Thomas A Dewland1, Eric Vittinghoff2, Tamara B Harris3, Jared W Magnani4, Yongmei Liu5, Fang-Chi Hsu6, Suzanne Satterfield7, Christina Wassel8, Gregory M Marcus9. 1. Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco ; Knight Cardiovascular Institute, Oregon Health & Science University, Portland. 2. Department of Epidemiology and Biostatistics, University of California, San Francisco. 3. Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Maryland. 4. Department of Medicine, Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts. 5. Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina. 6. Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina. 7. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee. 8. Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania. 9. Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco.
Abstract
BACKGROUND: Despite a lower prevalence of established atrial fibrillation (AF) risk factors, Whites exhibit substantially higher rates of this arrhythmia compared to Blacks. The mechanism underlying this observation is not known. Both inflammation and obesity are risk factors for AF, and adipose tissue is a known contributor to systemic inflammation. OBJECTIVES: We sought to determine the degree to which racial differences in AF risk are explained by differences in inflammation and adiposity. METHODS: Baseline serum inflammatory biomarker concentrations and abdominal adiposity (assessed by computed tomography) were quantified in a subset of Black and White participants without prevalent AF in the Health, Aging, and Body Composition (Health ABC) Study. Participants were prospectively followed for the diagnosis of AF using study ECGs and Medicare claims data. Cox proportional hazards models were used to determine the adjusted relative hazard of incident AF between races before and after biomarker adjustment. RESULTS: Among 2,768 participants (43% Black), 721 developed incident AF over a median follow up of 10.9 years. White race was associated with a heightened adjusted risk of incident AF (HR 1.55, 95% CI 1.30 to 1.84, p < 0.001). Abdominal adiposity was not associated with AF when added to the adjusted model. Among the studied biomarkers, adiponectin, TNF-α, TNF-α SR I, and TNF-α SR II concentrations were each higher among Whites and independently associated with a greater risk of incident AF. Together, these inflammatory cytokines mediated 42% (95% CI 15 to 119%, p = 0.004) of the adjusted race-AF association. CONCLUSIONS: Systemic inflammatory pathways significantly mediate the heightened risk of AF among Whites. The higher level of systemic inflammation and concomitant increased AF risk in Whites is not explained by racial differences in abdominal adiposity or the presence of other pro-inflammatory cardiovascular comorbidities.
BACKGROUND: Despite a lower prevalence of established atrial fibrillation (AF) risk factors, Whites exhibit substantially higher rates of this arrhythmia compared to Blacks. The mechanism underlying this observation is not known. Both inflammation and obesity are risk factors for AF, and adipose tissue is a known contributor to systemic inflammation. OBJECTIVES: We sought to determine the degree to which racial differences in AF risk are explained by differences in inflammation and adiposity. METHODS: Baseline serum inflammatory biomarker concentrations and abdominal adiposity (assessed by computed tomography) were quantified in a subset of Black and White participants without prevalent AF in the Health, Aging, and Body Composition (Health ABC) Study. Participants were prospectively followed for the diagnosis of AF using study ECGs and Medicare claims data. Cox proportional hazards models were used to determine the adjusted relative hazard of incident AF between races before and after biomarker adjustment. RESULTS: Among 2,768 participants (43% Black), 721 developed incident AF over a median follow up of 10.9 years. White race was associated with a heightened adjusted risk of incident AF (HR 1.55, 95% CI 1.30 to 1.84, p < 0.001). Abdominal adiposity was not associated with AF when added to the adjusted model. Among the studied biomarkers, adiponectin, TNF-α, TNF-α SR I, and TNF-α SR II concentrations were each higher among Whites and independently associated with a greater risk of incident AF. Together, these inflammatory cytokines mediated 42% (95% CI 15 to 119%, p = 0.004) of the adjusted race-AF association. CONCLUSIONS: Systemic inflammatory pathways significantly mediate the heightened risk of AF among Whites. The higher level of systemic inflammation and concomitant increased AF risk in Whites is not explained by racial differences in abdominal adiposity or the presence of other pro-inflammatory cardiovascular comorbidities.
Authors: Gregory M Marcus; Alvaro Alonso; Carmen A Peralta; Guillaume Lettre; Eric Vittinghoff; Steven A Lubitz; Ervin R Fox; Yamini S Levitzky; Reena Mehra; Kathleen F Kerr; Rajat Deo; Nona Sotoodehnia; Meggie Akylbekova; Patrick T Ellinor; Dina N Paltoo; Elsayed Z Soliman; Emelia J Benjamin; Susan R Heckbert Journal: Circulation Date: 2010-11-16 Impact factor: 29.690
Authors: Matthew Knuiman; Tom Briffa; Mark Divitini; Derek Chew; John Eikelboom; Brendan McQuillan; Joseph Hung Journal: Eur J Epidemiol Date: 2014-01-04 Impact factor: 8.082
Authors: Michiel Rienstra; Jenny X Sun; Steven A Lubitz; David S Frankel; Ramachandran S Vasan; Daniel Levy; Jared W Magnani; Lisa M Sullivan; James B Meigs; Patrick T Ellinor; Emelia J Benjamin Journal: Am Heart J Date: 2011-11-17 Impact factor: 4.749
Authors: Gregory M Marcus; Mary A Whooley; David V Glidden; Ludmila Pawlikowska; Jonathan G Zaroff; Jeffrey E Olgin Journal: Am Heart J Date: 2007-10-25 Impact factor: 4.749
Authors: Alvaro Alonso; Sunil K Agarwal; Elsayed Z Soliman; Marietta Ambrose; Alanna M Chamberlain; Ronald J Prineas; Aaron R Folsom Journal: Am Heart J Date: 2009-07 Impact factor: 4.749
Authors: Alan Sugrue; Ammar M Killu; David O Hodge; Christopher J McLeod; Thomas M Munger; Siva K Mulpuru; Douglas L Packer; Suraj Kapa; Samuel J Asirvatham; Paul A Friedman Journal: J Interv Card Electrophysiol Date: 2016-12-09 Impact factor: 1.900
Authors: Matthew A Christensen; Kaylin T Nguyen; Phyllis K Stein; Raymond B Fohtung; Elsayed Z Soliman; Thomas A Dewland; Eric Vittinghoff; Bruce M Psaty; Susan R Heckbert; Gregory M Marcus Journal: Heart Rhythm Date: 2017-10-27 Impact factor: 6.343
Authors: Franco Giulianini; Bastiaan Geelhoed; Kathryn L Lunetta; Jeffrey R Misialek; Maartje N Niemeijer; Michiel Rienstra; Lynda M Rose; Albert V Smith; Neal A Chatterjee; Dan E Arking; Patrick T Ellinor; Jan Heeringa; Honghuang Lin; Steven A Lubitz; Elsayed Z Soliman; Niek Verweij; Alvaro Alonso; Emelia J Benjamin; Vilmundur Gudnason; Bruno H C Stricker; Pim Van Der Harst; Daniel I Chasman; Christine M Albert Journal: Circulation Date: 2016-12-14 Impact factor: 29.690
Authors: Maria Monrad; Ahmad Sajadieh; Jeppe Schultz Christensen; Matthias Ketzel; Ole Raaschou-Nielsen; Anne Tjønneland; Kim Overvad; Steffen Loft; Mette Sørensen Journal: Environ Health Perspect Date: 2016-07-29 Impact factor: 9.031
Authors: Elvira V Bräuner; Jeanette T Jørgensen; Anne Katrine Duun-Henriksen; Claus Backalarz; Jens E Laursen; Torben H Pedersen; Mette K Simonsen; Zorana J Andersen Journal: J Am Heart Assoc Date: 2019-07-16 Impact factor: 5.501
Authors: Wendy Wang; Faye L Norby; Michael J Zhang; Jorge L Reyes; Amil M Shah; Elsayed Z Soliman; Pamela L Lutsey; Alvaro Alonso; Scott D Solomon; Riccardo M Inciardi; Lin Y Chen Journal: J Am Heart Assoc Date: 2021-10-29 Impact factor: 5.501