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. 2016 Aug 23;134(8):599-610.
doi: 10.1161/CIRCULATIONAHA.115.020090.

Trajectories of Cardiovascular Risk Factors and Incidence of Atrial Fibrillation Over a 25-Year Follow-Up: The ARIC Study (Atherosclerosis Risk in Communities)

Faye L Norby  1 , Elsayed Z Soliman  2 , Lin Y Chen  2 , Lindsay G S Bengtson  2 , Laura R Loehr  2 , Sunil K Agarwal  2 , Alvaro Alonso  2
Affiliations

Trajectories of Cardiovascular Risk Factors and Incidence of Atrial Fibrillation Over a 25-Year Follow-Up: The ARIC Study (Atherosclerosis Risk in Communities)

Faye L Norby et al. Circulation. .

Abstract

Background: Timing and trajectories of cardiovascular risk factor (CVRF) development in relation to atrial fibrillation (AF) have not been described previously. We assessed trajectories of CVRF and incidence of AF over 25 years in the ARIC study (Atherosclerosis Risk in Communities).

Methods: We assessed trajectories of CVRF in 2456 individuals with incident AF and 6414 matched control subjects. Subsequently, we determined the association of CVRF trajectories with the incidence of AF among 10 559 AF-free individuals (mean age, 67 years; 52% men; 20% blacks). Risk factors were measured during 5 examinations between 1987 and 2013. Cardiovascular events, including incident AF, were ascertained continuously. We modeled the prevalence of risk factors and cardiovascular outcomes in the period before and after AF diagnosis and the corresponding index date for control subjects using generalized estimating equations. Trajectories in risk factors were identified with latent mixture modeling. The risk of incident AF by trajectory group was examined with Cox models.

Results: The prevalence of stroke, myocardial infarction, and heart failure increased steeply during the time close to AF diagnosis. All CVRFs were elevated in AF cases compared with controls >15 years before diagnosis. We identified distinct trajectories for all the assessed CVRFs. In general, individuals with trajectories denoting long-term exposure to CVRFs had increased AF risk even after adjustment for single measurements of the CVRFs.

Conclusions: AF patients have increased prevalence of CVRF many years before disease diagnosis. This analysis identified diverse trajectories in the prevalence of these risk factors, highlighting their different roles in AF pathogenesis.

Keywords: atrial fibrillation; cardiovascular diseases; epidemiology.

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Figures

Figure 1
Figure 1
Predicted prevalence of cardiovascular risk factors and outcomes over time by AF status, ARIC, 1987-2011. Adjusted prevalence was modeled using general estimating equations held constant for age, race and sex. Predicted probabilities of cardiovascular risk factors and outcomes were then calculated based on a 65 year old male, stratified by race.
Figure 2
Figure 2
Odds ratios (OR) of cardiovascular risk factors and outcomes over time, based on AF status, adjusted for age, race and sex. OR <1 or >1 can be interpreted as a lower or higher odds, respectively, of the risk factor or cardiovascular outcome at a particular time period compared with the odds at the time of AF diagnosis date.
Figure 3
Figure 3
Trajectories in risk factors and outcomes over time, ARIC, 1987-1998. Groups are trajectory groups (percentage of the population in each group).
See this image and copyright information in PMC

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