Atrial Fibrillation and CHADS2 Risk Factors are Associated with Highly Sensitive C‐Reactive Protein Incrementally and Independently

Crandall, Mark A.; Horne, Michael; Day, John D.; Anderson, Jeffrey L.; Muhlestein, Joseph B; Crandall, Brian G.; Weiss, J. Peter; Lappé, Donald; Bunch, T. Jared

doi:10.1111/j.1540-8159.2009.02339.x

Cited by 37 publications

(23 citation statements)

References 46 publications

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“…This observation is particularly important as it highlights the need for further studies to elucidate new mechanisms for this association. Other potential but unproven mechanisms include: brain hypoperfusion due to beat-to-beat variability in the length of the cardiac cycle and reduced cardiac output (48); the pro-inflammatory state in AF (49, 50); and periventricular white matter lesions (51). …”

Section: Discussionmentioning

confidence: 99%

Cognitive Impairment Associated With Atrial Fibrillation

Kalantarian

Stern²,

Mansour³

et al. 2013

Ann Intern Med

356

243

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Background Atrial fibrillation (AF) has been linked with an increased risk of cognitive impairment and dementia. Purpose To complete a meta-analysis of studies examining the association between AF and cognitive impairment. Data Sources Electronic search of 5 large databases and hand search of article references. Study Selection Prospective and non-prospective studies reporting adjusted risk estimates for the relationship between AF and cognitive impairment. Data Extraction Two abstracters independently extracted data on study characteristics, risk estimates, methods of AF and outcome ascertainment, and methodological quality. Data Synthesis Twenty one studies were included in the meta-analysis. AF was significantly associated with a higher risk of cognitive impairment independent of stroke history (relative risk (RR) [95% confidence interval (CI)] =1.34 [1.13, 1.58]), in patients with first-ever or recurrent stroke (RR [95%] =2.7 [1.82, 4.00]) and in a broader population including patients with or without a history of stroke (RR [95% CI] =1.4 [1.19, 1.64]). However, there was significant heterogeneity among studies of the broader population (I2 =69.4 %). Limiting the analysis to prospective studies yielded similar results (RR [95% CI] =1.36 [1.12, 1.65]). Restricting the analysis to studies of dementia eliminated the significant heterogeneity (P value =0.137) but did not alter the pooled estimate substantially (RR [95% CI] = 1.38 [1.22, 1.56]). Limitations There is an inherent bias due to confounding variables in observational studies. There was significant heterogeneity among included studies. Conclusions Evidence suggests that AF is associated with a higher risk of cognitive impairment and dementia, with or without a history of clinical stroke. Further studies are required to elucidate the relationship between AF and subtypes of dementia as well as the etiology of cognitive impairment.

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Section: Discussionmentioning

confidence: 99%

Cognitive Impairment Associated With Atrial Fibrillation

Kalantarian

Stern²,

Mansour³

et al. 2013

Ann Intern Med

356

243

View full text Add to dashboard Cite

show abstract

“…This close relationship may be in part due to similar clinical risk factors for both conditions, such as age, hypertension, diabetes, smoking and systemic inflammation [9,23]. An increased systemic inflammatory status, a phenomenon proposed to be present in AF [24], has also been suggested to be associated with accelerated cognitive decline and increased risk for dementia [25,26]. In addition to inflammation, several studies showed that atherosclerosis was also involved in the pathogenesis of dementia by promoting both vascular and plaque/tangle pathologies [27,28].…”

Section: Pathogenesis Of Dementia In Atrial Fibrillationmentioning

confidence: 94%

Risk and prediction of dementia in patients with atrial fibrillation — A nationwide population-based cohort study

Liao

Chao

Liu

et al. 2015

International Journal of Cardiology

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“…hs-CRP and DROM, correlated better with CHADS-2 score than either one alone. Though the correlation of CHADS-2 score with plasma hs-CRP has previously been shown (15), this is the first study to show the correlation of this score with DROMs and the combination of the two biomarkers. The findings serve as indirect evidence in support of the causal association of inflammation and oxidative stress in the chronicity and thrombogenecity seen with AF.…”

Section: Discussionmentioning

confidence: 65%

A circulating biomarker risk-prediction model correlates with CHADS-2 risk score in chronic atrial fibrillation

Negi

Greener

Anand

et al. 2015

IJC Metabolic & Endocrine

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Background Inflammation and oxidative stress have been linked to the origin and persistence of atrial fibrillation (AF). CHADS-2 scoring system is a risk stratification schema well validated in prognostication of stroke in AF. We evaluated the association of markers of oxidative stress and inflammation with CHADS-2 scores in chronic AF patients. Methods CHADS-2 scores were calculated for 64 subjects with chronic AF. Serum markers of inflammation [C-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin 1β (IL-1β), tumor necrosis factor-α (TNF-α)] and of oxidative stress [Derivatives of reactive oxygen metabolites (DROMs) and isoprostanes (IsoPs)] were measured. Results Twenty subjects were categorized as 0 (no risk), 24 as 1 (intermediate risk) and 20 as 2 (severe risk) based on their CHADS-2 scores. High sensitivity-CRP (CHADS-2 0=40.0%, 1=70.0%, 2=90.0%; p=0.003) and DROMs (CHADS-2 0=45%, 1=78%, 2=80%; p=0.04) were positively associated with the CHADS-2 risk score. Subjects with intermediate to severe CHADS-2 risk retained significant associations with abnormal hs-CRP (OR: 5.3, 95%CI: 1.1–25.0) and DROMs (adjusted OR: 6.7, 95%CI: 1.2–38.8) after adjusting for gender and hypertension. In a multiple logistic interaction model, there was no significant interaction between hs-CRP and DROMs in their association with CHADS-2 risk categories (p=0.64). A biomarker risk-model, combining hs-CRP and DROMs, correlated well with the CHADS-2 risk categories (r= 0.49, p<0.001). Conclusions A biomarker risk-model using a combination of hs-CRP and DROMs correlates well with CHADS-2 risk scores in chronic AF. Either or both of these markers may add predictive power to future stroke risk prediction models.

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Atrial Fibrillation and CHADS2 Risk Factors are Associated with Highly Sensitive C‐Reactive Protein Incrementally and Independently

Abstract: Risks factors associated with AF were associated with higher hs-CRP in an incremental manner. The presence of AF increased hs-CRP across the CHADS2 score strata is supportive of the concept that AF is an inflammatory process and may convey independent risk.

Cited by 37 publications

References 46 publications

Cognitive Impairment Associated With Atrial Fibrillation

Cognitive Impairment Associated With Atrial Fibrillation

Risk and prediction of dementia in patients with atrial fibrillation — A nationwide population-based cohort study

A circulating biomarker risk-prediction model correlates with CHADS-2 risk score in chronic atrial fibrillation

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