Association between insulin resistance and risk of atrial fibrillation in non-diabetics

Aims Previous studies from Western countries have been unable to demonstrate a relationship between insulin resistance and new-onset atrial fibrillation. We aimed to evaluate this relationship in the nondiabetic Asian population. Methods Between 2001–2003, 8175 adults (mean age 51.5 years, 53% women) without both existing atrial fibrillation and diabetes and with insulin resistance measures at baseline were enrolled and were followed by biennial electrocardiograms thereafter until 2014. We constructed multivariable-adjusted Cox proportional hazard models for risk of incident atrial fibrillation. Results Over a median follow-up of 12.3 years, 136 participants (1.89/1000 person-years) developed atrial fibrillation. Higher homeostasis model assessment of insulin resistance (HOMA-IR) was independently associated with newly developed atrial fibrillation (hazard ratio 1.61, 95% confidence interval 1.14–2.28). Atrial fibrillation development increased at the HOMA-IR levels approximately between 1–2.5, and then plateaued afterwards ( p = 0.031). Conclusion There is a significant relationship between insulin resistance and atrial fibrillation development independent of other known risk factors, including obesity in a nondiabetic Asian population.

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Abstract 11097: Racial Differences in Clinical Outcomes in Elderly Patients With Atrial Fibrillation

Circulation ◽

10.1161/circ.130.suppl_2.11097 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Rajesh Kabra ◽

Peter Cram ◽

Saket Girotra ◽

Mary Vaughan-Sarrazin

Keyword(s):

Atrial Fibrillation ◽

Racial Differences ◽

Proportional Hazard ◽

Composite Outcome ◽

Newly Diagnosed ◽

Relative Hazard ◽

Risk Of Death ◽

Cox Proportional Hazard ◽

Cox Proportional Hazard Models

Introduction: Atrial fibrillation (AF) is associated with stroke and death, but the effect of race on these outcomes is not known. Methods: Medicare administrative data from 2010-2011 were used to identify patients with newly diagnosed AF who were categorized based on race as white, black and Hispanic. Racial differences in the primary outcome of death and secondary outcomes of stroke and the composite of stroke and death were assessed using Cox proportional hazard models. Results: Among 517,941 patients with newly diagnosed AF, 452,986 (87%) were whites, 36,425 (7%) were blacks and 28,530 (6%) were Hispanics. The mean age was 79 ± 8 years and 40.5% were males. Over a mean follow-up period of 0.9 years per patient, 68,250 (15.1%) whites, 7665 (20%) blacks and 4814 (16.9%) Hispanics died. Stroke was diagnosed in 6,509 (1.4%) whites, 843 (2.3%) blacks and 507 (1.8%) Hispanics. Compared to whites, blacks had a significantly higher hazard of death (Hazard Ratio [HR] =1.43; 95% CI 1.40-1.47; p<0.001), stroke (HR=1.69; 95% CI 1.57-1.81; p<0.001), and the composite outcome (HR= 1.46; 95% CI 1.43-1.49; p<0.001). After controlling for pre-existing co-morbidities, the higher hazard of death (HR 0.99; 95% CI 0.97-1.01; p=0.41) and the composite outcome (HR=1.02; 95% CI 0.99-1.04; p=0.135) in blacks were eliminated and the relative hazard of stroke (HR=1.44; 95% CI 1.34-1.55; p<0.001) was reduced compared to the whites. Similarly, Hispanics had a higher risk of death (HR= 1.13; 95% CI 1.10-1.17; p<0.001), stroke (HR=1.26; 95% CI, 1.15-1.38; p<0.001) and the composite outcome (HR= 1.15; 95% CI 1.12-1.18; p<0.001), as compared to whites. The relative hazard of death and the composite outcome were noted to be lower in Hispanics, compared to whites, after controlling for pre-existing co- morbidities (HR= 0.93; 95% CI 0.92-0.96; p<0.001 and HR= 0.95; 95% CI 0.92-0.97; p<0.001 respectively). The relative hazard of stroke was also attenuated (HR=1.15; 95% CI 1.05-1.26; p=0.002). Conclusions: In an elderly Medicare population with newly diagnosed AF, the risks of death and stroke are higher in blacks and Hispanics, as compared to whites. This is likely due to increased co-morbidities in blacks and Hispanics.

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Acute Dental Periapical Abscess and New-Onset Atrial Fibrillation: A Nationwide, Population-Based Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10132927 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2927

Author(s):

Amaar Obaid Hassan ◽

Gregory Y. H. Lip ◽

Arnaud Bisson ◽

Julien Herbert ◽

Alexandre Bodin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Multivariable Analysis ◽

National Database ◽

Increased Risk ◽

Periapical Abscess ◽

The Relationship ◽

Onset Atrial Fibrillation ◽

New Onset

There are limited data on the relationship of acute dental infections with hospitalisation and new-onset atrial fibrillation (AF). This study aimed to assess the relationship between acute periapical abscess and incident AF. This was a retrospective cohort study from a French national database of patients hospitalized in 2013 (3.4 million patients) with at least five years of follow up. In total, 3,056,291 adults (55.1% female) required hospital admission in French hospitals in 2013 while not having a history of AF. Of 4693 patients classified as having dental periapical abscess, 435 (9.27%) developed AF, compared to 326,241 (10.69%) without dental periapical abscess that developed AF over a mean follow-up of 4.8 ± 1.7 years. Multivariable analysis indicated that dental periapical abscess acted as an independent predictor for new onset AF (p < 0.01). The CHA2DS2VASc score in patients with acute dental periapical abscess had moderate predictive value for development of AF, with Area Under the Curve (AUC) 0.73 (95% CI, 0.71–0.76). An increased risk of new onset AF was identified for individuals hospitalized with dental periapical abscess. Careful follow up of patients with severe, acute dental periapical infections is needed for incident AF, as well as investigations of possible mechanisms linking these conditions.

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Long-term impact of new-onset atrial fibrillation complicating acute myocardial infarction on heart failure: insights from the NOAFCAMI-SH registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.1750 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S.L Xu ◽

J Luo ◽

H.Q Li ◽

Z.Q Li ◽

B.X Liu ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Acute Myocardial Infarction ◽

Natural Science ◽

Funding Source ◽

Onset Atrial Fibrillation ◽

New Onset

Abstract Background New-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI) has been associated with poor survival, but the clinical implication of NOAF on subsequent heart failure (HF) is still not well studied. We aimed to investigate the relationship between NOAF following AMI and HF hospitalization. Methods This retrospective cohort study was conducted between February 2014 and March 2018, using data from the New-Onset Atrial Fibrillation Complicating Acute Myocardial Infarction in ShangHai registry, where all participants did not have a documented AF history. Patients with AMI who discharged alive and had complete echocardiography and follow-up data were analyzed. The primary outcome was HF hospitalization, which was defined as a minimum of an overnight hospital stay of a participant who presented with symptoms and signs of HF or received intravenous diuretics. Results A total of 2075 patients were included, of whom 228 developed NOAF during the index AMI hospitalization. During up to 5 years of follow-up (median: 2.7 years), 205 patients (9.9%) experienced HF hospitalization and 220 patients (10.6%) died. The incidence rate of HF hospitalization among patients with NOAF was 18.4% per year compared with 2.8% per year for those with sinus rhythm. After adjustment for confounders, NOAF was significantly associated with HF hospitalization (hazard ratio [HR]: 3.14, 95% confidence interval [CI]: 2.30–4.28; p<0.001). Consistent result was observed after accounting for the competing risk of all-cause death (subdistribution HR: 3.06, 95% CI: 2.18–4.30; p<0.001) or performing a propensity score adjusted multivariable model (HR: 3.28, 95% CI: 2.39–4.50; p<0.001). Furthermore, the risk of HF hospitalization was significantly higher in patients with persistent NOAF (HR: 5.81; 95% CI: 3.59–9.41) compared with that in those with transient NOAF (HR: 2.61; 95% CI: 1.84–3.70; p interaction = 0.008). Conclusion NOAF complicating AMI is strongly associated with an increased long-term risk of heart. Cumulative incidence of outcome Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): 1. National Natural Science Foundation of China, 2. Natural Science Foundation of Shanghai

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Potato consumption and risk of pancreatic cancer in the HELGA cohort

British Journal Of Nutrition ◽

10.1017/s0007114518000788 ◽

2018 ◽

Vol 119 (12) ◽

pp. 1408-1415

Author(s):

Lene A. Åsli ◽

Tonje Braaten ◽

Anja Olsen ◽

Anne Tjønneland ◽

Kim Overvad ◽

...

Keyword(s):

Pancreatic Cancer ◽

Cancer Registries ◽

Glycaemic Index ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

Cox Proportional Hazard Models ◽

The Mean ◽

Potato Consumption ◽

Adjusted Model

AbstractPotatoes have been a staple food in many countries throughout the years. Potatoes have a high glycaemic index (GI) score, and high GI has been associated with several chronic diseases and cancers. Still, the research on potatoes and health is scarce and contradictive, and we identified no prospective studies that had investigated the association between potatoes as a single food and the risk of pancreatic cancer. The aim of this study was to prospectively investigate the association between potato consumption and pancreatic cancer among 114 240 men and women in the prospective HELGA cohort, using Cox proportional hazard models. Information on diet (validated FFQ’s), lifestyle and health was collected by means of a questionnaire, and 221 pancreatic cancer cases were identified through cancer registries. The mean follow-up time was 11·4 (95 % CI 0·3, 16·9) years. High consumption of potatoes showed a non-significantly higher risk of pancreatic cancer in the adjusted model (hazard ratio (HR) 1·44; 95 % CI 0·93, 2·22,Pfor trend0·030) when comparing the highestv.the lowest quartile of potato consumption. In the sex-specific analyses, significant associations were found for females (HR 2·00; 95 % CI 1·07, 3·72,Pfor trend0·020), but not for males (HR 1·01; 95 % CI 0·56, 1·84,Pfor trend0·34). In addition, we explored the associations by spline regression, and the absence of dose–response effects was confirmed. In this study, high potato consumption was not consistently associated with a higher risk of pancreatic cancer. Further studies with larger populations are needed to explore the possible sex difference.

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Farming tasks and the development of rheumatoid arthritis in the agricultural health study

Occupational and Environmental Medicine ◽

10.1136/oemed-2018-105361 ◽

2019 ◽

pp. oemed-2018-105361 ◽

Cited By ~ 4

Author(s):

Christine G Parks ◽

Armando Meyer ◽

Laura E Beane Freeman ◽

Jonathan Hofmann ◽

Dale P Sandler

Keyword(s):

Rheumatoid Arthritis ◽

Self Report ◽

Health Study ◽

Proportional Hazard ◽

Agricultural Health ◽

Cox Proportional Hazard ◽

Hazard Ratios ◽

Cox Proportional Hazard Models ◽

Agricultural Health Study

ObjectivesFarming has been associated with rheumatoid arthritis (RA). Some studies have evaluated the effects of pesticides, but other agricultural exposures may also affect immune response.MethodsWe investigated non-pesticide agricultural exposures in relation to RA in licensed pesticide applicators (n=27 175, mostly male farmers) and their spouses (n=22 231) in the Agricultural Health Study (AHS) cohort (1993–1997) who completed at least one follow-up survey through 2015. Incident RA cases (n=229 applicators and 249 spouses) were identified based on self-report confirmed by use of disease-modifying antirheumatic drugs or medical records. Hazard Ratios (HRs) and 95% Confidence Intervals (CIs) were estimated by Cox proportional hazard models adjusting for applicator status, state, smoking, education and specific pesticide use, allowing estimates to vary by median age when hazards assumptions were not met.ResultsOverall, RA was associated with regularly applying chemical fertilisers (HR=1.50; 95% CI 1.11 to 2.02), using non-gasoline solvents (HR=1.40; 95% CI 1.09 to 1.80), and painting (HR=1.26; 95% CI 1.00 to 1.59). In older applicators (>62 years), RA was associated with driving combines (HR=2.46; 95% CI 1.05 to 5.78) and milking cows (HR=2.56; 95% CI 1.01 to 6.53). In younger participants (≤62 years), RA was inversely associated with raising animals as well as crops (HR=0.68; 95% CI 0.51 to 0.89 vs crops only). Associations with specific crops varied by age: some (eg, hay) were inversely associated with RA in younger participants, while others (eg, alfalfa) were associated with RA in older participants.ConclusionThese findings suggest several agricultural tasks and exposures may contribute to development of RA.

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P1724Advanced interatrial block on electrocardiogram predicts new-onset atrial fibrillation during long term follow-up

European Heart Journal ◽

10.1093/eurheartj/ehx502.p1724 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

M.A. Baturova ◽

A. Lindgren ◽

J. Carlson ◽

Y. Shubik ◽

S.B. Olsson ◽

...

Keyword(s):

Atrial Fibrillation ◽

Long Term Follow Up ◽

Interatrial Block ◽

Onset Atrial Fibrillation ◽

New Onset

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Effectiveness and Safety of Non–Vitamin K Oral Anticoagulants in Comparison to Phenprocoumon: Data from 61,000 Patients with Atrial Fibrillation

Thrombosis and Haemostasis ◽

10.1160/th17-10-0733 ◽

2018 ◽

Vol 118 (03) ◽

pp. 526-538 ◽

Cited By ~ 30

Author(s):

Stefan Hohnloser ◽

Edin Basic ◽

Christopher Hohmann ◽

Michael Nabauer

Keyword(s):

Atrial Fibrillation ◽

Vitamin K ◽

Standard Dose ◽

Oral Anticoagulants ◽

Proportional Hazard ◽

Systemic Embolism ◽

Cox Proportional Hazard ◽

Hazard Ratios ◽

Cox Proportional Hazard Models ◽

Baseline Characteristics

AbstractAll pivotal trials have evaluated non–vitamin K oral antagonists (NOACs) against warfarin. However, in some regions of the world, phenprocoumon is the most widely used vitamin K antagonist (VKA). There is little evidence documenting effectiveness and safety of NOACs compared with phenprocoumon in atrial fibrillation (AF). A retrospective cohort study using a German claims database was conducted to assess effectiveness (stroke, systemic embolism [SE]) and safety (bleeding leading to hospitalization) during therapy with NOACs and phenprocoumon in 61,205 AF patients. Hazard ratios (HRs) for effectiveness and safety outcomes were derived from Cox proportional hazard models, adjusting for baseline characteristics. Propensity score matching was performed as a sensitivity analysis. As a prespecified subgroup analysis, the effects of reduced NOAC dosing were compared with phenprocoumon. A total of 61,205 patients were identified in whom phenprocoumon (n = 23,823, 38.9%), apixaban (n = 10,117, 16.5%), dabigatran (n = 5,122, 8.4%), or rivaroxaban (n = 22,143, 36.2%) was initiated. After adjusting for baseline confounders, all three NOACs tested had significantly lower risks of stroke/SE compared with phenprocoumon (apixaban—HR: 0.77, 95% CI: 0.66–0.90; dabigatran—HR: 0.74, 95% CI: 0.60–0.91; rivaroxaban—HR: 0.86, 95% CI: 0.76–0.97). Apixaban (HR: 0.58, 95% CI: 0.49–0.69) and dabigatran (HR: 0.64, 95% CI: 0.50–0.80) were associated with lower bleeding risks than phenprocoumon, whereas the risk was similar for rivaroxaban and phenprocoumon. All three NOACs showed reduced risk of intracranial bleeding compared with phenprocoumon. Reduced doses of NOACs were predominantly used in patients with advanced age and comorbidities with generally similar effectiveness and safety benefits compared with phenprocumon as standard-dose NOACs.

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Interatrial block, P terminal force or fragmented QRS do not predict new-onset atrial fibrillation in patients with severe chronic kidney disease

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01719-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Tapio Hellman ◽

Markus Hakamäki ◽

Roosa Lankinen ◽

Niina Koivuviita ◽

Jussi Pärkkä ◽

...

Keyword(s):

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

P Wave ◽

Stage 4 ◽

Ckd Stage ◽

Severe Chronic Kidney Disease ◽

Onset Atrial Fibrillation ◽

New Onset

Abstract Background The prevalence of left atrial enlargement (LAE) and fragmented QRS (fQRS) diagnosed using ECG criteria in patients with severe chronic kidney disease (CKD) is unknown. Furthermore, there is limited data on predicting new-onset atrial fibrillation (AF) with LAE or fQRS in this patient group. Methods We enrolled 165 consecutive non-dialysis patients with CKD stage 4–5 without prior AF diagnosis between 2013 and 2017 in a prospective follow-up cohort study. LAE was defined as total P-wave duration ≥120 ms in lead II ± > 1 biphasic P-waves in leads II, III or aVF; or duration of terminal negative portion of P-wave > 40 ms or depth of terminal negative portion of P-wave > 1 mm in lead V1 from a baseline ECG, respectively. fQRS was defined as the presence of a notched R or S wave or the presence of ≥1 additional R waves (R’) or; in the presence of a wide QRS complex (> 120 ms), > 2 notches in R or S waves in two contiguous leads corresponding to a myocardial region, respectively. Results Mean age of the patients was 59 (SD 14) years, 56/165 (33.9%) were female and the mean estimated glomerular filtration rate was 12.8 ml/min/1.73m2. Altogether 29/165 (17.6%) patients were observed with new-onset AF within median follow-up of 3 [IQR 3, range 2–6] years. At baseline, 137/165 (83.0%) and 144/165 (87.3%) patients were observed with LAE and fQRS, respectively. Furthermore, LAE and fQRS co-existed in 121/165 (73.3%) patients. Neither findings were associated with the risk of new-onset AF within follow-up. Conclusion The prevalence of LAE and fQRS at baseline in this study on CKD stage 4–5 patients not on dialysis was very high. However, LAE or fQRS failed to predict occurrence of new-onset AF in these patients.

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Second-Hand Smoke As a Predictor of Smoking Cessation Among Lung Cancer Survivors

Journal of Clinical Oncology ◽

10.1200/jco.2013.50.9695 ◽

2014 ◽

Vol 32 (6) ◽

pp. 564-570 ◽

Cited By ~ 44

Author(s):

Lawson Eng ◽

Jie Su ◽

Xin Qiu ◽

Prakruthi R. Palepu ◽

Henrique Hon ◽

...

Keyword(s):

Lung Cancer ◽

Smoking Cessation ◽

Cancer Survivors ◽

Second Hand Smoke ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

Cox Proportional Hazard Models ◽

Peer Smoking ◽

After Cancer

Purpose Second-hand smoke (SHS; ie, exposure to smoking of friends and spouses in the household) reduces the likelihood of smoking cessation in noncancer populations. We assessed whether SHS is associated with cessation rates in lung cancer survivors. Patients and Methods Patients with lung cancer were recruited from Princess Margaret Cancer Centre, Toronto, ON, Canada. Multivariable logistic regression and Cox proportional hazard models evaluated the association of sociodemographics, clinicopathologic variables, and SHS with either smoking cessation or time to quitting. Results In all, 721 patients completed baseline and follow-up questionnaires with a mean follow-up time of 54 months. Of the 242 current smokers at diagnosis, 136 (56%) had quit 1 year after diagnosis. Exposure to smoking at home (adjusted odds ratio [aOR], 6.18; 95% CI, 2.83 to 13.5; P < .001), spousal smoking (aOR, 6.01; 95% CI, 2.63 to 13.8; P < .001), and peer smoking (aOR, 2.49; 95% CI, 1.33 to 4.66; P = .0043) were each associated with decreased rates of cessation. Individuals exposed to smoking in all three settings had the lowest chances of quitting (aOR, 9.57; 95% CI, 2.50 to 36.64; P < .001). Results were similar in time-to-quitting analysis, in which 68% of patients who eventually quit did so within 6 months after cancer diagnosis. Subgroup analysis revealed similar associations across early- and late-stage patients and between sexes. Conclusion SHS is an important factor associated with smoking cessation in lung cancer survivors of all stages and should be a key consideration when developing smoking cessation programs for patients with lung cancer.

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