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. 2022 Apr 5;11(7):e024299.
doi: 10.1161/JAHA.121.024299. Epub 2022 Mar 24.

Risk Factors, Subsequent Disease Onset, and Prognostic Impact of Myocardial Infarction and Atrial Fibrillation

Stephan Camen  1   2 , Dora Csengeri  1 , Bastiaan Geelhoed  1 , Teemu Niiranen  3   4 , Francesco Gianfagna  5   6 , Julie K Vishram-Nielsen  7   8 , Simona Costanzo  9 , Stefan Söderberg  10 , Erkki Vartiainen  3 , Christin S Börschel  1   2 , Maria Benedetta Donati  9 , Maja-Lisa Løchen  11 , Francisco M Ojeda  1 , Jukka Kontto  3 , Ellisiv B Mathiesen  12   13 , Steen Jensen  10 , Wolfgang Koenig  14   15   16 , Frank Kee  17 , Giovanni de Gaetano  9 , Tanja Zeller  1   2 , Torben Jørgensen  7   18 , Hugh Tunstall-Pedoe  19 , Stefan Blankenberg  1   2 , Kari Kuulasmaa  3 , Allan Linneberg  7   20 , Veikko Salomaa  3 , Licia Iacoviello  5   9 , Renate B Schnabel  1   2
Affiliations

Risk Factors, Subsequent Disease Onset, and Prognostic Impact of Myocardial Infarction and Atrial Fibrillation

Stephan Camen et al. J Am Heart Assoc. .

Abstract

Background Although myocardial infarction (MI) and atrial fibrillation (AF) are frequent comorbidities and share common cardiovascular risk factors, the direction and strength of the association of the risk factors with disease onset, subsequent disease incidence, and mortality are not completely understood. Methods and Results In pooled multivariable Cox regression analyses, we examined temporal relations of disease onset and identified predictors of MI, AF, and all-cause mortality in 108 363 individuals (median age, 46.0 years; 48.2% men) free of MI and AF at baseline from 6 European population-based cohorts. During a maximum follow-up of 10.0 years, 3558 (3.3%) individuals were diagnosed exclusively with MI, 1922 (1.8%) with AF but no MI, and 491 (0.5%) individuals developed both MI and AF. Association of sex, systolic blood pressure, antihypertensive treatment, and diabetes appeared to be stronger with incident MI than with AF, whereas increasing age and body mass index showed a higher risk for incident AF. Total cholesterol and daily smoking were significantly related to incident MI but not AF. Combined population attributable fraction of cardiovascular risk factors was >70% for incident MI, whereas it was only 27% for AF. Subsequent MI after AF (hazard ratio [HR], 1.68; 95% CI, 1.03-2.74) and subsequent AF after MI (HR, 1.75; 95% CI, 1.31-2.34) both significantly increased overall mortality risk. Conclusions We observed different associations of cardiovascular risk factors with both diseases indicating distinct pathophysiological pathways. Subsequent diagnoses of MI and AF significantly increased mortality risk.

Keywords: atrial fibrillation; cohort study; mortality; myocardial infarction; risk factors.

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Figures

Figure 1
Figure 1. Temporal relations of myocardial infarction (MI) and atrial fibrillation (AF).
This graph shows the distribution of individuals who developed both AF and MI based on the time that elapsed between diagnoses of both events. Overall, 491 individuals were diagnosed with both diseases during a maximum follow‐up of 10.0 years.
Figure 2
Figure 2. Hazard ratios of cardiovascular risk factors for subsequent diagnoses of atrial fibrillation and myocardial infarction.
Hazard ratios and 95% CIs are provided. Analyses were adjusted for cohorts.
Figure 3
Figure 3. Bar chart showing the population attributable fractions (PAFs) of common cardiovascular risk factors for 5‐year incidence of myocardial infarction and atrial fibrillation.
Error bars represent 95% CIs. P values and CIs were estimated by bootstrapping with 500 repetitions. *Risk factors with a statistically significant (5% level) difference of the PAF for both diseases.
Figure 4
Figure 4. Common cardiovascular risk factors show different associations with incident AF and MI, their subsequent onset, and death.
AF indicates atrial fibrillation; BMI, body mass index; MI, myocardial infarction; and PAF, population attributable fraction.
See this image and copyright information in PMC

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