Abstract 11330: New-onset Atrial Fibrillation is Associated with an Increased Risk of Cardiovascular Morbidity and Mortality in Initially Healthy Women
Introduction Few contemporary studies have prospectively assessed the risk of morbidity and mortality in individuals with new-onset atrial fibrillation (AF), especially among women. Methods We prospectively followed 34724 women participating in the Women's Health Study from 1993 to 2009, aged >45 years and free of cardiovascular (CV) disease and AF at baseline. Multivariable Cox proportional hazards models with time-varying covariates for both new-onset AF and potential confounders were utilized to determine the risk of subsequent CV events among women with new onset AF. Secondary analyses limiting the predictor of interest to new-onset paroxysmal AF were performed to further minimize confounding by AF-associated co-morbidities. In these models, women with persistent or permanent AF were censored at the time of AF diagnosis. Results During a median follow-up of 14.5 years, 962 women developed a first episode of AF, 588 had a stroke, 355 heart failure, 492 a myocardial infarction, and 1444 women died (295 of CV causes). Among the women who developed AF, subsequent stroke developed in 41, myocardial infarction in 23, heart failure in 83 and 57 women died (23 of CV causes). New onset-AF was a strong risk factor for subsequent CV events, as shown in the Table. Adjustment for CV risk factors and intercurrent CV events attenuated these risk estimates, but incident AF remained significantly associated with all CV events. In analyses limited to paroxysmal AF events (n=621), the associations with non-fatal CV events were attenuated, but remained significant; however, the association with mortality was no longer significant in models controlling for interim CV events (Table). Conclusions New-onset AF is a predictor of subsequent CV events and mortality among women even in a healthy, low risk population. After controlling for non-fatal CV events, women presenting with paroxysmal AF were also at elevated risk of stroke, myocardial infarction and heart failure, but not mortality.
- © 2010 by American Heart Association, Inc.