Association of Peripheral Artery Disease With Incident Atrial Fibrillation: The ARIC (Atherosclerosis Risk in Communities) Study

• Type of Material: Article
• Authors: Wobo Bekwelem, University of Minnesota; Faye L. Norby, University of Minnesota; Sunil K. Agarwal, Mt. Sinai School of Medicine; Kunihiro Matsushita, Johns Hopkins University; Josef Coresh, Johns Hopkins University; Alvaro Alonso, Emory University; Lin Y. Chen, University of Minnesota
• Language: English
• Date: 2018-04-17
• Publisher: Wiley Open Access: Creative Commons Attribution Non-Commercial
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.117.007452
• Title of Journal or Parent Work: Journal of the American Heart Association
• ISSN: 2047-9980
• Volume: 7
• Issue: 8
• Start Page: e007452
• End Page: e007452
• Grant/Funding Information: Dr Chen receives grant support from the National Heart, Lung, and Blood Institute (R01HL126637).; Additional support was provided by American Heart Association grant 16EIA26410001 (Alonso).; The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I, HHSN2682017000021).
• Keywords: Cardiac & Cardiovascular Systems; atrial fibrillation; Science & Technology; DEATH; peripheral artery disease; STROKE; MANAGEMENT; CARDIOVASCULAR-DISEASE; IMPACT; ankle-brachial index; atherosclerosis; Cardiovascular System & Cardiology; MORTALITY; ANKLE-BRACHIAL INDEX; PREVALENCE; Life Sciences & Biomedicine; POPULATION; risk factors; OUTCOMES
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

BACKGROUND: Although peripheral artery disease as defined by ankle-brachial index (ABI) is associated with incident atrial fibrillation (AF), questions remain about the risk of AF in borderline ABI (>0.90 to <1.0) or noncompressible arteries (>1.4). We evaluated the association of borderline ABI and ABI >1.4 in the ARIC (Atherosclerosis Risk in Communities) study, a population-based prospective cohort study. METHODS AND RESULTS: We included 14 794 participants (age, 54.2±5.8 years, 55% women, 26% blacks) with ABI measured at the baseline (1987-1989) and without AF. AF was identified from hospital records, death certificates, and ECGs. Using Cox proportional hazards, we evaluated the association between ABI and AF. During a median follow-up of 23.3 years, there were 2288 AF cases. After adjustment for cardiovascular risk factors, hazard ratio (HR) (95% confidence interval) for AF among individuals with ABI <1.0 compared with ABI 1.0 to 1.4, was 1.13 (1.01-1.27). ABI >1.4 was not associated with increased AF risk. ABI ≤0.9 and borderline ABI were associated with a higher risk of AF compared with ABI 1.0 to 1.4. Demographics-adjusted HRs (95% confidence interval) were 1.43 (1.17-1.75) and 1.32 (1.16-1.50), respectively. However, the associations of ABI ≤0.9 and borderline ABI with AF were attenuated after adjusting for cardiovascular risk factors (HR [95% confidence interval], 1.10 [0.90-1.34] and 1.14 [1.00-1.30]), respectively. CONCLUSIONS: Peripheral artery disease indicated by low ABI, including borderline ABI, is a weak risk factor for AF. ABI >1.4 is not associated with an increased AF risk. The relationship between peripheral artery disease and AF appears to be mostly explained by traditional atherosclerotic risk factors.