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Commentary

Hypertension, Hyperlipidemia for Developing and Sustaining Atrial Fibrillation


May 04, 2021

mark munger, pharmdAtrial fibrillation is a major health care disorder being the most common arrhythmia, is associated with low quality of life, increased risk of morbidity and mortality, and a very high cost burden.1 Advancing age and tobacco smoking, alcohol abuse, obesity, diabetes, myocardial infarction and heart failure are putative risk factors for the development of atrial fibrillation.2-5 The presence of hypertension and hyperlipidemia are notable potentially mutable risk factors for development and sustaining of atrial fibrillation.  To this point, two recent studies have been published that shed light these risk factors. 

The first study used Mendelian randomization to investigate the potential casual association of blood pressure with the risk of developing atrial fibrillation.6 Genetic variants associated with blood pressure traits were utilized from the International Consortium of Blood Pressure-Genome-Wide Association Study of atrial fibrillation genetics (N=299,024). Assessment of 894 variants of > 1 million subjects of European ancestry showed an association between atrial fibrillation and systolic blood pressure with an odds ratio [OR]: 1.018 per 1 mmHg increase (95% CI: 1.001-1.028). The relationship was robust in sensitivity analysis and did not change when single-nucleotide polymorphisms or other possible confounders (ie, coronary artery disease and obesity) were excluded.  

The second study was a systematic review and meta-analysis of investigating the efficacy of statins on all-cause mortality in atrial fibrillation patients.7 In 14 studies (2 post-hoc analysis of randomized clinical trials; 8 prospective and 4 retrospective) with 100,287 atrial fibrillation patients, of whom 23,238 were taking statins for 12 months, the hazard ratio (HR) was 0.59 (95% CI: 0.54-0.65). The association was consistent by the confounders of age, sex, and the presence of cardiovascular or cerebrovascular disease. Cardiovascular-related mortality was reduced by 25%. 

These studies support that atrial fibrillation is preventable. Goal-directed use of antihypertensives and statin drugs appear to be effective strategies to reduce atrial fibrillation incidence, morbidity (ie, stroke, heart failure, dementia, and depression), and mortality.  

 

References:

  1. Kirchhof P, Benussi S, Kotecha D, et a. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the EACTS. Eur Heart J 2016;37:2893-2962.
  2. Alonso A, Krijthe BP, Aspelund T, et al. Simple risk model predicts of atrial fibrillation in a racially and geographically diverse population: the CHARGE-AF Consortioum. J Am Heart Assoc. 2013;18:e000102.
  3. Chamberlain AM, Alonso A, Gersh BP, et al. Multimorbidity and the risk of hospitalization and death in atrial fibrillation: a population-based study. Am Heart J 2017;185:74-84.
  4. Schnabel RB, Sullivan LM, Levy D, et al. Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study. Lancet 2009;386:739-45.
  5. Kim YG, Han K-D, Choi J-I, et al. Non-genetic risk factors for atrial fibrillation are equally important in both young and old age: a nationwide population-based study. Eur J Preve Cardiol 2020:doi:10.1177/20474877320915664.
  6. Georgiopoulos G, Ntritsos G, Stamatelopoulos K, et al. The relationship between blood pressure and risk of atrial fibirillation: a Mendelian randomization study. Eur J Prevent Cardiol 2021;doi:10:10.1093/eurjpc/zwab005.
  7. Pastori D, Baratta F, Di Rocco A, et al. Statin use and mortality in atrial fibrillation: A systematic review and meta-analysis of 100,287 patients. Pharmacol Res 2021:doi:org/10.1016/j.phrs.2021.105418

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