Abstract 13455: Association of Inflammation and Hemostasis Biomarkers with Atrial Fibrillation and Coronary Heart Disease: the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Introduction: Recent studies suggest atrial fibrillation (AF) is an independent risk factor for coronary heart disease (CHD). AF and CHD are both associated with increased levels of inflammation and hemostasis biomarkers but it is unknown whether these biomarkers modify CHD risk in AF.
Methods: The REasons for Geographic and Racial Differences in Stroke (REGARDS) study recruited 30,239 black and white participants between 2003 and 2007 who have been followed for CHD events through 2011. High-sensitivity C-reactive protein (CRP), d-dimer, factor VIII, and fibrinogen were measured in CHD cases (n=647) and a stratified cohort random sample (n=883). Using a case-cohort approach, Cox models tested the association between AF and CHD and whether hemostasis or inflammation biomarkers were associated with CHD in those with and without AF.
Results: At baseline, 12.2% of the CHD cases and 7.1% of the cohort random sample had AF. AF was associated with higher levels of factor VIII (β=10.2, p=0.03) and fibrinogen (β=27.4, p=0.002) but not D-dimer or CRP. Over a median of 4.4 years (interquartile range=3.1, 5.5), AF was associated with an increased risk of CHD (HR 2.08, 95% CI=1.15, 3.74) after adjusting for risk factors listed in Table 1. Per standard deviation increments, there were no significant interactions between AF and CRP, factor VIII, and fibrinogen (Table 1). The association of d-dimer with CHD was greater in those with AF (HR 2.52, 95% CI=1.49, 4.26) than in those without AF (HR 1.34, 95% CI=1.12, 1.61) (p-interaction=0.02).
Conclusions: D-dimer is a stronger risk factor for CHD in those with than without AF. Our data suggest that alterations in hemostasis play a unique role in the increased CHD risk among those with AF and d-dimer potentially is a useful marker for identifying AF persons at risk for CHD.
Author Disclosures: W.T. O’Neal: None. E.Z. Soliman: None. G. Howard: None. V. Howard: None. M.M. Safford: None. M. Cushman: None. N. Zakai: None.
- © 2014 by American Heart Association, Inc.