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Cholesterol paradox in patients with paroxysmal atrial fibrillation
M Annoura1, M Ogawa, K Kumagai
1Department of Internal Medicine, Fukuoka University School of Medicine, Fukuoka, Japan.
Insights
Low serum total cholesterol (TC) and triglyceride (TG) levels are associated with paroxysmal atrial fibrillation (PAF). Reduced high-density lipoprotein-cholesterol (HDL-C) may increase PAF risk, suggesting hypolipoproteinemia contributes to atrial fibrillation.
Area of Science:
- Cardiology
- Biochemistry
Background:
- Hypercholesterolemia is a significant risk factor for coronary heart disease (CHD).
- The relationship between serum lipids, lipoproteins, and paroxysmal atrial fibrillation (PAF) remains under-investigated.
- Existing research primarily focuses on hypercholesterolemia's impact on CHD, not its potential role in arrhythmias like PAF.
Purpose of the Study:
- To investigate the association between serum lipid profiles and paroxysmal atrial fibrillation (PAF).
- To determine if specific lipid or lipoprotein levels correlate with the prevalence of PAF.
- To explore the potential role of hypolipoproteinemia in the pathophysiology of PAF.
Main Methods:
- A case-control study design was employed.
- Cases were defined as individuals with ECG-detectable PAF, while controls had no history of PAF.
- Coronary heart disease patients were excluded to isolate the effects of lipids on PAF.
- Analysis of covariance and multiple logistic regression were used to analyze lipid data adjusted for age and gender.
Main Results:
- Patients with PAF exhibited lower mean serum total cholesterol (TC), triglyceride (TG), and high-density lipoprotein-cholesterol (HDL-C) levels compared to controls.
- Inverse and linear associations were observed between TC, TG, HDL-C quartiles and the prevalence of PAF.
- The association between TC or TG and PAF was significant only when HDL-C levels were low, not when they were high.
- Individuals with low TC/TG and low HDL-C had a significantly higher odds ratio for PAF compared to those with high TC/TG and high HDL-C.
Conclusions:
- Low serum levels of TC and TG are characteristic of patients with PAF.
- Reduced HDL-C levels appear to be a potential contributing factor to the development of PAF.
- Hypolipoproteinemia, particularly low HDL-C, may influence atrial electrophysiological properties, increasing vulnerability to atrial fibrillation.
Abstract:
Hypercholesterolemia is a major risk factor for coronary heart disease (CHD), but the associations among lipids, lipoproteins and paroxysmal atrial fibrillation (PAF) have not yet been reported. The associations among lipids, lipoproteins and PAF were examined in a case-control study, in which cases and controls were defined as those with/without definite ECG-detectable PAF, respectively. CHD patients were excluded from the study. The mean values of serum total cholesterol (TC), triglyceride (TG) and high density lipoprotein-cholesterol (HDL-C), after adjusting for age and gender, in patients with PAF were lower than those in patients without PAF (175 +/- 4 mg/dl vs. 190 +/- 3 mg/dl, 104 +/- 7 mg/dl vs. 123 +/- 6 mg/dl, 46.0 +/- 1.7 mg/dl vs. 51.8 +/- 1.4 mg/dl, respectively), as assessed by an analysis of covariance. After controlling for age and gender, TC, TG and HDL-C (all in quartiles) were inversely and linearly (p < 0.05) associated with the percentage of patients with PAF, as assessed by a multiple logistic regression analysis. The associations between TC or TG and PAF varied with the HDL-C level: significant when HDL-C was low (p < 0.05), but not when HDL-C was high. The odds ratio (relative risk of PAF) for patients with both low TC or TG and low HDL-C was 4.08 (95% CI: 1.81-9.57) times or 9. 40 (3.25-32.0) times higher (p < 0.01) than that for patients with high TC or TG and high HDL-C, respectively. In conclusion, low serum levels of TC and TG were found in PAF patients, while reduced HDL-C may cause PAF. Hypolipoproteinemia including low HDL-C may affect atrial vulnerability and cause atrial fibrillation.