Abstract 3985: Renal Dysfunction Predicts Atrial Fibrillation in Elderly Subjects: Results from the Cardiovascular Health Study
Objective: Recent scientific work has suggested a mechanistic link between activation of the renin angiotensin aldosterone (RAAS) system and the initiation and maintenance of atrial fibrillation (AF). Since kidney dysfunction results in RAAS dysregulation, we evaluated the association between kidney dysfunction and both prevalent and incident AF.
Methods and Results: Subjects were participants in the Cardiovascular Health Study (CHS), a population-based cohort of ambulatory elderly, who attended the 1992–1993 clinical visit. Measures of kidney function were creatinine-based estimated GFR and cystatin C. Prevalent AF was determined cross-sectionally from the baseline ECG. Incident AF was detected by annual ECG or by diagnosis of AF at hospitalization. Among the 4663 participants, 342 (7%) had AF at baseline and 579 (13%) developed incident AF during follow-up (mean 7.4 years). In unadjusted analysis, cystatin C was linearly associated with both prevalent and incident AF. After multivariate adjustment, the two highest quintiles were independently associated with prevalent AF [OR for quintile 4 of cystatin C 1.62, [1.07–2.44]; OR for quintile 5 of cystatin C 1.52, [1.00–2.31]]. In the longitudinal analysis, the adjusted associations of cystatin C quintiles with incident AF were: 1.39, [1.05–1.85] for quintile 2; 1.21, [0.91–1.61] for quintile 3; 1.22 [0.92–1.63] for quintile 4 and 1.42 [1.06–1.90] for quintile 5 of cystatin C) .
Conclusions: Declining renal function is an independent predictor of both prevalent and incident AF.