Dataset Information

Paradoxical association of lipoprotein measures with incident atrial fibrillation.

ABSTRACT: Low-density lipoprotein (LDL) cholesterol is a strong risk factor for atherosclerosis but has an inverse association with atrial fibrillation (AF). We aimed to provide insight into the paradoxical association of LDL cholesterol with AF by evaluating the relationship of various lipoprotein measures and incident AF.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 were measured 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 very-low-density lipoprotein 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 very-low-density lipoprotein particles (0.78, 0.62-0.99, P=0.04). By contrast, the larger cholesterol-rich LDL particles and all high-density lipoprotein measures were not associated with AF in multivariable models. Adjustment for inflammatory and dysglycemic biomarkers had minimal impact on these associations.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.ClinicalTrials.gov; Unique Identifier: NCT00000479.

SUBMITTER: Mora S

PROVIDER: S-EPMC4591535 | biostudies-literature | 2014 Aug

REPOSITORIES: biostudies-literature

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Paradoxical association of lipoprotein measures with incident atrial fibrillation.

Mora Samia S Akinkuolie Akintunde O AO Sandhu Roopinder K RK Conen David D Albert Christine M CM

Circulation. Arrhythmia and electrophysiology 20140525 4

<h4>Background</h4>Low-density lipoprotein (LDL) cholesterol is a strong risk factor for atherosclerosis but has an inverse association with atrial fibrillation (AF). We aimed to provide insight into the paradoxical association of LDL cholesterol with AF by evaluating the relationship of various lipoprotein measures and incident AF.<h4>Methods and results</h4>We prospectively evaluated lipoprotein measures among 23 738 healthy middle-aged and older women (median follow-up 16.4 years; N=795 incid ...[more]

PMID: 24860180

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Project description:ImportanceAtrial myopathy-characterized by alterations in left atrial (LA) function and size-is associated with ischemic stroke, independent of atrial fibrillation (AF). Electrocardiographic markers of atrial myopathy are associated with dementia, but it is unclear whether 2-dimensional echocardiographic (2DE)-defined LA function and size are associated with dementia.ObjectiveTo examine the association of LA function and size with incident dementia.Design, setting, and participantsThe Atherosclerosis Risk in Communities (ARIC) study is a community-based prospective cohort. An exploratory, retrospective analysis was conducted. ARIC centers are located in Forsyth County, North Carolina; Jackson, Mississippi; Washington County, Maryland; and suburban Minneapolis, Minnesota. For this analysis, visit 5 (2011-2013) served as the baseline. Participants without prevalent AF and stroke and who had 2DEs in 2011-2013 were included and surveilled through December 31, 2019.ExposuresLA function (reservoir strain, conduit strain, contractile strain, emptying fraction, passive emptying fraction, and active emptying fraction), and LA size (maximal and minimal volume index) as evaluated by 2DE.Main outcomes and measuresDementia cases were identified using in-person and phone cognitive assessments, hospitalization codes, and death certificates. Cox proportional hazards models were used.ResultsAmong 4096 participants (mean [SD] age, 75 [5] years; 60% women; 22% Black individuals), 531 dementia cases were ascertained over a median follow-up of 6 years. Dementia incidence for the lowest LA quintile was 4.80 for reservoir strain, 3.94 for conduit strain, 3.29 for contractile strain, 4.20 for emptying fraction, 3.67 for passive emptying fraction, and 3.27 for active emptying fraction per 100 person-years. After full-model adjustments, there were statistically significant associations between measures of LA function and dementia; the hazard ratios (HRs) from the lowest vs highest quintile for reservoir strain were 1.98 (95% CI, 1.42-2.75); for conduit strain, 1.50 (95% CI, 1.09-2.06); for contractile strain, 1.57 (95% CI, 1.16-2.14); for emptying fraction, 1.87 (95% CI, 1.31-2.65); and for active emptying fraction, 1.43 (95% CI, 1.04-1.96). LA passive emptying fraction was not significantly associated with dementia (HR, 1.26 [95% CI, 0.93-1.71]). Dementia incidence for the highest LA maximal volume index quintile was 3.18 per 100 person-years (HR for highest vs lowest quintile, 0.77 [95% CI, 0.58-1.02]) and for the highest minimal volume index quintile was 3.50 per 100 person-years (HR for the highest vs lowest quintile, 0.95 [95% CI, 0.71-1.28]). Both measures were not significantly associated with dementia. These findings were robust to sensitivity analyses that excluded participants with incident AF or stroke.Conclusions and relevanceIn this exploratory analysis of a US community-based cohort, several echocardiographic measures of lower LA function were significantly associated with an increased risk of subsequent dementia. Measures of LA size were not significantly associated with dementia risk. These findings suggest that impaired LA function may be a risk factor associated with dementia.

Dataset Information

Paradoxical association of lipoprotein measures with incident atrial fibrillation.

Publications

Paradoxical association of lipoprotein measures with incident atrial fibrillation.

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