Subclinical Atherosclerosis and Risk of Atrial Fibrillation

Abstract

Background: Myocardial infarction is an important risk factor for atrial fibrillation, but the role of subclinical atherosclerosis is unknown. This longitudinal study evaluates whether atherosclerosis affects the risk of atrial fibrillation in persons without overt coronary disease. Methods: This investigation was part of the Rotterdam Study, a population-based cohort study among persons 55 years or older. Participants with atrial fibrillation at baseline, with a history of myocardial infarction, or with angina pectoris and those who had undergone cardiac operative procedures were excluded, leaving 4407 subjects for the analyses. Baseline intima-media thickness of the common carotid artery and the presence of carotid plaques were used as indices of generalized atherosclerosis. During a median follow-up of 7.5 years, 269 cases of incident atrial fibrillation were identified. Relative risks were calculated with 95% confidence intervals, adjusted for age and sex, using the Cox proportional hazards model. Additional adjustments were made for body mass index, hypertension, systolic blood pressure, serum cholesterol level, smoking, diabetes mellitus, left ventricular hypertrophy on the electrocardiogram, and the use of cardiac medication. Results: The risk of atrial fibrillation was associated with carotid intima-media thickness (relative risk, 1.90; 95% confidence interval, 1.20-3.00, highest vs lowest quartile) and severity of carotid plaques (relative risk, 1.49; 95% confidence interval, 1.06-2.10, severe vs absence). Risk estimates were stronger in women than in men. Conclusions: Atherosclerosis in participants without manifest atherosclerotic disease is an independent risk factor for atrial fibrillation. These results suggest that aggressive treatment of asymptomatic atherosclerosis may help to prevent atrial fibrillation.

Association Between Peripheral Artery Disease and Incident Risk of Atrial Fibrillation: Strong Evidence Coming From Population‐Based Cohort Studies

“…Indeed, data indicate the increased inflammatory burden in patients with AF, connecting the presence of atherosclerosis and incident AF 12. These postulates are also corroborated by other studies underlining a strict relationship between another sign of systemic atherosclerosis, the intima‐media thickness, and AF 13, 14. From this perspective, we should probably start considering the onset of AF as the last stage of a multiple‐stage process, spanning throughout the entire lifetime, beginning with the presence of multiple risk factors and progressing throughout the development of systemic atherosclerosis and diagnosis of PAD (Figure 2).…”

Carotid Artery Wall Thickness and Leukoaraiosis: Preliminary Results Using Multidetector Row CT Angiography

“…17 IMT is correlated with systemic atherosclerosis and predicts the risk of recurrent strokes. [18][19][20] Recently published articles 21,22 suggested that MDCTA can evaluate the thickness of the carotid artery wall, referred to by Saba et al 21 as CAWT, and presented results indicating significant agreement between MDCTA and CD-US in the measurement of CAWT and IMT. 22 The purpose of this work was to investigate whether CAWT studied by using MDCTA is correlated with LA and its severity.…”

Use of Carotid Intima-Media Thickness to Identify Patients With Ischemic Stroke and Transient Ischemic Attack With Low Yield of Cardiovascular Sources of Embolus on Transesophageal Echocardiography

“…[1][2][3][4][5][6][7] Among patients with ischemic stroke, a low CIMT has been reported to have a high negative predictive value for the detection of complex aortic plaques, which are among the most prevalent CSE identified on TEE. 8 -13 Other evidence suggests that modern transthoracic echocardiography with bubble study is highly sensitive for the detection of intra-atrial communications, another commonly identified potential CSE after stroke.…”