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Association Between Vascular Cell Adhesion Molecule 1 and Atrial Fibrillation

医学 心房颤动 内科学 危险系数 前瞻性队列研究 骨保护素 人口 入射(几何) 比例危险模型 胃肠病学 心脏病学 置信区间 物理 受体 光学 环境卫生 激活剂(遗传学)
作者
Karin Willeit,Raimund Pechlaner,Peter Willeit,Philipp Skroblin,Bernhard Paulweber,Christiana Schernthaner,Thomas Toell,Georg Egger,Siegfried Weger,Martin Oberhollenzer,Ludmilla Kedenko,Bernhard Iglseder,Enzo Bonora,Georg Schett,Manuel Mayr,Johann Willeit,Stefan Kiechl
出处
期刊:JAMA Cardiology [American Medical Association]
卷期号:2 (5): 516-516 被引量:62
标识
DOI:10.1001/jamacardio.2017.0064
摘要

Accumulating evidence links inflammation and atrial fibrillation (AF).To assess whether markers of systemic and atrial inflammation are associated with incident AF in the general population.The Bruneck Study is a prospective, population-based cohort study with a 20-year follow-up (n = 909). The population included a random sample of the general community aged 40 to 79 years. Levels of 13 inflammation markers were measured at baseline in 1990. Findings were replicated in a case-control sample nested within the prospective Salzburg Atherosclerosis Prevention Program in Subjects at High Individual Risk (SAPHIR) study (n = 1770). Data analysis was performed from February to May 2016.Levels of 13 inflammation markers.Incident AF over a 20-year follow-up period in the Bruneck Study.Of the 909 participants included in the Bruneck Study, mean [SD] age was 58.8 (11.4) years and 448 (49.3%) were women. Among the 880 participants free of prevalent AF (n = 29) at baseline, 117 developed AF during the 20-year follow-up period (incidence rate, 8.2; 95% CI, 6.8-9.6 per 1000 person-years). The levels of soluble vascular cell adhesion molecule 1 (VCAM-1) and osteoprotegerin were significantly associated with incident AF (hazard ratio [HR], 1.49; 95% CI, 1.26-1.78; and 1.46; 95% CI, 1.25-1.69, respectively; P < .001 with Bonferroni correction for both), but osteoprotegerin lost significance after age and sex adjustment (HR, 1.05; 95% CI, 0.87-1.27; P > .99 with Bonferroni correction). Matrix metalloproteinase 9, metalloproteinase inhibitor 1, monocyte chemoattractant protein-1, P-selectin, fibrinogen, receptor activator of nuclear factor-κB ligand, high-sensitivity C-reactive protein, adiponectin, leptin, soluble intercellular adhesion molecule 1, and E-selectin all fell short of significance (after Bonferroni correction in unadjusted and age- and sex-adjusted analyses). The HR for a 1-SD higher soluble VCAM-1 level was 1.34 (95% CI, 1.11-1.62; Bonferroni-corrected P = .03) in a multivariable model. The association was of a dose-response type, at least as strong as that obtained for N-terminal pro-B-type natriuretic peptide (multivariable HR for a 1-SD higher N-terminal pro-B-type natriuretic peptide level, 1.15; 95% CI, 1.04-1.26), internally consistent in various subgroups, and successfully replicated in the SAPHIR Study (age- and sex-adjusted, and multivariable odds ratios for a 1-SD higher soluble VCAM-1 level, 1.91; 95% CI, 1.24-2.96, P = .003; and 2.59; 95% CI, 1.45-4.60; P = .001).Levels of soluble VCAM-1, but not other inflammation markers, are significantly associated with new-onset AF in the general community. Future studies should address whether soluble VCAM-1 is capable of improving AF risk classification beyond the information provided by standard risk scores.
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