Blood lipid levels, lipid-lowering medications, and the incidence of atrial fibrillation: the atherosclerosis risk in communities study

Abstract

Background: Several cardiovascular risk factors have been associated with the risk of atrial fibrillation (AF). Limited and inconsistent evidence exists on the association of blood lipid levels and lipid-lowering medication use with AF risk.

Methods and results: We analyzed 13 969 participants (25% African American, 45% men) free of AF at baseline from the Atherosclerosis Risk in Communities study. Fasting high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), triglycerides, and total cholesterol were measured at baseline (1987-1989) and each of 3 follow-up visits. The incidence of AF was ascertained through 2007. The association of the use of statins and other lipid-lowering medications with AF was estimated in 13 044 Atherosclerosis Risk in Communities participants attending visit 2 (1990-1992), adjusting for covariates from the previous visit. During a median follow-up of 18.7 years, there were 1433 incident AF cases. Multivariable hazard ratios (HRs) and 95% CIs of AF associated with a 1-SD increase in lipid levels were as follows: HDLc, 0.97 (0.91-1.04); LDLc, 0.90 (0.85-0.96); total cholesterol, 0.89 (0.84-0.95); and triglycerides, 1.00 (0.96-1.04). Participants taking lipid-lowering medications had an adjusted HR (95% CI) of AF of 0.96 (0.82-1.13) compared with those not taking medications, whereas those taking statins had an adjusted HR of 0.91 (0.66-1.25) compared with those taking other lipid-lowering medications.

Conclusions: Higher levels of LDLc and total cholesterol were associated with a lower incidence of AF. However, HDLc and triglycerides were not independently associated with AF incidence. No association was found between the use of lipid-lowering medications and incident AF.

Figure 1

Hazard Ratio and 95% confidence intervals of atrial fibrillation according to lipid level measurements at each visit, and as a time-varying variable, ARIC, 1987–2007. Results from separate Cox proportional hazard models adjusted for age, sex, race, study site, education, income, height, smoking status, drinking status, body mass index, systolic blood pressure, diastolic blood pressure, use of antihypertensive medication, diabetes, prevalent stroke, prevalent heart failure, prevalent coronary heart disease, and use of cholesterol medications

Figure 1

Hazard Ratio and 95% confidence intervals of atrial fibrillation according to lipid level measurements at each visit, and as a time-varying variable, ARIC, 1987–2007. Results from separate Cox proportional hazard models adjusted for age, sex, race, study site, education, income, height, smoking status, drinking status, body mass index, systolic blood pressure, diastolic blood pressure, use of antihypertensive medication, diabetes, prevalent stroke, prevalent heart failure, prevalent coronary heart disease, and use of cholesterol medications

Figure 1

Hazard Ratio and 95% confidence intervals of atrial fibrillation according to lipid level measurements at each visit, and as a time-varying variable, ARIC, 1987–2007. Results from separate Cox proportional hazard models adjusted for age, sex, race, study site, education, income, height, smoking status, drinking status, body mass index, systolic blood pressure, diastolic blood pressure, use of antihypertensive medication, diabetes, prevalent stroke, prevalent heart failure, prevalent coronary heart disease, and use of cholesterol medications

Figure 1

Hazard Ratio and 95% confidence intervals of atrial fibrillation according to lipid level measurements at each visit, and as a time-varying variable, ARIC, 1987–2007. Results from separate Cox proportional hazard models adjusted for age, sex, race, study site, education, income, height, smoking status, drinking status, body mass index, systolic blood pressure, diastolic blood pressure, use of antihypertensive medication, diabetes, prevalent stroke, prevalent heart failure, prevalent coronary heart disease, and use of cholesterol medications

Figure 2

Kaplan Meier survival curves for atrial fibrillation (AF) by categories of LDLc cholesterol (<100, 100–159, ≥160 mg/dL) from baseline (top panel) and from visit 4 (bottom panel), ARIC 1987–2007 and 1996–2007, respectively. Cox proportional hazards model excluding those on cholesterol-lowering medications at baseline, and adjusted for age, sex, study site, education, income, height, smoking status, drinking status, body mass index, systolic blood pressure, diastolic blood pressure, use of antihypertensive medication, diabetes, prevalent stroke, prevalent heart failure, and prevalent coronary heart disease. P for trend is considered across categories. The number of subjects at risk throughout the duration of the study follow-up are shown on the x-axis.

Figure 2

Kaplan Meier survival curves for atrial fibrillation (AF) by categories of LDLc cholesterol (<100, 100–159, ≥160 mg/dL) from baseline (top panel) and from visit 4 (bottom panel), ARIC 1987–2007 and 1996–2007, respectively. Cox proportional hazards model excluding those on cholesterol-lowering medications at baseline, and adjusted for age, sex, study site, education, income, height, smoking status, drinking status, body mass index, systolic blood pressure, diastolic blood pressure, use of antihypertensive medication, diabetes, prevalent stroke, prevalent heart failure, and prevalent coronary heart disease. P for trend is considered across categories. The number of subjects at risk throughout the duration of the study follow-up are shown on the x-axis.