Abstract 3203: Association of Markers of Inflammation with New-Onset Atrial Fibrillation in a Population-Based Sample: The Strong Heart Study
Background: Atrial fibrillation (AF) has been associated with increased C-reactive protein (CRP) and albuminuria, and AF inducibility is decreased in subjects whose CRP levels were lowered by statin treatment. However, whether CRP and fibrinogen, both markers of inflammation, predict new-onset AF in a population-based sample has not been examined.
Methods: 3541 participants in the 2nd Strong Heart Study examination between 1993–1995, aged 47– 80 years, with CRP and fibrinogen determinations and no prior AF, were followed for 10 years. New-onset AF was ascertained by review of medical records and ECG Minnesota coding.
Results: In a multivariable Cox model including age, gender, hypertension, diabetes, body mass index (BMI), and log urinary albumin/creatinine ratio (UACR), new-onset AF in 100 participants was predicted by serum CRP level (HR 1.44 per mg/L [95% CI 1.17–1.77], p=0.001) independent of effects of male gender (HR 1.67 [95% CI 1.11–2.52], p=0.014), age (HR 1.08 per year [95% CI 1.05–1.11], p≤0.0001), UACR (HR 1.18 [95% CI 1.06–1.31], p=0.002) and hypertension (HR 1.93 [95% CI 1.22–3.06], p=0.005). In a multivariable Cox model in which fibrinogen was substituted for CRP, new-onset AF was predicted by serum fibrinogen level (HR 1.31 per 83.44 mg/dL (1 SD of mean) [95% CI 1.06–1.61], p=0.013) independent of effects of gender (HR 1.63 [95% CI 1.08–2.46], p=0.020), age (HR 1.08 per year [95% CI 1.05–1.11], p≤0.0001), UACR (HR 1.12 [95% CI 1.00–1.25], p=0.05), and hypertension (HR 1.91 [95% CI 1.20–3.03], p=0.006). In a multivariable Cox model in which both CRP and fibrinogen were entered, new-onset AF was predicted by serum CRP level (HR 1.36 [95% CI 1.07–1.73], p=0.011) independent of effects of male gender (HR 1.69 [95% CI 1.12–2.55], p=0.012), age (HR 1.08 [95% CI 1.05–1.11], p≤0.0001), log UACR (HR 1.15 [95% CI 1.03–1.29], p=0.015), and hypertension (HR 1.93 [95% CI 1.22–3.06], p=0.005) but fibrinogen was no longer significant (HR 1.12 [95% CI 0.88–1.43], p=0.360). Diabetes and BMI were not associated with new-onset AF in any of the Cox models.
Conclusions: This study provides initial evidence that CRP and fibrinogen are additive risk factors for new-onset AF in a population-based sample, independent of effects of gender, age, hypertension, BMI, and UACR.