Abstract
Background
Peripheral blood metabolite profiles have yielded mechanistic insights into various cardiovascular disease states. We hypothesized that peripheral blood metabolite profiles would be associated with new onset atrial fibrillation (AF).
Methods and results
The study population comprised 1892 patients without AF at baseline, who, as part the MURDOCK Cardiovascular Disease Study molecular profiling cohort (n = 2023), had previously had determination of levels of 69 metabolites from frozen, fasting plasma specimens obtained during coronary angiography. We used Cox proportional hazards models to examine the association of 13 uncorrelated metabolite factors created from these data using principal components analysis (PCA) with new occurrences of AF during a median follow up of 2.8 (0.1–4.9) years. A total of 233 patients developed new AF (12.3%) during follow up. Patients with new onset AF were older (median 67 vs. 60 years); more often white (82 vs. 71%) and male (68 vs. 60%), and had more comorbidities than those who did not develop AF. After adjustment, PCA factor 1 (medium chain acylcarnitines; hazard ratio [HR]: 1.11 [1.01–1.22]), factor 2 (short chain dicarboxylacylcarnitines; HR: 1.21 [1.09–1.34]) and factor 5 (long chain acylcarnitines; HR: 1.19 [1.06–1.34]) were associated with new onset AF.
Conclusion
Metabolite profiles were associated with new onset AF among patients referred for coronary angiography. Validation of these observations in broader patient populations may provide better mechanistic insight into the development of AF, and may provide new opportunities for prevention and treatment.
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Atrial fibrillation (AF), the most common arrhythmia encountered in clinical practice, is associated with significant morbidity and mortality.1 Between 2.7 and 6.1 million individuals in the United States alone have AF, and these numbers are increasing. In addition to the effect on quality of life, AF is also associated with direct and indirect costs estimated at approximately $3600 per patient year.2., 3. Current treatment strategies are centered at either “rhythm control” with medications or interventions or “rate control,” in which patients remain in AF but ventricular rates are controlled.4., 5. In order to further improve management strategies or even prevent AF, a better means of identifying those at risk is needed. A number of studies have examined adaptation to and metabolic regulation of chronic AF at the tissue level.6., 7. The association of several circulating biomarkers with incident AF has been explored, including soluble ST2, growth differentiation factor-15, and troponin.8 However, the relationship between plasma metabolite levels and risk for developing AF is an area of ongoing research that warrants further exploration. Therefore, we examined the association between peripheral blood metabolite factors and the development of new onset AF in a longitudinal cohort of patients who had been referred for coronary angiography.
Peripheral blood metabolite profiles have yielded mechanistic insights into various cardiovascular disease states. We hypothesized that peripheral blood metabolite profiles would be associated with new onset atrial fibrillation (AF).
Methods and results
The study population comprised 1892 patients without AF at baseline, who, as part the MURDOCK Cardiovascular Disease Study molecular profiling cohort (n = 2023), had previously had determination of levels of 69 metabolites from frozen, fasting plasma specimens obtained during coronary angiography. We used Cox proportional hazards models to examine the association of 13 uncorrelated metabolite factors created from these data using principal components analysis (PCA) with new occurrences of AF during a median follow up of 2.8 (0.1–4.9) years. A total of 233 patients developed new AF (12.3%) during follow up. Patients with new onset AF were older (median 67 vs. 60 years); more often white (82 vs. 71%) and male (68 vs. 60%), and had more comorbidities than those who did not develop AF. After adjustment, PCA factor 1 (medium chain acylcarnitines; hazard ratio [HR]: 1.11 [1.01–1.22]), factor 2 (short chain dicarboxylacylcarnitines; HR: 1.21 [1.09–1.34]) and factor 5 (long chain acylcarnitines; HR: 1.19 [1.06–1.34]) were associated with new onset AF.
Conclusion
Metabolite profiles were associated with new onset AF among patients referred for coronary angiography. Validation of these observations in broader patient populations may provide better mechanistic insight into the development of AF, and may provide new opportunities for prevention and treatment.
Previous article in issue
Next article in issue
Atrial fibrillation (AF), the most common arrhythmia encountered in clinical practice, is associated with significant morbidity and mortality.1 Between 2.7 and 6.1 million individuals in the United States alone have AF, and these numbers are increasing. In addition to the effect on quality of life, AF is also associated with direct and indirect costs estimated at approximately $3600 per patient year.2., 3. Current treatment strategies are centered at either “rhythm control” with medications or interventions or “rate control,” in which patients remain in AF but ventricular rates are controlled.4., 5. In order to further improve management strategies or even prevent AF, a better means of identifying those at risk is needed. A number of studies have examined adaptation to and metabolic regulation of chronic AF at the tissue level.6., 7. The association of several circulating biomarkers with incident AF has been explored, including soluble ST2, growth differentiation factor-15, and troponin.8 However, the relationship between plasma metabolite levels and risk for developing AF is an area of ongoing research that warrants further exploration. Therefore, we examined the association between peripheral blood metabolite factors and the development of new onset AF in a longitudinal cohort of patients who had been referred for coronary angiography.
| Original language | English |
|---|---|
| Pages (from-to) | 54-59 |
| Number of pages | 6 |
| Journal | American Heart Journal |
| DOIs | |
| Publication status | Published - May 2019 |