and the stroke risk (sv: 1.3 vs 1.9; r=0.263; p >.001) significantly higher than their current risk to develop the disease. AF risk estimation (sv: 1.2 vs 1.3; r=.216; p =098) and the stroke risk estimation (sv: 1.5 vs 1.4; r=0.035; p=0,458) were comparable to the score assessments in the FU for non-AF cases. AF pat estimated their stroke risk significantly higher than their current risk (sv: 1.0 vs 1.3; r= 0.125; p<.001). The same was observed during FU (score value 1.0 vs 1.3; r= 0.105; p<.001). Conclusions More than 10% of pat were unable to give an estimate of their risk due to lack of disease and risk factor knowledge. The minority correctly estimated their risk to develop AF and/or a stroke. Half of the pat overestimated their risk profile. The study identifies predictors related to the awareness and knowledge of the diseases and highlight the need for more explicit educational programs to improve AF awareness.
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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