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Background Sarcoidosis is a granulomatous disease usually affecting the lungs, although cardiac morbidity may be common. The risk of these outcomes and the characteristics that predict them remain largely unknown. This study investigates the epidemiology of heart failure, atrioventricular block, and ventricular tachycardia among patients with and without sarcoidosis. Methods and Results We identified California residents aged ≥21 years using the Office of Statewide Health Planning and Development ambulatory surgery, emergency, or inpatient databases from 2005 to 2015. The risk of sarcoidosis on incident heart failure, atrioventricular block, and ventricular tachycardia were each determined. Linkage to the Social Security Death Index was used to ascertain overall mortality. Among 22 527 964 California residents, 19 762 patients with sarcoidosis (0.09%) were identified. Sarcoidosis was the strongest predictor of heart failure (hazard ratio [HR], 11.2; 95% CI, 10.7-11.7), atrioventricular block (HR, 117.7; 95% CI, 103.3-134.0), and ventricular tachycardia (HR, 26.1; 95% CI, 24.2-28.1) identified among all risk factors. The presence of any cardiac involvement best predicted each outcome. Approximately 22% (95% CI, 18%-26%) of the relationship between sarcoidosis and increased mortality was explained by the presence of at least 1 of these cardiovascular outcomes. Conclusions The magnitude of risk associated with sarcoidosis as a predictor of heart failure, atrioventricular block, and ventricular tachycardia, exceeds all established risk factors. Surveillance for and anticipation of these outcomes among patients with sarcoidosis is indicated, and consideration of a sarcoidosis diagnosis may be prudent among patients with heart failure, atrioventricular block, or ventricular tachycardia.

BACKGROUND:Cigarette smoking is known to increase the risk of atrial fibrillation (AF), and a recent cross-sectional analysis suggested that parental smoking may be an AF risk factor. OBJECTIVES:The purpose of this study was to assess if parental smoking predicts offspring AF in the Framingham Heart Study. METHODS:This study analyzed Framingham Offspring cohort participants with parents in the Original cohort with known smoking status during the offspring's childhood. Framingham participants were evaluated every 2 to 8 years and were under routine surveillance for incident AF. The authors assessed AF incidence among Offspring participants exposed to parental smoking through age 18 years and performed a mediation analysis to determine the extent to which offspring smoking might explain observed associations. RESULTS:Of 2,816 Offspring cohort participants with at least 1 parent in the Original cohort, 82% were exposed to parental smoking. For every pack/day increase in parental smoking, there was an 18% increase in offspring AF incidence (adjusted hazard ratio [HR]: 1.18; 95% confidence interval [CI]: 1.00 to 1.39; p = 0.04). Additionally, parental smoking was a risk factor for offspring smoking (adjusted odds ratio [OR]: 1.34; 95% CI: 1.17 to 1.54; p

Introduction: While long-term risk factors for new onset atrial fibrillation (AF) have been well-established, triggers for discrete episodes remain poorly studied and incompletely characterized. Hypothesis: We sought to describe common triggers for AF episodes and their relationships with patient characteristics. Methods: We invited symptomatic, paroxysmal AF patients enrolled in the Health eHeart Study and subscribers to StopAfib.org to complete a questionnaire regarding their AF triggers and cardiovascular risk factors. Results: Of 1,295 participants with symptomatic AF, 957 (74%) reported triggers for episodes of AF. In comparison to those without triggers and after multivariate adjustment, those reporting triggers had a 58% lower odds of congestive heart failure (odds ratio [OR] 0.29, 95% CI 0.14 to 0.60, p=0.001) and almost a two-fold greater odds of a family history of AF (OR 2.04, 95% CI 1.21 to 3.47, p=0.008). The most commonly reported triggers were alcohol (in 35%), caffeine (in 28%), exercise (in 23%), and lack of sleep (in 21%) [Figure]. Multivariable models revealed that younger patients, women, and those with a family history of AF more commonly experienced certain AF triggers. Overall, patients reported a median of two different triggers (interquartile range 1-3); female sex, Hispanic ethnicity, a history of obstructive sleep apnea, and a family history of AF were each associated with reporting a greater number of triggers. Within individuals, vagally-mediated triggers tended to cluster together. Conclusions: The majority of patient-reported triggers are modifiable, potentially identifying accessible means to prevent and reduce AF episodes. Exploring the interactions between AF patient type, including underlying genetic differences, and common exposures may prove to be a fruitful area of investigation. [ABSTRACT FROM AUTHOR]