Comparative Study

. 2015 Dec;8(12):e003786.

doi: 10.1161/CIRCIMAGING.115.003786.

Coronary Artery Calcium Progression and Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis

Wesley T O'Neal¹, Jimmy T Efird², Waqas T Qureshi², Joseph Yeboah², Alvaro Alonso², Susan R Heckbert², Saman Nazarian², Elsayed Z Soliman²

Affiliations

¹ From the Department of Internal Medicine (W.T.O.), Department of Internal Medicine, Section on Cardiology (W.T.Q., J.Y., E.Z.S.), and Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC (J.T.E.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.); Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle (S.R.H.); and Departments of Medicine and Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (S.N.). woneal@wakehealth.edu.
² From the Department of Internal Medicine (W.T.O.), Department of Internal Medicine, Section on Cardiology (W.T.Q., J.Y., E.Z.S.), and Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC (J.T.E.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.); Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle (S.R.H.); and Departments of Medicine and Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (S.N.).

PMID: 26659375
PMCID: PMC4681308
DOI: 10.1161/CIRCIMAGING.115.003786

Comparative Study

Coronary Artery Calcium Progression and Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis

Wesley T O'Neal et al. Circ Cardiovasc Imaging. 2015 Dec.

. 2015 Dec;8(12):e003786.

doi: 10.1161/CIRCIMAGING.115.003786.

Authors

Wesley T O'Neal¹, Jimmy T Efird², Waqas T Qureshi², Joseph Yeboah², Alvaro Alonso², Susan R Heckbert², Saman Nazarian², Elsayed Z Soliman²

Affiliations

¹ From the Department of Internal Medicine (W.T.O.), Department of Internal Medicine, Section on Cardiology (W.T.Q., J.Y., E.Z.S.), and Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC (J.T.E.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.); Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle (S.R.H.); and Departments of Medicine and Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (S.N.). woneal@wakehealth.edu.
² From the Department of Internal Medicine (W.T.O.), Department of Internal Medicine, Section on Cardiology (W.T.Q., J.Y., E.Z.S.), and Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC (J.T.E.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.); Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle (S.R.H.); and Departments of Medicine and Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (S.N.).

PMID: 26659375
PMCID: PMC4681308
DOI: 10.1161/CIRCIMAGING.115.003786

Abstract

Background: Coronary artery calcium (CAC) measured at a single time point has been associated with an increased risk for atrial fibrillation (AF). It is unknown whether CAC progression over time carries a similar risk.

Methods and results: This analysis included 5612 participants (mean age: 62±10; 52% women; 39% whites; 27% blacks; 20% Hispanics; 12% Chinese Americans) from the Multi-Ethnic Study of Atherosclerosis. Phantom-adjusted Agatston scores for baseline and follow-up measurements were used to compute change in CAC per year (≤0, 1-100, 101-300, and >300 U/year). AF was ascertained by review of hospital discharge records and from Medicare claims data through December 31, 2010. Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association between CAC progression and AF. Over a median follow-up of 5.6 years (25th, 75th percentiles=5.1, 6.8), a total of 203 (3.6%) incident AF cases were detected. Any CAC progression (>0/year) was associated with an increased risk for AF (HR=1.55, 95% CI=1.10, 2.19), and the risk increased with higher levels of CAC progression (≤0/year: HR=1.0 [reference]; 1-100/year: HR=1.47, 95% CI=1.03, 2.09; 101-300/year: HR=1.92, 95%CI=1.15, 3.20; >300/year: HR=3.23, 95%CI=1.48, 7.05). An interaction was observed by age with the association of CAC progression with AF being stronger for younger (<61 years: HR=3.53, 95% CI=1.29, 9.69) compared with older (≥61 years: HR=1.42, 95% CI=0.99, 2.04) participants (P interaction=0.037).

Conclusions: CAC progression during an average of 5 to 6 years of follow-up is associated with an increased risk for AF.

Keywords: atherosclerosis; atrial fibrillation; coronary calcium; coronary vessels; epidemiology.

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Figures

Figure 1. Unadjusted Cumulative Incidence of Atrial Fibrillation by CAC Progression (N=5,612)^*
^*Cumulative incidence curves are statistically different (log-rank p <0.0001). CAC=coronary artery calcium.

Figure 2. Unadjusted Cumulative Incidence of Atrial Fibrillation by CAC Progression Level (N=5,612)^*
^*Cumulative incidence curves are statistically different between all groups (log-rank p <0.0001). CAC=coronary artery calcium.

Figure 3. Multivariable Risk of Atrial Fibrillation by CAC Progression^*
^*Each hazard ratio was computed using a restricted cubic spline model with the median change in CAC/year value of 0.26 as the reference and was adjusted for age, sex, race/ethnicity, education, income, baseline CAC, systolic blood pressure, body mass index, diabetes, smoking, total cholesterol, high-density lipoprotein cholesterol, antihypertensive medications, lipid-lowering therapies, aspirin, and left ventricular hypertrophy. Dotted-lines represent the 95% confidence interval. CAC=coronary artery calcium.

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Comment in

Calcified Pipes: You Better Call the Electrician Too.
Pokorney SD, Piccini JP. Pokorney SD, et al. Circ Cardiovasc Imaging. 2015 Dec;8(12):e004202. doi: 10.1161/CIRCIMAGING.115.004202. Circ Cardiovasc Imaging. 2015. PMID: 26659369 No abstract available.

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Coronary Artery Calcium Progression and Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis

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Coronary Artery Calcium Progression and Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis

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