Association between oxidative stress and atrial fibrillation

• Authors: Ayman Samman Tahhan, Emory University; Pratik B. Sandesara, Emory University; Salim S. Hayek, Emory University; Ayman Alkhoder, Emory University; Kaavya Chivukula, Emory University; Muhammad Hammadah, Emory University; Heval Mohamed-Kelli, Emory University; Wesley T. O'Neal, Emory University; Matthew Topel, Emory University; Nima Ghasemzadeh, Emory University; Yi-An Ko, Emory University; Hiroshi Aida, Emory University; Mazen Gafeer, Emory University; Laurence Sperling, Emory University; Viola Vaccarino, Emory University; Yongliang Liang, Emory University; Dean Jones, Emory University; Arshed Quyyumi, Emory University
• Journal Title: Heart Rhythm
• Volume: Volume 14, Number 12
• Publisher: Elsevier: 12 months | 2017-12-01, Pages 1849-1855
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.hrthm.2017.07.028
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; Atrial fibrillation; Oxidative stress; Glutathione; Redox potentials; Inflammation; C-REACTIVE PROTEIN; ANTIOXIDANT THERAPY; CARDIAC-SURGERY; HEART-FAILURE; RISK; MARKERS; HUMANS; INFLAMMATION; ERYTHROCYTES; PREVENTION

Abstract

Background Oxidative stress (OS) may be a key mechanism underlying the development of atrial fibrillation (AF) in experimental studies, but data in humans remain limited. Objective Systemic OS can be estimated by measurements of circulating levels of the aminothiols including glutathione, cysteine, and their oxidized products. We tested the hypothesis that the redox potentials of glutathione (EhGSH) and cysteine will be associated with prevalent and incident AF. Methods Plasma levels of aminothiols were measured in 1439 patients undergoing coronary angiography, of whom 148 (10.3%) had a diagnosis of AF. After a median follow-up of 6.3 years, 104 of 917 patients (11.5%) developed incident AF. Multivariate logistic regression and Cox regression models were used to determine whether OS markers were independent predictors of prevalent and incident AF after adjustment for traditional risk factors, heart failure, coronary artery disease, and high-sensitivity C-reactive protein level. Results For each 10% increase in EhGSH, the odds of prevalent AF was 30% higher (odds ratio [OR] 1.3; 95% confidence interval [CI] 1.1–1.7; P =.02) and 90% higher (OR 1.9; 95% CI 1.3–2.7; P =.004) when the median was used as a cutoff. The EhGSH level above the median was more predictive of chronic AF (OR 4.0; 95% CI 1.3–12.9; P =.01) than of paroxysmal AF (OR 1.7; 95% CI 1.1–2.7; P =.03). Each 10% increase in EhGSH level was associated with a 40% increase in the risk of incident AF (hazard ratio 1.4; 95% CI 1.1–1.7; P =.01). Conclusion Increased OS measured by the redox potentials of glutathione is associated with prevalent and incident AF. Therapies that modulate OS need to be investigated to treat and prevent AF.