Atrial fibrillation and the risk of myocardial infarction

Abstract

Importance: Myocardial infarction (MI) is an established risk factor for atrial fibrillation (AF). However, the extent to which AF is a risk factor for MI has not been investigated.

Objective: To examine the risk of incident MI associated with AF.

Design, setting, and participants: A prospective cohort of 23,928 participants residing in the continental United States and without coronary heart disease at baseline were enrolled from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort between 2003 and 2007, with follow-up through December 2009.

Main outcomes and measures: Expert-adjudicated total MI events (fatal and nonfatal).

Results: Over 6.9 years of follow-up (median 4.5 years), 648 incident MI events occurred. In a sociodemographic-adjusted model, AF was associated with about 2-fold increased risk of MI (hazard ratio [HR], 1.96 [95% CI, 1.52-2.52]). This association remained significant (HR, 1.70 [95% CI, 1.26-2.30]) after further adjustment for total cholesterol, high-density lipoprotein cholesterol, smoking status, systolic blood pressure, blood pressure-lowering drugs, body mass index, diabetes, warfarin use, aspirin use, statin use, history of stroke and vascular disease, estimated glomerular filtration rate, albumin to creatinine ratio, and C-reactive protein level. In subgroup analysis, the risk of MI associated with AF was significantly higher in women (HR, 2.16 [95% CI, 1.41-3.31]) than in men (HR, 1.39 [95% CI, 0.91-2.10]) and in blacks (HR, 2.53 [95% CI, 1.67-3.86]) than in whites (HR, 1.26 [95% CI, 0.83-1.93]); for interactions, P = .03 and P = .02, respectively. On the other hand, there were no significant differences in the risk of MI associated with AF in older (≥75 years) vs younger (<75 years) participants (HR, 2.00 [95% CI, 1.16-3.35] and HR, 1.60 [95% CI, 1.11-2.30], respectively); for interaction, P = .44.

Conclusions and relevance: AF is independently associated with an increased risk of incident MI, especially in women and blacks. These findings add to the growing concerns of the seriousness of AF as a public health burden: in addition to being a well-known risk factor for stroke, AF is also associated with increased risk of MI.

Figure 1

Unadjusted Cumulative Incidence of Myocardial Infarction by Baseline Atrial Fibrillation Status

Figure 2

Sex-Race Stratified Age-Adjusted Incidence Rates and Multivariable-Adjusted Hazard Ratios of Myocardial Infarction by Atrial Fibrillation (AF) Status Data specified across horizontal braces are reported as hazard ratio (95% CI). All models were adjusted for age, sex, race, region of residence, education level, income, total cholesterol, high-density lipoprotein cholesterol, smoking status, systolic blood pressure, body mass index, diabetes, blood pressure–lowering drug use, warfarin use, aspirin use, statin use, history of noncardiac vascular disease (stroke, peripheral artery disease, and aortic aneurysm), estimated glomerular filtration rate lower than 60 mL/min/1.73 m², log-transformed C-reactive protein, and log-transformed albumin to creatinine ratio.