Atrial Fibrillation and Coronary Events: Competing Risks and Bidirectional Mediation in a Longitudinal Swedish Cohort

Area of Science:

• Cardiovascular Medicine
• Epidemiology
• Biostatistics

Background:

• Atrial fibrillation (AF) and coronary events (CEs) frequently coexist.
• The interplay of risk factors and mediation pathways between AF and CEs is not well understood.

Purpose of the Study:

• To investigate the differential associations of risk factors with incident AF and CEs.
• To examine the bidirectional mediation effects between AF and CEs.

Main Methods:

• A large Swedish cohort study analyzed 25,963 subjects without prior AF, CEs, stroke, or heart failure.
• Multivariable-adjusted Cox models and competing risk analysis assessed risk factor associations.
• Mediation models evaluated bidirectional pathways between AF and CEs.

Main Results:

• Adiposity indices were more strongly associated with AF, while traditional risk factors predominantly linked to CEs.
• Higher apolipoprotein A1 (apoA1) levels correlated with higher AF risk but lower CEs risk; higher apolipoprotein B (apoB) showed opposite associations.
• Diabetes-associated AF risk was significantly mediated by prior CEs (41.5%); prior AF mediated 26.1% of adiposity index effects on CEs.

Conclusions:

• AF and CEs exhibit distinct risk profiles and significant bidirectional mediation.
• Findings support refined risk stratification for AF, CEs, and their co-occurrence.
• Integrated prevention strategies are crucial for managing the comorbidity of AF and CEs.