Inflammation and hemostasis in atrial fibrillation and coronary heart disease: The REasons for Geographic And Racial Differences in Stroke study

Atherosclerosis. 2015 Nov;243(1):192-7. doi: 10.1016/j.atherosclerosis.2015.09.009. Epub 2015 Sep 8.


Background: Recent studies suggest atrial fibrillation (AF) is an independent risk factor for coronary heart disease (CHD).

Aims: To determine if alterations in hemostasis or inflammation explain the association between AF and CHD.

Methods: C-reactive protein (CRP), D-dimer, factor VIII, and fibrinogen were measured in incident CHD cases (n = 647) and a stratified cohort random sample (CRS, n = 1104) between 2003 and 2007 from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Using a case-cohort approach, Cox models examined whether inflammation or hemostasis biomarkers explained the association between AF and CHD.

Results: In participants free of CHD at baseline, 12.2% of CHD cases and 7.1% of the CRS had AF. Over a median follow-up of 4.4 years, all biomarkers were associated with an increased risk of CHD in those with and those without AF after adjusting for CHD risk factors. The association of D-dimer with CHD was greater in those with AF (HR 2.52, 95% CI = 1.49, 4.26) than those without AF (HR 1.34, 95% CI = 1.12, 1.61) (p-interaction = 0.02). Similar interactions were not observed for the other biomarkers.

Conclusions: Our results suggest that alterations in D-dimer, a marker of hemostasis, explain the association between AF and CHD. Potentially, D-dimer is a useful biomarker to assess CHD risk in persons with AF.

Keywords: Atrial fibrillation; Biological markers; Coronary disease.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / ethnology*
  • Biomarkers / metabolism
  • C-Reactive Protein / metabolism
  • Coronary Disease / complications
  • Coronary Disease / ethnology*
  • Ethnicity
  • Factor VIII / metabolism
  • Female
  • Fibrin Fibrinogen Degradation Products / metabolism
  • Fibrinogen / metabolism
  • Geography
  • Hemostasis*
  • Humans
  • Inflammation / pathology*
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Stroke / complications*
  • Stroke / ethnology*


  • Biomarkers
  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D
  • F8 protein, human
  • Factor VIII
  • Fibrinogen
  • C-Reactive Protein