Trajectories of Cardiovascular Risk Factors and Incidence of Atrial Fibrillation Over a 25-Year Follow-Up The ARIC Study (Atherosclerosis Risk in Communities)

• Type of Material: Article
• Authors: Faye L. Norby, University of Minnesota; Elsayed Z. Soliman, Wake Forest School of Medicine; Lin Y. Chen, University of Minnesota; Lindsay G.S. Bengtson, Health Economics and Outcomes Research, Life Sciences; Laura R. Loehr, University of North Carolina; Sunil K. Agarwal, Mount Sinai Heart Center; Alvaro Alonso, Emory University
• Language: English
• Date: 2016-08-23
• Publisher: American Heart Association
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 American Heart Association, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1161/CIRCULATIONAHA.115.020090
• Title of Journal or Parent Work: Circulation
• ISSN: 0009-7322
• Volume: 134
• Issue: 8
• Start Page: 599
• End Page: 610
• Grant/Funding Information: This work was additionally supported by American Heart Association grant 16EIA26410001 (Alonso).; The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN26820110 0012C).
• Keywords: SURVIVAL; SURVEILLANCE; Life Sciences & Biomedicine; epidemiology; Science & Technology; Cardiovascular System & Cardiology; cardiovascular diseases; TRENDS; Peripheral Vascular Disease; INDEPENDENT RISK; STROKE; IMPACT; HEART-FAILURE; Cardiac & Cardiovascular Systems; atrial fibrillation; MORTALITY; MYOCARDIAL-INFARCTION; DISEASE
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery

Abstract

Background: Timing and trajectories of cardiovascular risk factor (CVRF) development in relation to atrial fibrillation (AF) have not been described previously. We assessed trajectories of CVRF and incidence of AF over 25 years in the ARIC study (Atherosclerosis Risk in Communities). Methods: We assessed trajectories of CVRF in 2456 individuals with incident AF and 6414 matched control subjects. Subsequently, we determined the association of CVRF trajectories with the incidence of AF among 10 559 AF-free individuals (mean age, 67 years; 52% men; 20% blacks). Risk factors were measured during 5 examinations between 1987 and 2013. Cardiovascular events, including incident AF, were ascertained continuously. We modeled the prevalence of risk factors and cardiovascular outcomes in the period before and after AF diagnosis and the corresponding index date for control subjects using generalized estimating equations. Trajectories in risk factors were identified with latent mixture modeling. The risk of incident AF by trajectory group was examined with Cox models. Results: The prevalence of stroke, myocardial infarction, and heart failure increased steeply during the time close to AF diagnosis. All CVRFs were elevated in AF cases compared with controls > 15 years before diagnosis. We identified distinct trajectories for all the assessed CVRFs. In general, individuals with trajectories denoting long-term exposure to CVRFs had increased AF risk even after adjustment for single measurements of the CVRFs. Conclusions: AF patients have increased prevalence of CVRF many years before disease diagnosis. This analysis identified diverse trajectories in the prevalence of these risk factors, highlighting their different roles in AF pathogenesis.