1. Lipid levels in midlife and risk of atrial fibrillation over 3 decades—Experience from the Swedish AMORIS cohort: A cohort study.
- Author
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Ding, Mozhu, Wennberg, Alexandra, Gigante, Bruna, Walldius, Göran, Hammar, Niklas, and Modig, Karin
- Subjects
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DYSLIPIDEMIA , *HDL cholesterol , *ATRIAL fibrillation , *LDL cholesterol , *BLOOD lipids , *LIPIDS - Abstract
Background: The role of cholesterol levels in the development of atrial fibrillation (AF) is still controversial. In addition, whether and to what extent apolipoproteins are associated with the risk of AF is rarely studied. In this study, we aimed to investigate the association between blood lipid levels in midlife and subsequent risk of new-onset AF. Methods and findings: This population-based study included 65,136 individuals aged 45 to 60 years without overt cardiovascular diseases (CVDs) from the Swedish Apolipoprotein-Related Mortality Risk (AMORIS) cohort. Lipids were measured in 1985 to 1996, and individuals were followed until December 31, 2019 for incident AF (i.e., study outcome). Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox regression, adjusting for age, sex, and socioeconomic status. Over a mean follow-up of 24.2 years (standard deviation 7.5, range 0.2 to 35.9), 13,871 (21.3%) incident AF cases occurred. Higher levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) were statistically significantly associated with a lower risk of AF during the first 5 years of follow-up (HR = 0.61, 95% CI: 0.41 to 0.99, p = 0.013; HR = 0.64, 95% CI: 0.45 to 0.92, p = 0.016), but not thereafter (HR ranging from 0.94 [95% CI: 0.89 to 1.00, p = 0.038] to 0.96 [95% CI: 0.77 to 1.19, p > 0.05]). Lower levels of high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A-I (ApoA-I) and higher triglycerides (TG)/HDL-C ratio were statistically significantly associated with a higher risk of AF during the entire follow-up (HR ranging from 1.13 [95% CI: 1.07 to 1.19, p < 0.001] to 1.53 [95% CI: 1.12 to 2.00, p = 0.007]). Apolipoprotein B (ApoB)/ApoA-I ratio was not associated with AF risk. The observed associations were similar among those who developed incident heart failure (HF)/coronary heart disease (CHD) and those who did not. The main limitations of this study include lack of adjustments for lifestyle factors and high blood pressure leading to potential residual confounding. Conclusions: High TC and LDL-C in midlife was associated with a lower risk of AF, but this association was present only within 5 years from lipid measurement and not thereafter. On the contrary, low HDL-C and ApoA-I and high TG/HDL-C ratio were associated with an increased risk of AF over almost 35 years of follow-up. ApoB/ApoA-I ratio was not associated with AF risk. Mozhu Ding and colleagues investigate investigate the association between blood lipid levels in midlife and subsequent risk of new-onset atrial fibrillation in Sweden. Author summary: Why was this study done?: High cholesterol level is an established risk factor for cardiovascular diseases (CVDs), such as coronary heart disease (CHD). However, the role of cholesterol levels in the development of atrial fibrillation (AF), a very common cardiac arrhythmia in older adults, is debated. Compared to cholesterols, apolipoprotein B (ApoB), apolipoprotein A-I (ApoA-I), and their ratios have been shown to better predict CVD, but whether and how they are associated with AF is unclear. What did the researchers do and find?: In this large Swedish cohort with blood-based biomarker information, 65,136 individuals free of overt CVD and aged 45 to 60 years at lipid measurement were followed for up to 35 years for new-onset AF. High levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) were associated with a lower risk of AF (hazard ratio, HR = 0.61, 95% confidence interval (CI): 0.41 to 0.99, p = 0.013; HR = 0.64, 95% CI: 0.45 to 0.92, p = 0.016), but this association was present only during the first 5 years since lipid measurement. On the contrary, low levels of high-density lipoprotein cholesterol (HDL-C) and ApoA-I and a high triglyceride (TG)/HDL-C ratio were associated with an increased risk of AF throughout the follow-up time (HR ranging from 1.13 [95% CI: 1.07 to 1.19, p < 0.001] to 1.53 [95% CI: 1.12 to 2.00, p = 0.007]). High ApoB/ApoA-I ratio was not associated with the risk of subsequent AF. What do these findings mean?: Dyslipidemia expressed by a high TC or LDL-C, or a poor atherogenic to anti-atherogenic balance, does not seem to be associated with an increased risk of developing AF. Instead, the findings suggest that metabolic syndrome and inflammation, as indicated by low HDL-C and ApoA-I and a high TG/HDL-C ratio, may play a role in the onset of AF. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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