Validation of the Framingham Heart Study and CHARGE-AF Risk Scores for Atrial Fibrillation in Hispanics, African-Americans, and Non-Hispanic Whites

Shulman, Eric; Kargoli, Faraj; Aagaard, Per; Hoch, Ethan; Biase, Luigi Di; Fisher, John D.; Gross, Jay N.; Kim, Soo G.; Krumerman, Andrew; Ferrick, Kevin J.

doi:10.1016/j.amjcard.2015.10.009

Cited by 48 publications

(32 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…5,6 We found that trajectories of systolic BP and antihypertensive treatment were associated with 15-year risk of incident AF. We identified five different trajectories for systolic BP that demonstrated the long-term patterns of systolic BP in FHS.…”

Section: Discussionmentioning

confidence: 79%

See 1 more Smart Citation

Trajectories of Risk Factors and Risk of New-Onset Atrial Fibrillation in the Framingham Heart Study

et al. 2016

View full text Add to dashboard Cite

The associations of long-term patterns of risk factors and the risk of incident atrial fibrillation are incompletely characterized. Among 4351 Framingham Study participants (mean age 50±11 years at baseline examination, 57% women) from the Original and Offspring cohorts we defined longitudinal patterns, referred to as trajectories, of atrial fibrillation risk factors and a composite atrial fibrillation risk score using approximately 16-years of data. We used Cox proportional hazards models to examine the association of trajectories to 15-year risk of atrial fibrillation. During follow-up, 719 participants developed atrial fibrillation. Five distinct trajectory groups were identified for systolic blood pressure: groups 1 and 2 (normotensive throughout), group 3 (prehypertensive), group 4 (hypertensive initially with decreasing blood pressure), and group 5 (hypertensive and increasing blood pressure). In multivariable-adjusted analyses, compared to group 1, groups 4 (hazard ratio, 2.05; 95% confidence interval, 1.24 to 3.37) and 5 (hazard ratio, 1.95; 95% confidence interval, 1.08 to 3.49) were associated with incident atrial fibrillation. Three trajectory groups were identified for antihypertensive treatment. Compared with the group with no treatment throughout, the other two groups were associated with increased risk of incident atrial fibrillation. Distinct trajectories for diastolic blood pressure, smoking, diabetes, and the composite risk score were not associated with increased 15-year risk of atrial fibrillation. Longitudinal trajectories may distinguish how exposures related to atrial fibrillation contribute towards prospective atrial fibrillation risk. Distinct trajectory groups with persistently elevated systolic blood pressure and longer antihypertensive treatment are associated with increased risk of incident atrial fibrillation.

show abstract

Section: Discussionmentioning

confidence: 79%

“…The CHARGE-AF risk score has been validated in two independent studies. 5,6 We hypothesized that risk factors and CHARGE-AF risk score trajectories are associated with increased 15-year risk of incident AF.…”

Section: Introductionmentioning

confidence: 99%

Trajectories of Risk Factors and Risk of New-Onset Atrial Fibrillation in the Framingham Heart Study

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Moreover, it was recently replicated in a European community-based study, including more than 24,000 individuals, although it required recalibration, 12 and in an ethnically diverse inner-city population of more than 45,000 individuals. 11 Thus far, the CHARGE-AF risk score has been tested on more than 95,000 individuals across different ancestries, providing increased generalizability compared with other risk scores for AF prediction.…”

Section: Discussionmentioning

confidence: 99%

“…10 The CHARGE-AF risk score provided increased discrimination compared to the FHS AF risk score and the generalizability was wider, due to the inclusion of more diverse cohorts. Recently, the CHARGE-AF risk score was validated in >45,000 Hispanics, African-Americans, and non-Hispanic whites in an inner-city North-American population, 11 and in a recalibrated version in the European population-based EPIC Norfolk study, with more than 24,000 individuals. 12 …”

mentioning

confidence: 99%

A comparison of the CHARGE–AF and the CHA2DS2-VASc risk scores for prediction of atrial fibrillation in the Framingham Heart Study

Christophersen

Yin

Larson

et al. 2016

American Heart Journal

View full text Add to dashboard Cite

Background Atrial fibrillation (AF) affects more than 33 million individuals worldwide and increases risks of stroke, heart failure, and death. The CHARGE-AF risk score was developed to predict incident AF in three American cohorts and it was validated in two European cohorts. The CHA2DS2-VASc risk score was derived to predict risk of stroke, peripheral embolism, and pulmonary embolism in individuals with AF, but it has been increasingly used for AF risk prediction. We compared CHARGE-AF risk score versus CHA2DS2-VASc risk score for incident AF risk in a community-based cohort. Methods and Results We studied Framingham Heart Study participants aged 46 to 94 years without prevalent AF and with complete covariates. We predicted AF risk using Fine-Gray proportional sub-distribution hazards regression. We used the Wald χ2 statistic for model fit, C-statistic for discrimination, and Hosmer-Lemeshow (HL) χ2 statistic for calibration. We included 9722 observations (mean age 63.9 ± 10.6 years, 56% women) from 4548 unique individuals: 752 (16.5%) developed incident AF and 793 (17.4%) died. The mean CHARGE-AF score was 12.0 ± 1.2 and the sub-distribution hazard ratio (sHR) for AF per unit increment was 2.15 (95% CI, 99–131%; P < .0001). The mean CHA2DS2-VASc score was 2.0 ± 1.5 and the sHR for AF per unit increment was 1.43 (95% CI, 37%-51%; P < .0001). The CHARGE-AF model had better fit than CHA2DS2-VASc (Wald χ2 = 403 vs 209, both with 1 df), improved discrimination (C-statistic = 0.75, 95% CI, 0.73–0.76 vs C-statistic = 0.71, 95% CI, 0.69–0.73), and better calibration (HL χ2 = 5.6, P = .69 vs HL χ2 = 28.5, P < .0001). Conclusion The CHARGE-AF risk score performed better than the CHA2DS2-VASc risk score at predicting AF in a community-based cohort.

show abstract

“…SAS macro %RCT_Reg was used for fitting the model. 29 Multivariable models were adjusted for AF risk factors that have been reported consistently in association with incident AF: 4;5;30;31 age, sex, height, weight, systolic blood pressure, diastolic blood pressure, current smoking, diabetes, hypertension treatment, myocardial infarction, and heart failure. Since natriuretic peptides and CRP have consistently been related to AF, additional models included BNP and CRP.…”

Section: Methodsmentioning

confidence: 99%

Asymmetric dimethylarginine, related arginine derivatives, and incident atrial fibrillation

Schnabel

Maas

Wang

et al. 2016

American Heart Journal

View full text Add to dashboard Cite

Background Oxidative stress plays an important role in the development of atrial fibrillation (AF). Arginine derivatives including asymmetric dimethylarginine (ADMA) are central to nitric oxide metabolism and nitrosative stress. Whether blood concentrations of arginine derivatives are related to incidence of AF is uncertain. Methods and Results In 3310 individuals (mean age 58±10 years, 54% women) from the community-based Framingham Study we prospectively examined the relations of circulating levels of ADMA, L-arginine, symmetric dimethylarginine (SDMA), and the ratio of L-arginine/ADMA to incidence of AF using proportional hazards regression models. Over a median follow-up time of 10 years 247 AF cases occurred. Using age- and sex-adjusted regression models, ADMA was associated with a hazard ratio of 1.15 per one standard deviation increase in loge-biomarker concentration (95% confidence interval 1.02 to 1.29, P=0.02) for AF, which was no longer significant after further risk factor adjustment (hazard ratio 1.09, 95% confidence interval 0.97 to 1.23, P=0.15). Neither L-arginine nor symmetric dimethylarginine was related to new-onset AF. A clinical model comprising clinical risk factors for AF (for age, sex, height, weight, systolic blood pressure, diastolic blood pressure, current smoking, diabetes, hypertension treatment, myocardial infarction, and heart failure) (C-statistic: 0.781; 95% confidence interval, 0.753 to 0.808) was not improved by the addition of ADMA (0.782; 95% confidence interval, 0.755 to 0.809). Conclusions ADMA and related arginine derivatives were not associated with incident AF in the community after accounting for other clinical risk factors and confounders. Its role in the pathogenesis of AF needs further refinement.

show abstract

Validation of the Framingham Heart Study and CHARGE-AF Risk Scores for Atrial Fibrillation in Hispanics, African-Americans, and Non-Hispanic Whites

Cited by 48 publications

References 25 publications

Trajectories of Risk Factors and Risk of New-Onset Atrial Fibrillation in the Framingham Heart Study

Trajectories of Risk Factors and Risk of New-Onset Atrial Fibrillation in the Framingham Heart Study

A comparison of the CHARGE–AF and the CHA2DS2-VASc risk scores for prediction of atrial fibrillation in the Framingham Heart Study

Asymmetric dimethylarginine, related arginine derivatives, and incident atrial fibrillation

Contact Info

Product

Resources

About