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AF identified as risk factor for MI, especially in women, blacks
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Atrial fibrillation has been identified as an independent risk factor for incident MI, especially in women and blacks, according to new data from the REGARDS study.
Elsayed Z. Soliman
Elsayed Z. Soliman, MD, MSc, MS, of Wake Forest Baptist Medical Center, and colleagues analyzed a prospective cohort of 23,928 participants without CHD at baseline who participated in the REGARDS study between 2003 and 2007, with follow-up through 2009.
During a median of 4.5 years of follow-up, 648 incident MI events occurred. The researchers found that AF was associated with a nearly twofold increased risk for MI (HR=1.96; 95% CI, 1.52-2.52). The risk remained about the same after adjustment for total cholesterol, HDL, smoking, systolic BP, antihypertensive medication use, BMI, diabetes, history of stroke or vascular disease, estimated glomerular filtration rate, albumin to creatinine ratio, C-reactive protein level, and use of warfarin, aspirin and statins (HR=1.7; 95% CI, 1.26-2.3).
A subgroup analysis indicated that risk for MI associated with AF was higher in women (HR=2.16; 95% CI, 1.41-3.31) compared with men (HR=1.39; 95% CI, 0.91-2.1; P for interaction=.03) and in blacks (HR=2.53; 95% CI, 1.67-3.86) compared with in whites (HR=1.26; 95% CI, 0.83-1.93; P for interaction=.02).
There was no difference in AF-associated risk for MI between participants aged 75 years and older (HR=2; 95% CI, 1.16-3.35) and younger than 75 years (HR=1.6; 95% CI, 1.11-2.3; P for interaction=.44).
Warfarin users were less likely to have AF-associated risk for MI (HR=0.76; 95% CI, 0.29-1.94) compared with those who did not use warfarin (HR=1.92; 95% CI, 1.42-2.6; P for interaction=.02). The same was not true for aspirin use (users, HR=2.13; 95% CI, 1.44-3.15; nonusers, HR=1.36; 95% CI, 0.86-2.15; P for interaction=.15).
“In our study, individuals taking blood thinners were at lower risk for heart attack from AF, suggesting a potential role for blood thinners in prevention of heart attacks in AF patients,” Soliman said in a press release. “Traditionally, blood thinners are used to manage AF complications such as stroke, but now there is another dimension to the problem. We need to determine the best strategy to prevent heart attack in AF patients while still dealing with potential stroke risk.”
Disclosure: The researchers report no relevant financial disclosures.
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