Patients with a Combination of Atrial Fibrillation and Chronic Heart Failure in Clinical Practice: Comorbidities, Drug Treatment and Outcomes

Aim. To assess in clinical practice the structure of multimorbidity, cardiovascular pharmacotherapy and outcomes in patients with a combination of atrial fibrillation (AF) and chronic heart failure (CHF) based on prospective registries of patients with cardiovascular diseases (CVD).Materials and Methods. The data of 3795 patients with atrial fibrillation (AF) were analyzed within the registries RECVASA (Ryazan), RECVASA FP (Moscow, Kursk, Tula, Yaroslavl), REGION-PO and REGION-LD (Ryazan), REGION-Moscow, REGATA (Ryazan). The comparison groups consisted of 3016 (79.5%) patients with AF in combination with CHF and 779 (29.5%) patients with AF without CHF. The duration of prospective observation is from 2 to 6 years.Results. Patients with a combination of AF and CHF (n=3016, age was 72.0±10.3 years; 41.8% of men) compared with patients with AF without CHF (n=779, age was 70.3±12.0 years; 43.5% of men) had a higher risk of thromboembolic complications (CHA2DS2-VASc – 4.68±1.59 and 3.10±1.50; p<0.001) and hemorrhagic complications (HAS-BLED – 1.59±0.77 and 1.33±0.76; p<0.05). Patients with a combination of AF and CHF significantly more often (p<0.001) than in the absence of CHF were diagnosed with arterial hypertension (93.9% and 83.8%), coronary heart disease (87.9% and 53,5%), myocardial infarction (28.4% and 14.0%), diabetes mellitus (22.4% and 7.7%), chronic kidney disease (24.8% and 16.2%), as well as respiratory diseases (20.1% and 15.3%; p=0.002). Patients with AF in the presence of CHF, compared with patients without CHF, were more often diagnosed with a permanent form of arrhythmia (49.3% and 32.9%; p<0.001) and less often paroxysmal (22.5% and 46.2%; p<0.001) form of arrhythmia. Ejection fraction ≤40% (9.3% and 1.2%; p<0.001), heart rate ≥90/min (23.7% and 19.3%; p=0.008) and blood pressure ≥140/90 mm Hg (59.9% and 52.2%; p<0.001) were recorded with AF in the presence of CHF more often than in the absence of CHF. The frequency of proper cardiovascular pharmacotherapy was higher, albeit insufficient, in the presence of CHF (64.9%) than in the absence of it (56.1%), but anticoagulants were prescribed less frequently when AF and CHF were combined (38.8% and 49, 0%; p<0.001). The frequency of unreasonable prescription of antiplatelet agents instead of anticoagulants was 52.5% and 33.3% (p<0.001) in the combination of AF, CHF and coronary heart disease, as well as in the combination of AF with coronary heart disease but without CHF. Patients with AF and CHF during the observation period compared with those without CHF had higher mortality from all causes (37.6% and 30.3%; p=0.001), the frequency of non-fatal cerebral stroke (8.2% and 5.4%; p=0.032) and myocardial infarction (4.7% and 2.5%; p=0.036), hospitalizations for CVD (22.8% and 15.5%; p<0.001).Conclusion. Patients with a combination of AF and CHF, compared with the group of patients with AF without CHF, were older, had a higher risk of thromboembolic and hemorrhagic complications, they were more often diagnosed with other concomitant cardiovascular and chronic noncardiac diseases, decreased left ventricular ejection fraction, tachysystole, failure to achieve the target blood pressure level in the presence of arterial hypertension. The frequency of prescribing proper cardiovascular pharmacotherapy was higher, albeit insufficient, in the presence of CHF, while the frequency of prescribing anticoagulants was less. The incidence of mortality from all causes, the development of non-fatal myocardial infarction and cerebral stroke, as well as the incidence of hospitalizations for CVDs were higher in AF associated with CHF.

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Cardiology and vascular disease

Oxford Handbook of General Practice ◽

10.1093/med/9780199671038.003.0010 ◽

2014 ◽

pp. 231-292

Author(s):

Chantal Simon ◽

Hazel Everitt ◽

Françoise van Dorp ◽

Matt Burkes

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Blood Pressure ◽

Coronary Heart Disease ◽

Heart Disease ◽

Cardiovascular Risk ◽

Blood Pressure Measurement ◽

Arterial System ◽

System P ◽

Symptoms And Signs

Symptoms and signs of CVD Examining the heart Examination of the arterial system Cardiac investigations Brief guide to common ECG changes Prevention of coronary heart disease Estimating cardiovascular risk Blood pressure measurement Hypertension Hyperlipidaemia Angina Drug treatment of angina After myocardial infarction Chronic heart failure...

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The clinical course of atrial fibrillation in patients with coronary heart disease

Clinical Medicine (Russian Journal) ◽

10.18821/0023-2149-2016-94-8-591-595 ◽

2016 ◽

Vol 94 (8) ◽

pp. 591-595 ◽

Cited By ~ 1

Author(s):

V. I. Podzolkov ◽

Aida I. Tarzimanova ◽

R. G. Gataulin

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Coronary Heart Disease ◽

Heart Disease ◽

Chronic Heart Failure ◽

Clinical Course ◽

History Of ◽

Group 2 ◽

Group 1

The modern medical literature practically does not contain clinical publications reporting studies of factors responsible for progression of atrial fibrillation (AF) in patients with coronary heart disease (CHD). It accounts for the importance of investigations into evolution of the clinical course of AF in such patients.Aim. To elucidate evolution of the clinical course of AF in patients with CHD in a long-term prospective study.Materials and methods. The study included. 112 patient aged 57-74 (mean 67.44±3.3) years with CHD and paroxysmal form of AF carried outfrom 2011 to 2015. Evolution of the clinical course of AF was evaluated based on the number of arrhythmic attacks during the last 3 months. The appearance ofprolonged persistent AF episodes or permanent AF was regarded as progression of arrhythmia.Results. During the 4 year study, 64 (57,2%) patients (group 1) did not experiencea rise in the frequency and duration of AF attacks. Progression of arrhythmia was documented in 48 (42,8%) of the 112 (100%) patients (group 2). These patients more frequently had the history of myocardial infarction and chronic heart failure than patients of group 1. The latter had the mean values of left ventricular (LV) ejection fraction 61,23±6,24%, i.e. significantly higher than 48,47±8,4% in group 2.47 and 28 % of the patients in group 2and 1 respectively suffered mitral regurgitation (p<0,05). Patients of group 2 had significantly more akineticzones. Intake of nitroglycerin in group 1 resulted in positive dynamics of local LV contractility that did not change in patients of group 2. Conclusion. 42,8% of the patients with CHD and paroxysmal form of AF experienced progression of arrhythmia into a persistent or permanent form. Predictors of AF progression in patients with CHD are the history of myocardial infarction, chronic heart failure, mitral regurgitation, and irreversible changes in local myocardial LV contraction.

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Tends in beta-blocker administration and in prevalence of indications for their usage in heart failure with preserved ejection fraction: an analysis of randomized clinical trials

European Heart Journal ◽

10.1093/eurheartj/ehab724.0899 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

E Kokhan ◽

G Kiyakbaev ◽

Z.H Kobalava

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Coronary Heart Disease ◽

Heart Disease ◽

Ejection Fraction ◽

Randomized Clinical Trials ◽

The Other ◽

Preserved Ejection Fraction ◽

Over Time

Abstract Background Despite the lack of data supporting their benefits, beta-blockers (BBs) frequently prescribed for heart failure with preserved ejection fraction (HFpEF). This may be due to the other indications (coronary heart disease, atrial fibrillation, etc.) on the one hand and due to clinical inertia with translation evidence from heart failure with reduced ejection fraction to HFpEF on the other. Purpose To assess the trends in BBs administration and prevalence of the possible indications for their usage (hypertension, atrial fibrillation, coronary heart disease, myocardial infarction) in the participants of the randomized clinical trials (RCTs) of HFpEF. Methods A systematic literature search of PubMed database was performed. RCTs of pharmacological treatment of HFpEF carried out between 1993 and 2019 were used. Studies of the effectiveness of BBs usage, or studies performed in specific populations (HFpEF+coronary heart disease or HFpEF+hypertension, etc.) were excluded. Features at enrolment date and data on the frequency of BBs admission and the prevalence of hypertension, atrial fibrillation, coronary heart disease, and myocardial infarction were extracted. The trends over time of enrolment were analyzed using the Mann-Kendall test. Results Of the 718 filtered publications, 14 RCTs met the inclusion and exclusion criteria fully. In the most recent trials, up to 75–80% of patients received BBs. Time trends analysis revealed that between 1993–2019 years the frequency of BBs use among the participants of the RCTs of HFpEF significantly increased (tau=0.51, p=0.014). No such change was observed in the prevalence of coronary heart disease, myocardial infarction, hypertension, and atrial fibrillation (all p>0.05). Prevalence of hypertension and atrial fibrillation showed a tendency toward increasing (tau=0.4, p=0.055 and tau=0.043, p=0.063, respectively) which became statistically significant for atrial fibrilation with the exclusion of the ALDO-DHF study (tau=0.5; p=0.042). The prevalence of myocardial infarction tended to decrease over time (tau=−0.73; p=0.06). Conclusion Over the last 20 years, the proportion of patients who used BB at enrolment in RCTs of HFpEF increased significantly. There was no statistically significant increase in the prevalence of the formal indications for their usage such as atrial fibrillation, hypertension, coronary heart disease or myocardial infarction. This fact requires attention since some retrospective studies have revealed that BBs use in HFpEF patients is associated with an increased risk of hospitalizations. FUNDunding Acknowledgement Type of funding sources: None.

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Abstract MP77: Projected Impact of Shifting Population Distributions of Blood Pressure on Rates of Coronary Heart Disease, Heart Failure and Stroke: The Atherosclerosis Risk in Communities Study

Circulation ◽

10.1161/circ.127.suppl_12.amp77 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Shakia T Hardy ◽

Laura R Loehr ◽

Kenneth R Butler ◽

Patricia P Chang ◽

Aaron R Folsom ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Coronary Heart Disease ◽

African American ◽

Heart Disease ◽

Population Distribution ◽

The United States ◽

Incidence Rates ◽

Atherosclerosis Risk In Communities ◽

Atherosclerosis Risk

Introduction: Rates of cerebrovascular disease, heart failure (HF), and coronary heart disease (CHD), increase progressively as blood pressure rises. Several authors have estimated the theoretical effects of shifting the population distribution of blood pressure; however few studies have examined the degree to which modest decrements in blood pressure affect HF incidence, or included a racially diverse population. Methods: Incident HF was identified by a first hospitalization with discharge diagnosis code of 428.X. Incident hospitalized (definite or probable) CHD and stroke were classified according to protocol. We used multivariable regression to estimate incidence rate differences (IRD) for HF, CHD, and stroke that could be associated with a two mm Hg reduction in systolic blood pressure (SBP) in 15,744 participants from the Atherosclerosis Risk in Communities Study. Results: Over a mean of 18.3 years of follow up, age-adjusted incidence rates for HF, CHD, and stroke were higher among African American than Caucasians (Table 1). After adjusting for antihypertensive use, gender, and age, a two mm Hg decrement in SBP across the total population was associated with an estimated 24/100,000 person-years (PY) and 39/100,000 PY fewer incident HF events in Caucasians and African Americans, respectively. The projected disease reductions were of smaller absolute magnitude for incident CHD and incident stroke. Extrapolation to the African American and Caucasian U.S. populations age greater than 45 years suggests that a two mmHg decrement in SBP could result in approximately 22,000 fewer incident HF events, 15,000 fewer incident CHD events, and 5,000 fewer incident stroke events annually. Conclusion: Our results suggest that modest shifts in SBP, consistent with what could theoretically be achieved through population level lifestyle interventions, could substantially decrease the incidence of HF, stroke, and CHD in the United States, especially among African American populations.

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Relationship Between a Plant‐Based Dietary Portfolio and Risk of Cardiovascular Disease: Findings From the Women's Health Initiative Prospective Cohort Study

Journal of the American Heart Association ◽

10.1161/jaha.121.021515 ◽

2021 ◽

Author(s):

Andrea J. Glenn ◽

Kenneth Lo ◽

David J. A. Jenkins ◽

Beatrice A. Boucher ◽

Anthony J. Hanley ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Postmenopausal Women ◽

Prospective Cohort ◽

Health Initiative ◽

Dietary Portfolio ◽

Diet Score

Background The plant‐based Dietary Portfolio combines established cholesterol‐lowering foods (plant protein, nuts, viscous fiber, and phytosterols), plus monounsaturated fat, and has been shown to improve low‐density lipoprotein cholesterol and other cardiovascular disease (CVD) risk factors. No studies have evaluated the relation of the Dietary Portfolio with incident CVD events. Methods and Results We followed 123 330 postmenopausal women initially free of CVD in the Women's Health Initiative from 1993 through 2017. We used Cox proportional‐hazard models to estimate adjusted hazard ratios (HRs) and 95% CI of the association of adherence to a Portfolio Diet score with CVD outcomes. Primary outcomes were total CVD, coronary heart disease, and stroke. Secondary outcomes were heart failure and atrial fibrillation. Over a mean follow‐up of 15.3 years, 13 365 total CVD, 5640 coronary heart disease, 4440 strokes, 1907 heart failure, and 929 atrial fibrillation events occurred. After multiple adjustments, adherence to the Portfolio Diet score was associated with lower risk of total CVD (HR, 0.89; 95% CI, 0.83–0.94), coronary heart disease (HR, 0.86; 95% CI, 0.78–0.95), and heart failure (HR, 0.83; 95% CI, 0.71–0.99), comparing the highest to lowest quartile of adherence. There was no association with stroke (HR, 0.97; 95% CI, 0.87–1.08) or atrial fibrillation (HR, 1.10; 95% CI, 0.87–1.38). These results remained statistically significant after several sensitivity analyses. Conclusions In this prospective cohort of postmenopausal women in the United States, higher adherence to the Portfolio Diet was associated with a reduction in incident cardiovascular and coronary events, as well as heart failure. These findings warrant further investigation in other populations.

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Genetic markers of atrial fibrillation in patients with hypertension in combination with non-cardiac diseases

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2019-1-83 ◽

2019 ◽

Vol 23 (1) ◽

pp. 83

Author(s):

L. D. Hidirova ◽

D. A. Yakhontov ◽

S. A. Zenin ◽

V. N. Maximov

Keyword(s):

Diabetes Mellitus ◽

Atrial Fibrillation ◽

Blood Pressure ◽

Coronary Heart Disease ◽

Heart Disease ◽

Relative Risk ◽

Conflict Of Interest ◽

Hdl Cholesterol ◽

Cardiac Diseases ◽

Il6 Gene

Letter to the editor:The world medical community has categorised atrial fibrillation (AF) as one of the three cardiovascular ‘epidemics of the 21st century’, along with chronic heart failure and diabetes mellitus [1]. In recent years, the prevalence of AF has increasing steadily. However, the exact cause for the increase in the incidence of AF cannot be explained only by the increase in life expectancy, prevalence of cardiac valve disease or prevalence of myocardial infarction [2].Although AF occurs in individuals with various manifestations of coronary heart disease, it is increasingly being diagnosed in patients with arterial hypertension without coronary heart disease [3]. AF causes serious cardiovascular complications; thus, a deep understanding of its pathogenetic aspects and a comprehensive study that considers comorbid pathologies for identifying the predictors of the development and progression of AF are required [4].Hereditary factors can play a significant role in the development of AF and hypertension; consequently, the worldwide practice of scientific research in basic medicine pays significant attention to the molecular genetics methods of analysis.This study aimed to evaluate the genetic determinants in patients with hypertension with AF progression accompanied by various extra-cardiac comorbid pathologies.This prospective cohort study included 167 patients with a paroxysmal and persistent form of AF and stage III hypertonic disease without coronary heart disease. The average age of the patients was 53.3 ± 7.1 years. DNA isolation from blood leucocytes was performed using phenol–chloroform extraction. The rs1378942 polymorphism of the CSK gene, the rs220073 polymorphism and the -174G/C polymorphism (rs1800795) of the IL6 gene were assessed using polymerase chain reaction-restriction fragment length polymorphism. The statistical hypotheses were considered significant at a critical level of p = 0.05, i.e. the difference was considered statistically significant at p < 0.05. The lower limit of evidentiary power was equal to 80%.This study reported associations between the rs1378942 polymorphism of the CSK gene, the rs1800795 polymorphism of the IL6 gene and the rs220073 polymorphism and the progression of AF in combination with the following associated diseases: hypertension, chronic obstructive pulmonary disease, hypothyroidism, type 2 diabetes mellitus and abdominal obesity. The relative risk of the progression of AF in carriers of the allele C was 1.94 times higher than that in carriers of the allele A [95% confidence interval (CI), 1.21–3.09]. Carriage of the AA genotype was conditionally protective against the progression of AF (relative risk, 0.41; 95% CI, 0.21–0.80; p = 0.010).Associations of the rs1378942 and rs1800795 polymorphisms with the risk of recurrence of AF in combination with certain diseases were also found. In addition, associations were identified between rs1378942 and glomerular filtration rate, systolic and diastolic blood pressure, left atrial wall thickness and glucose, high-density lipoprotein (HDL) cholesterol, triglyceride and creatinine levels; between rs220073 and levels of triglycerides, atherogenic index, creatinine, fibrinogen and the number of months before the development of relapse and between rs1800795 and HDL cholesterol, creatinine and galectin-3 levels and diastolic blood pressure.The secondary form of AF as a multi-factorial disease develops under the influence of many factors of both the external environment and hereditary nature. The complexity of the etio-pathogenesis of the disease makes it extremely difficult for researchers to identify the factors that play a leading role in the development of the pathological process. Currently, associative studies of AF with polymorphisms of >260 genes have been conducted, and genome-wide associative studies have been performed as well. The reproducibility of the results depends on several factors: age, sex, comorbidities, ethnicity, penetrance, expressiveness, pleiotropy, various epigenetic influences and many more.Despite the limitations of the sample, our study adds to the data material already available that can serve in the prognostic assessment of the development and progression of AF. Further studies will allow the development of a personalised algorithm for predicting the progression of AF in hypertension combined with extra-cardiac diseases. In this regard, further larger studies are necessary that involve other institutions and a larger sample of patients, which will make it possible to predict the progression of AF with the definition of additional molecular criteria for evaluating the effectiveness of pathogenetic therapy and the possibilities of targeted treatment. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.

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Abstract 14: Cardiac Biomarkers are Associated With Findings on Brain MRI in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.141.suppl_1.14 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Cited By ~ 1

Author(s):

Andreea M Rawlings ◽

Christie M Ballantyne ◽

Rebecca F Gottesman ◽

Ron C Hoogeveen ◽

Timothy M Hughes ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Troponin T ◽

Brain Mri ◽

Standard Deviation Increase ◽

Cortical Volume ◽

Galectin 3

Background: Cerebrovascular disease is often the consequence of cardiac disease. Our aim was to examine associations of biomarkers of cardiovascular disease, high sensitivity troponin T (hs-cTnT), NT-proBNP, and galectin-3, with cerebrovascular signs: lacunar infarcts, lobar and subcortical microhemorrhages, cortical infarcts, and white matter hyperintensity (WMH) volume. We also examined total cortical and Alzheimer’s Disease (AD) signature region volumes. Methods: We conducted a cross-sectional analysis of 1748 ARIC participants from the 2011-2013 exam who had biomarker measurements, completed a brain MRI, and did not have a clinical history of stroke. We used linear regression to model brain volumes, modeled as Z scores, and logistic regression for all other outcomes; biomarkers were log transformed. We repeated analyses excluding persons with coronary heart disease, atrial fibrillation, and heart failure. Results: The mean age of participants was 76, 62% were female, and 21% were Black. All biomarkers were associated with total cortical volume. Each standard deviation increase in log hs-cTnT was associated with lower total cortical volume (adjusted beta = -0.08, 95% CI: -0.12, -0.05); results for the other biomarkers were similar (Figure). All biomarkers were associated with lobar microhemorrhages. Hs-cTnT and NT-proBNP were associated with WMH volume, but galectin-3 was not. No biomarker was associated with subcortical microhemorrhages or cortical infarcts. Results were similar in persons without coronary heart disease, atrial fibrillation, or heart failure (conditions associated with cerebral thromboembolism). Conclusions: In persons free of clinical cardiovascular disease, biomarkers of cardiac stretch, strain, and fibrosis were associated cerebral small vessel disease and reduced cortical volume, but not in a specific pattern suggestive of AD pathogenesis. This suggests subclinical vascular insults affect brain structure through mixed pathogenic processes.

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Cardiology

Oxford Handbook for Medical School ◽

10.1093/med/9780199681907.003.0008 ◽

2019 ◽

pp. 177-198

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Chest Pain ◽

Venous Pressure ◽

Structural Defects ◽

Pressure Waveform ◽

St Elevation ◽

Electrocardiogram Interpretation

Cardiology specializes in disorders of the heart, primarily ischaemic heart disease, rhythm disturbances (arrhythmias), and structural defects. Emergency presentations with chest pain, breathlessness, or palpitations are extremely common. This chapter describes the pathophysiology, presentation, diagnosis, and management of the leading cardiac complaints including unstable angina, ST elevation myocardial infarction (STEMI), non-STEMI, atrial fibrillation, heart failure, hypertension, infective endocarditis, and syncope. Basic electrocardiogram interpretation is explained, in addition to the jugular venous pressure waveform and risk stratification tools for atrial fibrillation and heart failure. A practical guide to the cardiovascular examination (as well as tips for success in exam situations) is included.

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Association of occupational exposures with cardiovascular disease among US Hispanics/Latinos

Heart ◽

10.1136/heartjnl-2018-313463 ◽

2018 ◽

Vol 105 (6) ◽

pp. 439-448 ◽

Cited By ~ 10

Author(s):

Catherine M Bulka ◽

Martha L Daviglus ◽

Victoria W Persky ◽

Ramon A Durazo-Arvizu ◽

James P Lash ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Cerebrovascular Disease ◽

Organic Solvents ◽

Occupational Exposures ◽

Latino Workers ◽

Prevalence Ratios

ObjectiveCardiovascular disease (CVD) is a leading cause of mortality and morbidity in the USA. The role of occupational exposures to chemicals in the development of CVD has rarely been studied even though many agents possess cardiotoxic properties. We therefore evaluated associations of self-reported exposures to organic solvents, metals and pesticides in relation to CVD prevalence among diverse Hispanic/Latino workers.MethodsCross-sectional data from 7404 employed individuals, aged 18–74 years, enrolled in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were analysed. Participants from four US cities provided questionnaire data and underwent clinical examinations, including ECGs. CVD was defined as the presence of at least one of the following: coronary heart disease, atrial fibrillation, heart failure or cerebrovascular disease. Prevalence ratios reflecting the relationship between each occupational exposure and CVD as well as CVD subtypes were calculated using Poisson regression models.ResultsHispanic/Latino workers reported exposures to organic solvents (6.5%), metals (8.5%) and pesticides (4.7%) at their current jobs. Overall, 6.1% of participants had some form of CVD, with coronary heart disease as the most common (4.3%) followed by cerebrovascular disease (1.0%), heart failure (0.8%) and atrial fibrillation (0.7%). For individuals who reported working with pesticides, the prevalence ratios for any CVD were 2.18 (95% CI 1.34 to 3.55), coronary heart disease 2.20 (95% CI 1.31 to 3.71), cerebrovascular disease 1.38 (95% CI 0.62 3.03), heart failure 0.91 (95% CI 0.23 to 3.54) and atrial fibrillation 5.92 (95% CI 1.89 to 18.61) after adjustment for sociodemographic, acculturation, lifestyle and occupational characteristics. Metal exposures were associated with an almost fourfold (3.78, 95% CI 1.24 to 11.46) greater prevalence of atrial fibrillation. Null associations were observed for organic solvent exposures.ConclusionsOur results suggest that working with metals and pesticides could be risk factors for CVD among Hispanic/Latino workers. Further work is needed to evaluate these relationships prospectively.

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