Association of sickle cell trait with atrial fibrillation: The REGARDS cohort

• Type of Material: Article
• Authors: Daniel R. Douce, University of Vermont; Elsayed Z. Soliman, Wake Forest University; Rakhi Naik, Johns Hopkins University; Hyacinth Hyacinth, Emory University; Mary Cushman, University of Vermont; Cheryl A. Winkler, National Cancer Institute; George Howard, University of Alabama Birmingham; Ethan M. Lange, University of Colorado; Leslie A. Lange, University of Colorado; Marguerite R. Irvin, University of Alabama Birmingham; Neil A. Zakai, University of Vermont
• Language: English
• Date: 2019-07-01
• Publisher: Churchill Livingstone Inc. Medical Publishers
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 published by Elsevier.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jelectrocard.2019.04.010
• Title of Journal or Parent Work: Journal of Electrocardiology
• Volume: 55
• Start Page: 1
• End Page: 5
• Grant/Funding Information: Additionally, this project has been funded in part with Federal funds from the Frederick National Laboratory for Cancer Research, National Institutes of Health, under contract [HHSN261200800001E].; This research project is supported by a cooperative agreement from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service [U01 NS041588].; Additional funding was provided by Lake Champlain Cancer Research Organization Inc.
• Keywords: Sickle cell trait; Hemoglobin; Atrial fibrillation; Prevalence; Cardiac & Cardiovascular Systems; Life Sciences & Biomedicine; Thromboembolism; Chronic kidney disease; Death; Prolongation; Epidemiology; Cardiovascular System & Cardiology; Risk; Science & Technology; Mortality; Racial differences
• Research Categories: Health Sciences, Epidemiology; Biology, Cell; Health Sciences, Oncology; Biology, Biostatistics

Abstract

Background: Sickle cell trait (SCT), sickle cell disease’s (SCD) carrier status, has been recently associated with worse cardiovascular and renal outcomes. An increased prevalence of atrial fibrillation (AF) is documented in SCD patients; however, studies in individuals with SCT are lacking. Objectives: To determine the association of SCT with AF Methods: Among African-American participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study we assessed the association of SCT (by ECG or medical history) with prevalent AF using logistic regression adjusting for age, sex, income, education, history of stroke, myocardial infarction, diabetes, hypertension, and chronic kidney disease. A second evaluation was performed a mean of 9.2 years later among available participants, and the same model was used to test the association of SCT with incident AF. Results: In 10,409 participants with baseline ECG data and genotyping, 778 (7.5%) had SCT and 811 (7.8%) had prevalent AF. After adjusting for age, sex, education and income, SCT was associated with AF, OR 1.32 (95% CI 1.03–1.70). The association with incident AF assessed at the second in-home visit with the same adjustments was similar; OR 1.25 (95% CI 0.77–2.03). Conclusions: SCT was associated with a higher prevalence of AF and a non-significantly higher incident AF over a 9.2 year period independent of AF risk factors. SCT remained associated with prevalent AF after adjusting for potential factors on the causal pathway such as hypertension and chronic kidney disease suggesting alternate mechanisms for the increased risk.