Fotios Barkas1, Moses Elisaf1, Panagiotis Korantzopoulos2, Stavroula Tsiara1, Evangelos Liberopoulos3. 1. Department of Internal Medicine, School of Medicine, University of Ioannina, Greece. 2. Department of Cardiology, School of Medicine, University of Ioannina, Greece. 3. Department of Internal Medicine, School of Medicine, University of Ioannina, Greece. Electronic address: vaglimp@yahoo.com.
Abstract
AIM: To investigate the value of CHADS2 and CHA2DS2-VASc scores in predicting atrial fibrillation (AF) among dyslipidemic individuals and assess the additional value of incorporating low levels of high-density lipoprotein cholesterol (HDL-C). METHODS: This observational study included 1241 individuals attending a lipid clinic. Models including clinical and laboratory parameters were constructed to test the predictive value of CHADS2 and CHA2DS2-VASc scores as well as low HDL-C levels for incident AF. Low HDL-C levels were defined as <40 and <50mg/dL for male and female subjects, respectively. RESULTS: After excluding 18 patients with AF at baseline, 1223 subjects were followed-up for a median period of 6years (IQR: 4-10), and 34 (2.8%) developed AF. Baseline CHADS2 (OR: 1.71; 95% CI: 1.28-2.29, p<0.001) and CHA2DS2-VASc scores (OR: 1.56; 95% CI: 1.26-1.92, p<0.001) as well as low HDL-C levels (OR: 3.79; 95% CI: 1.85-7.75, p<0.001) were significantly associated with new-onset AF. ROC curve analyses showed that both CHADS2 and CHA2DS2-VASc scores were significant predictors for new-onset AF (C-Statistic: CHADS2 0.679, p<0.001; CHA2DS2-VASc 0.698, p<0.001). Higher CHADS2 scores were associated with reduced event-free survival from AF (log-rank=10.62, p=0.001) with differences potentiated if stratified by CHA2DS2-VASc score (log-rank=22.29, p<0.001). After incorporating low HDL-C levels, both scores achieved slightly higher C-Statistic for AF prediction (0.690 and 0.707, respectively, p<0.001). CONCLUSIONS: CHADS2 and CHA2DS2-VASc scores predict new AF in dyslipidemic patients. Risk prediction improved modestly when low HDL-C levels were included.
AIM: To investigate the value of CHADS2 and CHA2DS2-VASc scores in predicting atrial fibrillation (AF) among dyslipidemic individuals and assess the additional value of incorporating low levels of high-density lipoprotein cholesterol (HDL-C). METHODS: This observational study included 1241 individuals attending a lipid clinic. Models including clinical and laboratory parameters were constructed to test the predictive value of CHADS2 and CHA2DS2-VASc scores as well as low HDL-C levels for incident AF. Low HDL-C levels were defined as <40 and <50mg/dL for male and female subjects, respectively. RESULTS: After excluding 18 patients with AF at baseline, 1223 subjects were followed-up for a median period of 6years (IQR: 4-10), and 34 (2.8%) developed AF. Baseline CHADS2 (OR: 1.71; 95% CI: 1.28-2.29, p<0.001) and CHA2DS2-VASc scores (OR: 1.56; 95% CI: 1.26-1.92, p<0.001) as well as low HDL-C levels (OR: 3.79; 95% CI: 1.85-7.75, p<0.001) were significantly associated with new-onset AF. ROC curve analyses showed that both CHADS2 and CHA2DS2-VASc scores were significant predictors for new-onset AF (C-Statistic: CHADS2 0.679, p<0.001; CHA2DS2-VASc 0.698, p<0.001). Higher CHADS2 scores were associated with reduced event-free survival from AF (log-rank=10.62, p=0.001) with differences potentiated if stratified by CHA2DS2-VASc score (log-rank=22.29, p<0.001). After incorporating low HDL-C levels, both scores achieved slightly higher C-Statistic for AF prediction (0.690 and 0.707, respectively, p<0.001). CONCLUSIONS: CHADS2 and CHA2DS2-VASc scores predict new AF in dyslipidemic patients. Risk prediction improved modestly when low HDL-C levels were included.
Authors: Olivia L Hulme; Shaan Khurshid; Lu-Chen Weng; Christopher D Anderson; Elizabeth Y Wang; Jeffrey M Ashburner; Darae Ko; David D McManus; Emelia J Benjamin; Patrick T Ellinor; Ludovic Trinquart; Steven A Lubitz Journal: JACC Clin Electrophysiol Date: 2019-10-02