Atrial fibrillation and venous thromboembolism: evidence of bidirectionality in the Atherosclerosis Risk in Communities Study

• Type of Material: Article
• Authors: Pamela L. Lutsey, University of Minnesota; F.L. Norby, University of Minnesota; Alvaro Alonso, Emory University; Mary Cushman, University of Vermont; L.Y. Chen, University of Minnesota; E.D. Michos, Johns Hopkins University; A.R. Folsom, University of Minnesota
• Language: English
• Date: 2018-04-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 International Society on Thrombosis and Haemostasis Essentials
• Final Published Version (URL): http://dx.doi.org/10.1111/jth.13974
• Title of Journal or Parent Work: Journal of Thrombosis and Haemostasis
• ISSN: 1538-7933
• Volume: 16
• Issue: 4
• Start Page: 670
• End Page: 679
• Grant/Funding Information: The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C).; This work was also supported by the National Heart Lung and Blood Institute grants R01HL59367 (A. R. Folsom), R01HL126637 (L. Y. Chen), and American Heart Association grant 16EIA26410001 (A. Alonso).
• Keywords: HEART-DISEASE; Science & Technology; MANAGEMENT; epidemiology; CARDIOVASCULAR-DISEASE; Peripheral Vascular Disease; venous thromboembolism; Atherosclerosis Risk in Communities (ARIC) Study; racial disparities; SYMPTOMATIC PULMONARY-EMBOLISM; Life Sciences & Biomedicine; atrial fibrillation; Hematology; FAILURE; PATHOPHYSIOLOGY; DEEP-VEIN THROMBOSIS; Cardiovascular System & Cardiology; STROKE; AFRICAN-AMERICANS
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Atrial fibrillation (AF) may increase risk of venous thromboembolism (VTE), and vice versa. Bidirectionality was assessed prospectively via data from 15 129 black and white individuals. AF was associated with greater risk of developing VTE, and VTE with greater risk of AF. Associations were strongest among blacks and in the first 6 months after initial diagnosis. Summary: Background Atrial fibrillation (AF) and venous thromboembolism (VTE) frequently co-occur. These conditions have shared risk factors and are accompanied by coagulation abnormalities. Furthermore, mechanistic pathways may directly link the disorders. Objectives To test the hypothesis that individuals with incident AF are at greater risk of developing VTE, and those with VTE are at elevated risk of AF. We also tested whether associations were stronger in the first 6 months after the initial diagnosis, and explored race differences. Patients/Methods A total of 15 129 ARIC study participants (45–64 years, 55% female, 26% Black) were followed from 1987 to 2011 for incident AF and VTE (median follow-up 19.8 years). Multivariable-adjusted Cox regression was used, with AF and VTE modeled as time-dependent exposures. Results Incident AF was associated with greater risk of subsequent incident VTE (hazard ratio [95% CI], 1.71 [1.32–2.22]); the association was stronger in Black people (2.30 [1.48–3.58]) and during the first 6 months after AF diagnosis (5.08 [3.08–8.38]). Similarly, incident VTE was associated with increased risk of incident AF (1.73 [1.34–2.24]), especially in Black people (2.40 [1.55–3.74]) and in the first 6 months after VTE diagnosis (4.50 [2.61–7.77]). Conclusions The occurrence of AF was associated with increased risk of incident VTE, and occurrence of VTE was associated with greater risk of incident AF. Associations were particularly strong among Black people and during the first 6 months after the initial diagnosis, although they remained elevated even after 6 months. These findings highlight patient populations that may be at increased risk of AF and VTE, and perhaps should be targeted with preventive strategies.