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Published on: February 26, 2013
Reduced Risk of Atrial Fibrillation Following Cholecystectomy: A Nationwide Population-Based Study
Tung Ching Ho1,2, Yu-Ching Chen2, Che-Chen Lin3
1Department of Cardiology, Chang Hua Hospital, Changhua County, Taiwan.
Insights
Gallstone disease (GD) significantly increases the risk of developing atrial fibrillation (AF). Cholecystectomy, a gallbladder removal surgery, was associated with a reduced risk of AF in patients with GD.
Area of Science:
- Cardiology
- Gastroenterology
- Epidemiology
Background:
- Gallstone disease (GD) is a known risk factor for cardiovascular disease.
- The association between GD and atrial fibrillation (AF) has not been previously established.
- Investigating this link is crucial for understanding cardiovascular risks associated with GD.
Purpose of the Study:
- To determine if gallstone disease (GD) is associated with an increased risk of atrial fibrillation (AF).
- To evaluate the impact of cholecystectomy on AF risk in patients with GD.
- To analyze AF risk in relation to age and CHA2DS2-VASc scores within the GD population.
Main Methods:
- A population-based cohort study utilizing the Taiwan National Health Insurance Research Database (2001-2011).
- A cohort of 230,076 patients with GD was compared to an equal number of matched controls.
- Statistical analysis included hazard ratios (HR) and 95% confidence intervals (CI) to assess AF risk.
Main Results:
- Patients with GD had a significantly higher risk of developing AF (HR: 1.20, 95% CI: 1.16-1.25).
- GD patients without cholecystectomy showed a markedly increased AF risk (HR: 1.57, 95% CI: 1.50-1.63).
- Cholecystectomy was associated with a reduced AF risk (HR: 0.85, 95% CI: 0.81-0.90).
- AF risk increased with age and CHA2DS2-VASc score in the GD cohort.
Conclusions:
- Gallstone disease is independently associated with an elevated risk of atrial fibrillation.
- Cholecystectomy may mitigate the risk of AF in patients with gallstone disease.
- Regular cardiovascular monitoring is recommended for GD patients, particularly younger individuals with additional risk factors.
Abstract:
Background: Gallstone disease (GD) is associated with a high risk of cardiovascular disease. However, it is unknown whether GD contributes to atrial fibrillation (AF). We aimed to investigate the association between GD and AF. Methods: We performed a population-based cohort study using data from the Taiwan National Health Insurance Research Database between 2001 and 2011. A GD cohort of 230,076 patients was compared with a control cohort consisting of an equal number of patients matched for age, sex, cardiovascular and gastrointestinal comorbidities. Results: In total, 5,992 (49.8/10,000 person-years) patients with GD and 5,804 (44.5/10,000 person-years) controls developed AF. GD increased AF risk with a hazard ratio (HR) of 1.20 [95% confidence interval (CI), 1.16-1.25]. In patients with GD but without cholecystectomy, the HR of AF reached 1.57 (95% CI = 1.50-1.63). After cholecystectomy, the HR of AF significantly decreased to 0.85 (95% CI = 0.81-0.90). Among the three age groups with GD (<45, 45-64, and ≥65 years), the adjusted HRs of AF were 1.59 (95% CI = 1.08-2.33), 1.31 (95% CI = 1.18-1.45), and 1.18 (95% CI = 1.13-1.22), respectively. Compared with patients with a CHA2DS2-VASc score equal to 0, the HRs of AF risk among total cohort patients and a score equal to 1, 2, 3, and ≥ 4 were 1.28 (95% CI = 1.15-1.43), 2.26 (95% CI = 2.00-2.56), 3.81 (95% CI = 3.35-4.34), and 5.09 (95% CI = 4.42-5.87), respectively. Conclusion: This population-based longitudinal follow-up study showed that patients with GD had an increased AF risk. Moreover, cholecystectomy was related to reduced AF risk. Cardiovascular checkups may be necessary for patients with GD, especially those who are young and have other typical risk factors.
