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Association Between Carotid Atherosclerosis and Atrial Fibrillation, Cardiac, and Renal Function
David Leander Rimmele1, Katrin Borof2, Märit Jensen1
1Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Insights
Carotid atherosclerosis (CA) is linked to heart dysfunction markers, but not renal function, independent of common risk factors. Carotid ultrasound aids in assessing cardiovascular risk by identifying cardiac dysfunction.
Area of Science:
- Cardiology
- Vascular Medicine
- Nephrology
Background:
- Carotid atherosclerosis (CA) is a significant indicator of cardiovascular risk.
- Understanding the interplay between CA, atrial fibrillation (AF), heart function, and renal function is crucial for risk stratification.
- Traditional risk factors may mediate these associations, necessitating further investigation.
Purpose of the Study:
- To investigate whether traditional risk factors mediate the association between carotid atherosclerosis (CA) and atrial fibrillation (AF), heart function, and renal function.
- To determine the independent associations of CA with AF, NT-proBNP, and eGFR.
- To evaluate the utility of carotid ultrasound in assessing cardiovascular risk profiles.
Main Methods:
- Cross-sectional analysis of the first cohort from the population-based Hamburg City Health Study (n=9,466, aged 45-74).
- Carotid ultrasound assessed CA (CIMT ≥ 1 mm or plaques).
- NT-proBNP and eGFR measured heart and renal function, respectively. Multivariable regression analyzed associations.
Main Results:
- CA was present in 34% of participants.
- Individuals with CA showed higher prevalence of AF (9.6% vs 4.3%), elevated NT-proBNP (100 vs 73 pg/mL), and lower eGFR (82.8 vs 87.1 mL/min).
- CA remained independently associated with NT-proBNP but not eGFR after adjusting for risk factors. The association with AF was not independent of NT-proBNP.
Conclusions:
- Carotid atherosclerosis is independently associated with markers of cardiac dysfunction (NT-proBNP), mediated through common risk factors and NT-proBNP itself.
- The association between CA and AF appears to be mediated by NT-proBNP levels.
- CA is not associated with renal function (eGFR) independent of other factors. Carotid ultrasound is valuable for cardiovascular risk assessment.
Objective:
The aim was to analyse whether the association between carotid atherosclerosis (CA) and atrial fibrillation (AF), heart function, and renal function is mediated by traditional risk factors.
Methods:
In the prospective, single centre, long term, population based Hamburg City Health Study citizens, between 45 and 74 years of age were studied by cross sectional analysis of the first cohort. Laboratory values, blood pressure, heart rhythm, and body mass index (BMI) were examined. Carotid intima media thickness (CIMT) and plaques were assessed by carotid ultrasound, and CA was defined as either CIMT ≥ 1 mm or presence of plaques or both. N-terminal pro-brain natriuretic peptide (NT-proBNP), and glomerular filtration rate (eGFR) were quantified as measures of heart and renal function. Association between CA and AF, NT-proBNP, and eGFR was analysed by multivariable linear and logistic regression.
Results:
Of the first 10 000 participants, carotid ultrasound was available for 9 466 (95%). Of these, 2 937 (31%) had carotid plaques, 643 (7%) had CIMT ≥ 1 mm, and 412 (4%) presented with both, so that 3 168 (34%) had CA. Participants with CA had AF more frequently (9.6% vs. 4.3%; p < .001), higher levels of NT-proBNP (median 100 vs. 73 pg/mL; p < .001), and lower eGFR (82.8 vs. 87.1 mL/min; p < .001) than those without CA. Adjusted for age and sex, CA was associated with AF (p = .01; OR 1.29) and higher NT-proBNP levels (p < .001; β = 0.12), but not with eGFR. After further adjustment for vascular risk factors and history of cardiovascular diseases, CA remained associated with NT-proBNP (p < .001; β = 0.10), but additionally adjusted for NT-proBNP (p < .001; OR 2.80) not with AF.
Conclusion:
CA is independently associated with higher levels of NT-proBNP, through common risk factors and NT-proBNP with AF, and not with renal function. CA's association with a marker of cardiac dysfunction beyond known common risk factors supports the value of carotid ultrasound in defining patients' cardiovascular risk profile. The measures of CA, i.e., CIMT and carotid plaque, had an equally directed and additive influence.
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