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Clinical Articles, News & Views

Coronary artery calcium progression and atrial fibrillation

Coronary artery calcium (CAC) progression is associated with a ‘dose-response’ increase in risk for development of atrial fibrillation (AF) according to findings recently reported by lead author Dr Wesley O’Neal (Wake Forest School of Medicine, Winston-Salem, North Carolina, USA) from the Multi-Ethnic Study of Atherosclerosis (MESA) study.1

MESA had earlier reported that CAC measured at a single time point is associated with an increased risk for AF. It was however unknown whether CAC progression over time carries a similar risk.

This latest analysis included 5,612 participants, mean age: 62 (52% of whom were women), from the Multi-Ethnic Study of Atherosclerosis (MESA) study. Phantom-adjusted Agatston (calcium) scores for baseline and follow-up measurements were used to compute change in CAC per year (≤0, 1–100, 101–300, and >300 U/year). AF was ascertained by review of hospital discharge records. Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association between CAC progression and AF.

Over a median follow-up of 5.6 years a total of 203 (3.6%) incident AF cases were detected. Any CAC progression (>0/year) was associated with an increased risk for AF and the risk increased with higher levels of CAC progression. An interaction was observed by age with the association of CAC progression with AF being stronger for younger (<61 years), compared with older (≥61 years) participants.

The study does not provide insights into the underlying mechanisms of the link between CAC and AF. While these remain poorly understood, one hypothesis is that AF is promoted by vascular-disease related left atrial enlargement.

Reference

1. O’Neal WT, Efird JT, Qureshi WT, et al. Coronary artery calcium progression and atrial fibrillation: the Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Imaging 2015;8:e003786. http://dx.doi.org/10.1161/CIRCIMAGING.115.003786

Published on: January 14, 2016

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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