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Blood Biomarkers and the Risk of Coronary Disease in Atrial Fibrillation
Andres Cordova Sanchez1, Katherine Wilkinson1, Samuel A P Short2
1University of Vermont Larner College of Medicine Burlington VT USA.
Insights
Biomarkers like NT-proBNP and GDF-15 predict coronary heart disease (CHD) in atrial fibrillation (AF) patients. These markers, related to myocardial strain and inflammation, offer insights into AF
Area of Science:
- Cardiology
- Biomarker Research
- Arrhythmia Studies
Background:
- Atrial fibrillation (AF) is a common arrhythmia and a newly identified risk factor for coronary heart disease (CHD).
- The underlying mechanisms linking AF to CHD are not well understood.
- Biomarkers may elucidate these mechanisms and identify CHD predictors in AF patients.
Purpose of the Study:
- To investigate the association between cardiovascular risk biomarkers and incident CHD in individuals with prevalent AF.
- To identify specific biomarkers that can predict the risk of developing CHD in the AF population.
Main Methods:
- Utilized data from the REGARDS cohort study (30,239 adults aged 45+).
- Included 1818 participants with baseline AF and no history of stroke or CHD.
- Measured 13 cardiovascular risk biomarkers and used Cox proportional hazards models to assess incident CHD risk.
Main Results:
- Over 9 years, 201 (11%) participants developed incident CHD.
- NT-proBNP (N-terminal pro-B-type natriuretic peptide) and GDF-15 (growth differentiation factor 15) showed the strongest associations with incident CHD.
- Other associated biomarkers included C-reactive protein, interleukin-6, D-dimer, cholesterol, lipoprotein(a), triglycerides, low-density lipoprotein, and gamma-glutamyl transferase.
Conclusions:
- Several biomarkers are significantly associated with incident CHD in patients with AF.
- Myocardial strain markers (NT-proBNP) and inflammation markers (GDF-15, interleukin-6) demonstrated the largest predictive associations.
- These findings highlight the role of myocardial strain and inflammation in the pathophysiology linking AF to CHD.
Background:
Atrial fibrillation (AF) is the most common arrhythmia. Although it was recently identified as a risk factor for coronary heart disease (CHD), the underlying pathophysiology is not well understood. Biomarkers could provide insights on underlying mechanisms and identify potential predictors of CHD among people with AF.
Methods:
The REGARDS (Reasons for Geographic and Racial Differences in Stroke) cohort study enrolled 30 239 White and Black adults aged 45 and older in 2003 to 2007. Among those with baseline AF and no history of stroke or CHD, 13 cardiovascular risk biomarkers were measured at baseline. We calculated hazard ratios (HR) for incident CHD by biomarkers using Cox proportional hazards model adjusting for risk factors and use of statins, aspirin, and anticoagulants.
Results:
Among 1818 participants with prevalent AF mean age was 69 years (SD 10 years). There were 201 (11%) cases of incident CHD over 9 years. Several biomarkers were associated with incident CHD: NT-proBNP (N-terminal pro-B-type natriuretic peptide), GDF-15 (growth differentiation factor 15), C-reactive protein, interleukin-6, D-dimer, cholesterol, lipoprotein(a), triglycerides, low-density lipoprotein, and gamma-glutamyl transferase, with HRs 1.17 to 1.69 per SD increment. There were no associations for Factor VIII, galectin 3, and high-density lipoprotein. The largest associations were for NT-proBNP and GDF-15 with respective HRs per SD 1.69 (95% CI, 1.42-2.01) and 1.45 (95% CI, 1.21-1.74). Comparing the top versus bottom tertile, the largest associations were NT-proBNP (HR 3.14 [95% CI 2.03-4.84]), interleukin-6 (HR, 2.69 [95% CI, 1.78-4.06]), and GDF-15 (HR, 2.20 [95% CI, 1.38-3.51]).
Conclusions:
Multiple biomarkers were associated with incident CHD in AF with the largest associations being myocardial strain and inflammation.
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