Metabolic syndrome and atrial fibrillation in patients with essential hypertension

Vyssoulis, G.; Karpanou, Eva A.; Adamopoulos, Dionysios; Kyvelou, Stella-Maria; Tzamou, Vanessa; Michaelidis, Andreas; Stefanadis, Christodoulos

doi:10.1016/j.numecd.2011.03.011

Cited by 23 publications

(20 citation statements)

References 26 publications

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“…Prior studies have been inconsistent on the association of HDL-cholesterol with AF. While some found an inverse association, 5, 14, 15, 29-32 others found no association. 6, 33, 34 These mixed results for HDL-cholesterol may be related in part to the choice of covariables included in models.…”

Section: Discussionmentioning

confidence: 96%

Paradoxical Association of Lipoprotein Measures With Incident Atrial Fibrillation

Mora

Akinkuolie

Sandhu

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background Low-density-lipoprotein (LDL) cholesterol is a strong risk factor for atherosclerosis but has an inverse association with AF. We aimed to provide insight into the paradoxical association of LDL-cholesterol with atrial fibrillation (AF) by evaluating the relationship of various lipoprotein measures and incident AF. Methods and Results We prospectively evaluated lipoprotein measures among 23,738 healthy middle-aged and older women (median follow-up 16.4 years; N=795 incident AF events). Baseline LDL-cholesterol was directly measured, lipoprotein particle concentrations and size were measured by nuclear magnetic resonance spectroscopy, and apolipoproteins by immunoassay. Cox regression models were adjusted for age, AF risk factors, inflammatory, and dysglycemic biomarkers. After multivariable adjustment, inverse associations with AF were observed (hazard ratio, 95% confidence interval for top versus bottom quintile, p value) for LDL-cholesterol (0.72, 0.56-0.92, p=0.009), the total number of LDL particles (0.77, 0.60-0.99, p=0.045) and VLDL particles (0.78, 0.61-0.99, p=0.04), which was driven by the number of cholesterol-poor small LDL (0.78, 0.61-1.00, p=0.05) and small VLDL particles (0.78, 0.62-0.99, p=0.04). By contrast, the larger cholesterol-rich LDL particles and all HDL measures were not associated with AF in multivariable models. Adjustment for inflammatory and dysglycemic biomarkers had minimal impact on these associations. Conclusions In this prospective study, the inverse association between LDL-cholesterol and AF extended to several other atherogenic lipoproteins, and these associations are unlikely to be mediated by direct cholesterol effects. Clinical Trial Registration clinicaltrials.gov; Unique Identifier: NCT00000479

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Section: Discussionmentioning

confidence: 96%

Paradoxical Association of Lipoprotein Measures With Incident Atrial Fibrillation

Mora

Akinkuolie

Sandhu

et al. 2014

Circ: Arrhythmia and Electrophysiology

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“…Several studies have described a positive association of uncontrolled BP and AF. 8,14,27,29 For example, Grundvold et al described higher AF risk among men with baseline uncontrolled SBP (≥ 140 mmHg) or DBP (≥ 80 mmHg) compared to those with controlled BP. 14 Vyssoulis G et al reported increased prevalence of AF with increasing SBP in persons with essential HTN.…”

Section: Discussionmentioning

confidence: 99%

“…14 Vyssoulis G et al reported increased prevalence of AF with increasing SBP in persons with essential HTN. 29 But, none of the aforementioned studies have stratified hypertensive persons based on antihypertensive treatment resistance and have not taken antihypertensive medication classes into account. In the current study, we stratified persons with HTN into distinct categories based on BP level and treatment resistance.…”

Section: Discussionmentioning

confidence: 99%

Is there an association between the prevalence of atrial fibrillation and severity and control of hypertension? The REasons for Geographic And Racial Differences in Stroke study

Bhatt

Gamboa

Safford

et al. 2016

Journal of the American Society of Hypertension

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Background The association of atrial fibrillation (AF) with the severity and control of hypertension (HTN) remains unclear. Methods We analyzed data from the national biracial cohort of REasons for Geographic And Racial Differences in Stroke (REGARDS) study. The AF prevalence ratios were estimated and full multi-variable adjustment included demographics, risk factors, medication adherence, HTN duration and antihypertensive medication classes. Results Of the 30,018 study participants (8.6% with AF), 4,386 had normotension (4.3% with AF), 5,916 had prehypertension (4.3 with AF%), 12,294 had controlled HTN (11.2% with AF), 5,587 had uncontrolled HTN (8.1% with AF), 547 had controlled apparent treatment resistant hypertension (aTRH) (19.2% with AF), and 1288 had uncontrolled aTRH (15.5% with AF). Compared with normotension, the AF prevalence ratios for prehypertension, controlled HTN, uncontrolled HTN, controlled aTRH and uncontrolled aTRH groups in fully adjusted model were 1.01 (95% CI 0.84 – 1.21), 1.42 (1.18 – 1.71), 1.37 (1.14 – 1.65), 1.17 (0.86 – 1.58) and 1.42 (1.10 – 1.84) respectively (p < 0.001). Conclusion The prevalence of AF was similar among persons with HTN regardless of BP level and antihypertensive treatment resistance.

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“…In a population of non‐diabetic patients with essential hypertension, Vyssoulis identified that MS was directly and independently related to the prevalence of AF. Even more important was the fact that the increasing number of MS components were associated with a gradual increment in the risk of AF, with various components having different hazard ratios . In the ARIC study, increased blood pressure was associated with the highest relative risk (HR, 1.95), whereas elevated fasting glucose levels were associated with the lowest risk (HR, 1.16) Ancillary factors associated with the MS, hyperuricaemia, albuminuria and non‐alcoholic steatohepatitis, have also been linked to a higher risk of AF …”

Section: Incidence and Frequency Of Atrial Fibrillation In The Type 2mentioning

confidence: 99%

“…Even more important was the fact that the increasing number of MS components were associated with a gradual increment in the risk of AF, with various components having different hazard ratios. 25 In the ARIC study, increased blood pressure was associated with the highest relative risk (HR, 1.95), whereas elevated fasting glucose levels were associated with the lowest risk (HR, 1.16) 26 Ancillary factors associated with the MS, hyperuricaemia, albuminuria and non-alcoholic steatohepatitis, have also been linked to a higher risk of AF. [27][28][29] An additional very relevant feature of the MS is increased sympathetic activity, with episodes of AF being preceded by autonomic fluctuations.…”

Section: Incidence and Frequency Of Atrial Fibrillation In The Typementioning

confidence: 99%

Atrial fibrillation and type 2 diabetes: Prevalence, etiology, pathophysiology and effect of anti‐diabetic therapies

Bell

Goncalves

2018

Diabetes Obesity Metabolism

102

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New-onset atrial fibrillation (NAF) is increased in the type 2 diabetic patient because of the presence of the metaboli syndrome and increased sympathetic activity. This results in inflammation, endothelial dysfunction and myocardial steatosis which, in turn, lead to atrial fibrosis and dilatation. The end result is the development of structural and electrical atrial remodeling. Drugs that lower insulin resistance, particularly pioglitazone, decrease the incidence of NAF while drugs that, through hypoglycaemia, stimulate the sympathetic nervous system, insulin and secretagogues, increase the incidence of NAF. Currently there is no evidence that GLP-1 agonists, SGLT2 inhibitors and DPP-4 inhibitors either accelerate or decelerate the development of NAF.

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Metabolic syndrome and atrial fibrillation in patients with essential hypertension

Cited by 23 publications

References 26 publications

Paradoxical Association of Lipoprotein Measures With Incident Atrial Fibrillation

Paradoxical Association of Lipoprotein Measures With Incident Atrial Fibrillation

Is there an association between the prevalence of atrial fibrillation and severity and control of hypertension? The REasons for Geographic And Racial Differences in Stroke study

Atrial fibrillation and type 2 diabetes: Prevalence, etiology, pathophysiology and effect of anti‐diabetic therapies

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