Abstract 45: Effect Of Atrial Fibrillation On Brain Atrophy And Cognitive Deficits In Persons Aged ≥65 Years: Analysis Of Cardiovascular Health Study

Background: We tested the hypothesis that surrogate markers of brain degeneration such as atrophy are more prevalent in persons with atrial fibrillation who are at risk for cognitive deficits. Methods: We analyzed the data from the 2,962 women and 2,239 men and added minority cohort of 256 men and 431 women (all aged ≥65 years) enrolled in the Cardiovascular Health Study. Examination components have included medical history questionnaires, measurement of ankle-brachial index, abdominal and carotid ultrasound studies, ambulatory electrocardiograms, and cerebral magnetic resonance imaging (MRI) over the past decade. Atrophy was graded using a nine point scale (1 through 9) based on severity of atrophy. Logistic regression analysis was performed to determine the relationship between atrial fibrillation and prominent atrophy after adjusting for potential confounders. Results: Atrial fibrillation was present in 125 (3.4%) of the 2775 participants who received an MRI at baseline evaluation. The mean mini mental status score (±SD) was similar among participants with atrial fibrillation compared to those without atrial fibrillation (27.8 ±2.3 versus 27.6 ±2.7, p=0.4). The proportion of participants with prominent sulcal atrophy (score of 4 or greater) was non significantly higher among patients with atrial fibrillation (61 of 125 and 1097 of 2650, p=0.1). The proportion of participants with prominent ventricular atrophy (score of 4 or greater) was non significantly higher among patients with atrial fibrillation (69 of 126 and 1287 of 2651, p=0.2). The proportion of participants with previous cortical infarction (46 of 125 and 765 of 2650, p=0.06) and marked perivascular space expansion (5 of 125 and 27 of 2650, p=0.006) on MRI was significantly higher among patients with atrial fibrillation and sulcal atrophy. After adjusting for age, gender, and previous infarction, participants with atrial fibrillation did not have a higher risk of prominent atrophy (odds ratio 0.7, 95% confidence interval 0.5 -0.9, p=0.005). Conclusions: We observed that brain atrophy was more prevalent among persons with atrial fibrillation but due to the age differences and the higher occurrence of previous infarctions.

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Letter by Mont et al Regarding Article, “Physical Activity and Incidence of Atrial Fibrillation in Older Adults: The Cardiovascular Health Study”

Circulation ◽

10.1161/circulationaha.108.821926 ◽

2009 ◽

Vol 119 (5) ◽

Cited By ~ 2

Author(s):

Lluís Mont ◽

Josep Brugada ◽

Roberto Elosua

Keyword(s):

Physical Activity ◽

Atrial Fibrillation ◽

Older Adults ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study

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Abstract MP03: Plasma Sphingolipids and Risks of Heart Failure and Atrial Fibrillation in Older Adults: The Cardiovascular Health Study

Circulation ◽

10.1161/circ.137.suppl_1.mp03 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Rozenn N Lemaitre ◽

Paul N Jensen ◽

Barbara McKnight ◽

Andrew Hoofnagle ◽

Irena B King ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Fatty Acid ◽

Lower Risk ◽

Cardiovascular Health ◽

Biological Activities ◽

Experimental Studies ◽

Health Study ◽

Cardiovascular Health Study

Introduction: Ceramides and sphingomyelins (sphingolipids) are circulating lipids involved in multiple physiological pathways relevant to heart failure (HF) and atrial fibrillation (AF), including apoptosis, oxidative stress, and inflammation. Experimental studies suggest that sphingolipids with different saturated fatty acids exhibit different biological activities, but their relationships with HF and AF are unknown. Hypothesis: Higher levels of plasma ceramide and sphingomyelin that contain the fatty acid 16:0 are associated with higher risks of HF and AF; and higher levels of ceramides and sphingomyelins that contain the fatty acid 20:0, 22:0 or 24:0 are associated with lower risks. Methods: We measured sphingolipids in the Cardiovascular Health Study (CHS) in plasma samples from 1994-95 (N=4026) or from 1992-93 (N=586). We assessed the separate associations of the levels of 8 sphingolipids with risks of incident HF and incident AF using Cox regression. A p-value threshold of 0.006 was used to account for multiple testing. Results: Among 4,612 participants, 1179 incident HF and 1198 incident AF occurred during >40,000 person-years of follow-up. In adjusted analyses, higher levels of Cer-16 (ceramide with 16:0) and SM-16 (sphingomyelin with 16:0) were associated with higher risk of incident HF, but not with risk of incident AF (Table). In contrast, higher levels of Cer-20, Cer-22 and Cer-24 were each associated with lower risk of AF, but not with risk of HF. Higher levels of SM-20, SM-22, and SM-24 tended to be associated with lower risks of AF and HF, with only the association of SM-20 with AF significant. Conclusions: Plasma levels of ceramide and sphingomyelin with 16:0 show different associations with HF and AF than species with 20:0, 22:0 or 24:0. Associations of Cer-16 and SM-16 specifically with higher risk of HF may be due to a role of apoptosis in HF. The novel findings that Cer-20, Cer-22, and Cer-24 are associated with lower risk of AF warrant further examination of the role of these sphingolipids in protecting from AF.

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Abstract P420: Alcohol Consumption and Longitudinal Changes in Magnetic Resonance Imaging-defined Brain Abnormalities: The Cardiovascular Health Study

Circulation ◽

10.1161/circ.141.suppl_1.p420 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Simona Costanzo ◽

Traci M Bartz ◽

Giovanni de Gaetano ◽

Augusto F Di Castelnuovo ◽

Licia Iacoviello ◽

...

Keyword(s):

White Matter ◽

Alcohol Consumption ◽

Brain Atrophy ◽

Alcohol Intake ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study ◽

Brain Volumes ◽

Total Brain

Introduction: Alcohol intake has been related with a complex group of associations with brain structure in cross-sectional analyses, but to our knowledge, its prospective relationship with structural brain abnormalities detected by MRI has never been reported. Hypothesis: We hypothesized that consumers of 1-<7 drinks/week would have slower progression of leukoaraiosis (white matter abnormalities) but more rapid progression of brain atrophy than longer-term abstainers. Methods: As part of the Cardiovascular Health Study, 1 996 adults aged ≥65 years underwent MRI scanning in 1991-94 and again in 1997-99, having excluded 120 participants with a history of cerebrovascular disease before the initial scan. Alcohol consumption was assessed at each annual visit by self-reported intake of wine, beer and liquor. A 10-point white matter grade (WMG) and ventricular grade (VG) were assessed in a standardized and blinded manner in both scans; hippocampal and total brain volumes were also quantified on the second scan. We estimated the associations of alcohol intake in categories (as reported closest to the date of initial scan), with MRI findings at follow-up with multinomial ordered logistic regression (WMG ≤ 3 ref and ≥ 4; VG ≤ 3 ref , =4 and ≥5) using inverse probability weighting to account for attrition. Results: We observed a U-shaped association with WMG, with significantly lower risk among participants consuming 1-<7 drinks/week (OR 0.38; 95% CI 0.17-0.82, table) than long-term abstainers (P quadtrend = 0.01). For VG, the association was inverse (P trend = 0.06), with significantly less progression among drinkers of 1-<7 drinks/week than long-term abstainers (OR 0.62; 95% CI 0.40-0.97). We identified no significant associations of alcohol intake with quantitative mean hippocampal or total brain volumes at the second scan. Conclusions: Compared with long-term abstention, consumption of 1-<7 drinks/week of alcohol was generally associated with less progression of leukoaraiosis and some measures of brain atrophy in older adults.

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Plasma Ceramides and Sphingomyelins in Relation to Atrial Fibrillation Risk: The Cardiovascular Health Study

Journal of the American Heart Association ◽

10.1161/jaha.119.012853 ◽

2020 ◽

Vol 9 (4) ◽

Author(s):

Paul N. Jensen ◽

Amanda M. Fretts ◽

Andrew N. Hoofnagle ◽

Colleen M. Sitlani ◽

Barbara McKnight ◽

...

Keyword(s):

Atrial Fibrillation ◽

Fatty Acids ◽

Palmitic Acid ◽

Cardiovascular Health ◽

Saturated Fatty Acids ◽

Behenic Acid ◽

Hazard Ratio ◽

Health Study ◽

Cardiovascular Health Study ◽

Long Chain

Background Ceramides exhibit multiple biological activities that may influence the pathophysiological characteristics of atrial fibrillation (AF). Whether the length of the saturated fatty acid carried by the ceramide or their sphingomyelin precursors are associated with AF risk is not known. Methods and Results Among 4206 CHS (Cardiovascular Health Study) participants (mean age, 76 years; 40% men) who were free of prevalent AF at baseline, we identified 1198 incident AF cases over a median 8.7 years of follow‐up. We examined 8 sphingolipid species: ceramide and sphingomyelin species with palmitic acid and species with very‐long‐chain saturated fatty acids: arachidic; behenic; and lignoceric. In adjusted Cox regression analyses, ceramides and sphingomyelins with very‐long‐chain saturated fatty acids were associated with reduced AF risk (ie, per 2‐fold higher ceramide with behenic acid hazard ratio, 0.71; 95% CI, 0.59–0.86; sphingomyelin with behenic acid hazard ratio, 0.60; 95% CI, 0.46–0.77). In contrast, ceramides and sphingomyelins with palmitic acid were associated with increased AF risk (ceramide with palmitic acid hazard ratio, 1.31; 95% CI, 1.03–1.66; sphingomyelin with palmitic acid hazard ratio, 1.73; 95% CI, 1.18–2.55). Associations were attenuated with adjustment for NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), but did not differ significantly by age, sex, race, body mass index, or history of coronary heart disease. Conclusions Our findings suggest that several ceramide and sphingomyelin species are associated with incident AF, and that these associations differ on the basis of the fatty acid. Ceramides and sphingomyelins with palmitic acid were associated with increased AF risk, whereas ceramides and sphingomyelins with very‐long‐chain saturated fatty acids were associated with reduced AF risk.

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