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Association of Peripheral Artery Disease With Incident Atrial Fibrillation: The ARIC (Atherosclerosis Risk in Communities) Study.

TitleAssociation of Peripheral Artery Disease With Incident Atrial Fibrillation: The ARIC (Atherosclerosis Risk in Communities) Study.
Publication TypeJournal Article
Year of Publication2018
AuthorsBekwelem W, Norby FL, Agarwal SK, Matsushita K, Coresh JJ, Alonso A
Secondary AuthorsChen LYee
JournalJ Am Heart Assoc
Volume7
Issue8
Date Published2018 04 17
ISSN2047-9980
KeywordsAnkle Brachial Index, Atherosclerosis, Atrial Fibrillation, Electrocardiography, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Peripheral Arterial Disease, Population Surveillance, Prospective Studies, Risk Assessment, Risk Factors, Time Factors, United States
Abstract

BACKGROUND: Although peripheral artery disease as defined by ankle-brachial index (ABI) is associated with incident atrial fibrillation (AF), questions remain about the risk of AF in borderline ABI (>0.90 to 1.4). We evaluated the association of borderline ABI and ABI >1.4 in the ARIC (Atherosclerosis Risk in Communities) study, a population-based prospective cohort study.

METHODS AND RESULTS: We included 14 794 participants (age, 54.2±5.8 years, 55% women, 26% blacks) with ABI measured at the baseline (1987-1989) and without AF. AF was identified from hospital records, death certificates, and ECGs. Using Cox proportional hazards, we evaluated the association between ABI and AF. During a median follow-up of 23.3 years, there were 2288 AF cases. After adjustment for cardiovascular risk factors, hazard ratio (HR) (95% confidence interval) for AF among individuals with ABI 1.4 was not associated with increased AF risk. ABI ≤0.9 and borderline ABI were associated with a higher risk of AF compared with ABI 1.0 to 1.4. Demographics-adjusted HRs (95% confidence interval) were 1.43 (1.17-1.75) and 1.32 (1.16-1.50), respectively. However, the associations of ABI ≤0.9 and borderline ABI with AF were attenuated after adjusting for cardiovascular risk factors (HR [95% confidence interval], 1.10 [0.90-1.34] and 1.14 [1.00-1.30]), respectively.

CONCLUSIONS: Peripheral artery disease indicated by low ABI, including borderline ABI, is a weak risk factor for AF. ABI >1.4 is not associated with an increased AF risk. The relationship between peripheral artery disease and AF appears to be mostly explained by traditional atherosclerotic risk factors.

DOI10.1161/JAHA.117.007452
Alternate JournalJ Am Heart Assoc
PubMed ID29666066
PubMed Central IDPMC6015443
Grant ListR01 HL126637 / HL / NHLBI NIH HHS / United States
HHSN268201700001I / HL / NHLBI NIH HHS / United States
16EIA26410001 / / American Heart Association-American Stroke Association / United States
HHSN268201700004I / HL / NHLBI NIH HHS / United States
HHSN268201700002I / HL / NHLBI NIH HHS / United States
HHSN268201700005I / HL / NHLBI NIH HHS / United States
HHSN268201700003I / HL / NHLBI NIH HHS / United States