Dataset Information

The Determinants of the 13-Year Risk of Incident Atrial Fibrillation in a Russian Population Cohort of Middle and Elderly Age.

ABSTRACT: Atrial fibrillation (AF) is the most common arrhythmia and a predictor of the complications of atherosclerotic cardiovascular diseases (ASCVDs), particularly thromboembolic events and the progression of heart failure. We analyzed the determinants of the 13-year risk of incident AF in a Russian population cohort of middle and elderly age. A random population sample (n = 9360, age 45-69 years) was examined at baseline in 2003-2005 and reexamined in 2006-2008 and 2015-2017 in Novosibirsk (the HAPIEE study). Incident AF was being registered during the average follow-up of 13 years. The final analysis included 3871 participants free from baseline AF and cardiovascular disease (CVD) who participated in all three data collections. In a multivariable-adjusted Cox regression model, the 13-year risk of AF was positively associated with the male sex (hazard ratio (HR) = 2.20; 95% confidence interval (CI) 1.26-3.87); age (HR = 1.10 per year; 95% CI 1.07-1.14); body mass index (BMI), (HR = 1.11 per unit; 95% CI 1.07-1.15); systolic blood pressure (SBP), (HR = 1.02 per 1 mmHg; 95% CI 1.01-1.02), and it was negatively associated with total cholesterol (TC), (HR = 0.79 per 1 mmol/L; 95% CI 0.66-0.94). In women, the risk of AF was more strongly associated with hypertension (HT) and was also negatively related to total cholesterol (TC) level (HR = 0.74 per 1 mmol/L; 95% CI 0.56-0.96). No independent association was found with mean alcohol intake per drinking occasion. These results in a Russian cohort have an implication for the prediction of AF and ASCVD complications in the general population.

SUBMITTER: Shapkina M

PROVIDER: S-EPMC8779704 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

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The Determinants of the 13-Year Risk of Incident Atrial Fibrillation in a Russian Population Cohort of Middle and Elderly Age.

Shapkina Marina M Ryabikov Andrey A Mazdorova Ekaterina E Titarenko Anastasia A Avdeeva Ekaterina E Mazurenko Elena E Shcherbakova Lilia L Pikhart Hynek H Bobak Martin M Malyutina Sofia S

Journal of personalized medicine 20220117 1

Atrial fibrillation (AF) is the most common arrhythmia and a predictor of the complications of atherosclerotic cardiovascular diseases (ASCVDs), particularly thromboembolic events and the progression of heart failure. We analyzed the determinants of the 13-year risk of incident AF in a Russian population cohort of middle and elderly age. A random population sample (<i>n</i> = 9360, age 45-69 years) was examined at baseline in 2003-2005 and reexamined in 2006-2008 and 2015-2017 in Novosibirsk (th ...[more]

PMID: 35055437

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Project description:BackgroundThe most prominent risk factor for atrial fibrillation (AF) is chronological age; however, underlying mechanisms are unexplained. Algorithms using epigenetic modifications to the human genome effectively predict chronological age. Chronological and epigenetic predicted ages may diverge in a phenomenon referred to as epigenetic age acceleration (EAA), which may reflect accelerated biological aging. We sought to evaluate for associations between epigenetic age measures and incident AF.MethodsMeasures for 4 epigenetic clocks (Horvath, Hannum, DNA methylation [DNAm] PhenoAge, and DNAm GrimAge) and an epigenetic predictor of PAI-1 (plasminogen activator inhibitor-1) levels (ie, DNAm PAI-1) were determined for study participants from 3 population-based cohort studies. Cox models evaluated for associations with incident AF and results were combined via random-effects meta-analyses. Two-sample summary-level Mendelian randomization analyses evaluated for associations between genetic instruments of the EAA measures and AF.ResultsAmong 5600 participants (mean age, 65.5 years; female, 60.1%; Black, 50.7%), there were 905 incident AF cases during a mean follow-up of 12.9 years. Unadjusted analyses revealed all 4 epigenetic clocks and the DNAm PAI-1 predictor were associated with statistically significant higher hazards of incident AF, though the magnitudes of their point estimates were smaller relative to the associations observed for chronological age. The pooled EAA estimates for each epigenetic measure, with the exception of Horvath EAA, were associated with incident AF in models adjusted for chronological age, race, sex, and smoking variables. After multivariable adjustment for additional known AF risk factors that could also potentially function as mediators, pooled EAA measures for 2 clocks remained statistically significant. Five-year increases in EAA measures for DNAm GrimAge and DNAm PhenoAge were associated with 19% (adjusted hazard ratio [HR], 1.19 [95% CI, 1.09-1.31]; P<0.01) and 15% (adjusted HR, 1.15 [95% CI, 1.05-1.25]; P<0.01) higher hazards of incident AF, respectively. Mendelian randomization analyses for the 5 EAA measures did not reveal statistically significant associations with AF.ConclusionsOur study identified adjusted associations between EAA measures and incident AF, suggesting that biological aging plays an important role independent of chronological age, though a potential underlying causal relationship remains unclear. These aging processes may be modifiable and not constrained by the immutable factor of time.

Project description:BackgroundAtrial fibrillation (AF) is the most common arrhythmia that is associated with high morbidity and mortality. The prevalence of AF increases with age and the elderly constitute a vulnerable cohort for higher stroke and bleeding complications.MethodsA total of 2163 adult consecutive patients with AF in 19 hospitals and 11 outpatient clinics in Jordan were enrolled in the Jordan AF study from May 2019 to January 2021. The clinical characteristics, demographics, and risk profiles of the elderly patients (≥80 years old) were compared to the younger patients (<80 years old).ResultsOf 2163 patients, 379 (17.5%) constituted the elderly group. The elderly group had higher prevalence of hypertension (79.9% vs 73.5%, p=0.01), lower prevalence of smoking (5.0% vs 15.2%, p<0.001) and lower body mass index (28.1 ± 5.5 kg/m2 vs 29.8 ± 6.2 kg/m2, p<0.001) compared with younger patients. They also had more strokes or systemic emboli (25.6% vs 14.7%, p<0.001), heart failure (30.3% vs 22.9%, p=0.002), pulmonary hypertension (30.6% vs 24.8%, p=0.02), and chronic kidney disease (13.5% vs 8.3%, p=0.002). The elderly cohort had higher mean CHA2DS2-VASc (5.0 ± 1.5 vs 3.6 ± 1.8, p<0.001) and HAS-BLED scores (2.2 ± 1.1 vs 1.5 ± 1.1, p<0.001) compared to younger group. Among 370 elderly with non-valvular AF (NVAF), oral anticoagulant agents (OACs) were prescribed for 278 (84.2%) of eligible high-risk patients. Of the 1402 younger patients with NVAF, OACs were prescribed for 1133 (84.3%) of eligible patients. Direct oral anticoagulant agents (DOACs) were more frequently used in the elderly compared to the young (72.3% vs 62.3%, p<0.001).ConclusionElderly Middle Eastern AF patients have worse baseline clinical profiles and higher risk scores compared to younger patients. The majority of the elderly were prescribed guideline directed OACs, with higher use of DOACs than the younger cohort.Clinical studies registrationThe study is registered on clinicaltrials.gov (unique identifier number NCT03917992).

Project description:Background and aimsAtrial fibrillation (AF) is the most common sustained arrhythmia in adults. Investigations of risk factor profiles for AF according to age and genetic risk groups are essential to promote individualized strategies for the prevention and control of AF.MethodsA total of 409 661 participants (mean age, 56 years; 46% men) free of AF at baseline and with complete information about risk factors were included from the UK Biobank cohort. The hazard ratios and population-attributable risk (PAR) percentages of incident AF associated with 23 risk factors were examined, including 3 social factors, 7 health behaviours, 6 cardiometabolic factors, 6 clinical comorbidities, and the genetic risk score (GRS), across 3 age groups (40-49, 50-59, and 60-69 years) and 3 genetic risk groups (low, moderate, and high GRS).ResultsAfter a follow-up of 5 027 587 person-years, 23 847 participants developed AF. Most cardiometabolic factors and clinical comorbidities showed a significant interaction with age, whereby the associations were generally strengthened in younger groups (Pinteraction < .002). However, only low LDL cholesterol, renal dysfunction, and cardiovascular disease showed a significant interaction with genetic risk, and the associations with these factors were stronger in lower genetic risk groups (Pinteraction < .002). Cardiometabolic factors consistently accounted for the largest number of incident AF cases across all age groups (PAR: 36.2%-38.9%) and genetic risk groups (34.0%-41.9%), with hypertension and overweight/obesity being the two leading modifiable factors. Health behaviours (PAR: 11.5% vs. 8.7%) and genetic risk factors (19.1% vs. 14.3%) contributed to more AF cases in the 40-49 years group than in the 60-69 years group, while the contribution of clinical comorbidities remained relatively stable across different age groups. The AF risk attributable to overall cardiometabolic factors (PAR: 41.9% in the low genetic risk group and 34.0% in the high genetic risk group) and clinical comorbidities (24.7% and 15.9%) decreased with increasing genetic risk. The impact of social factors on AF was relatively low across the groups by age and genetic risk.ConclusionsThis study provided comprehensive information about age- and genetic predisposition-related risk factor profiles for AF in a cohort of UK adults. Prioritizing risk factors according to age and genetic risk stratifications may help to achieve precise and efficient prevention of AF.

Dataset Information

The Determinants of the 13-Year Risk of Incident Atrial Fibrillation in a Russian Population Cohort of Middle and Elderly Age.

Publications

The Determinants of the 13-Year Risk of Incident Atrial Fibrillation in a Russian Population Cohort of Middle and Elderly Age.

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