Atrial ectopy as a mediator of the association between race and atrial fibrillation

Matthew A. Christensen, Kaylin T. Nguyen, Phyllis K. Stein, Raymond B. Fohtung, Elsayed Z. Soliman, Thomas Dewland, Eric Vittinghoff, Bruce M. Psaty, Susan R. Heckbert, Gregory M. Marcus

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Blacks have a lower risk of atrial fibrillation (AF) despite having more AF risk factors, but the mechanism remains unknown. Premature atrial contraction (PAC) burden is a recently identified risk factor for AF. Objective: The purpose of this study was to determine whether the burden of PACs explains racial differences in AF risk. Methods: PAC burden (number per hour) was assessed by 24-hour ambulatory electrocardiographic (ECG) monitoring in a randomly selected subset of patients in the Cardiovascular Health Study. Participants were followed prospectively for the development of AF, diagnosed by study ECG and hospital admission records. Results: Among 938 participants (median age 73 years; 34% black; 58% female), 206 (22%) developed AF over a median follow-up of 11.0 years (interquartile range 6.1-13.4). After adjusting for age, sex, body mass index, coronary disease, congestive heart failure, diabetes, hypertension, alcohol consumption, smoking status, and study site, black race was associated with a 42% lower risk of AF (hazard ratio 0.58, 95% confidence interval [CI] 0.40-0.85; P = .005). The baseline PAC burden was 2.10 times (95% CI 1.57-2.83; P <.001) higher in whites than blacks. There was no detectable difference in premature ventricular contraction (PVC) burden by race. PAC burden mediated 19.5% (95% CI 6.3-52.5) of the adjusted association between race and AF. Conclusion: On average, whites exhibited more PACs than blacks, and this difference statistically explains a modest proportion of the differential risk of AF by race. The differential PAC burden, without differences in PVCs, by race suggests that identifiable common exposures or genetic influences might be important to atrial pathophysiology.

Original languageEnglish (US)
JournalHeart Rhythm
DOIs
StateAccepted/In press - 2017

Fingerprint

Atrial Fibrillation
Atrial Premature Complexes
Confidence Intervals
Ambulatory Electrocardiography
Ventricular Premature Complexes
Hospital Records
Polyvinyl Chloride
Alcohol Drinking
Coronary Disease
Body Mass Index
Heart Failure
Smoking
Hypertension
Health

Keywords

  • Arrhythmia
  • Atrial fibrillation
  • Atrial premature beat
  • Premature atrial contraction
  • Race

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Christensen, M. A., Nguyen, K. T., Stein, P. K., Fohtung, R. B., Soliman, E. Z., Dewland, T., ... Marcus, G. M. (Accepted/In press). Atrial ectopy as a mediator of the association between race and atrial fibrillation. Heart Rhythm. https://doi.org/10.1016/j.hrthm.2017.09.034

Atrial ectopy as a mediator of the association between race and atrial fibrillation. / Christensen, Matthew A.; Nguyen, Kaylin T.; Stein, Phyllis K.; Fohtung, Raymond B.; Soliman, Elsayed Z.; Dewland, Thomas; Vittinghoff, Eric; Psaty, Bruce M.; Heckbert, Susan R.; Marcus, Gregory M.

In: Heart Rhythm, 2017.

Research output: Contribution to journalArticle

Christensen, MA, Nguyen, KT, Stein, PK, Fohtung, RB, Soliman, EZ, Dewland, T, Vittinghoff, E, Psaty, BM, Heckbert, SR & Marcus, GM 2017, 'Atrial ectopy as a mediator of the association between race and atrial fibrillation', Heart Rhythm. https://doi.org/10.1016/j.hrthm.2017.09.034
Christensen, Matthew A. ; Nguyen, Kaylin T. ; Stein, Phyllis K. ; Fohtung, Raymond B. ; Soliman, Elsayed Z. ; Dewland, Thomas ; Vittinghoff, Eric ; Psaty, Bruce M. ; Heckbert, Susan R. ; Marcus, Gregory M. / Atrial ectopy as a mediator of the association between race and atrial fibrillation. In: Heart Rhythm. 2017.
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abstract = "Background: Blacks have a lower risk of atrial fibrillation (AF) despite having more AF risk factors, but the mechanism remains unknown. Premature atrial contraction (PAC) burden is a recently identified risk factor for AF. Objective: The purpose of this study was to determine whether the burden of PACs explains racial differences in AF risk. Methods: PAC burden (number per hour) was assessed by 24-hour ambulatory electrocardiographic (ECG) monitoring in a randomly selected subset of patients in the Cardiovascular Health Study. Participants were followed prospectively for the development of AF, diagnosed by study ECG and hospital admission records. Results: Among 938 participants (median age 73 years; 34{\%} black; 58{\%} female), 206 (22{\%}) developed AF over a median follow-up of 11.0 years (interquartile range 6.1-13.4). After adjusting for age, sex, body mass index, coronary disease, congestive heart failure, diabetes, hypertension, alcohol consumption, smoking status, and study site, black race was associated with a 42{\%} lower risk of AF (hazard ratio 0.58, 95{\%} confidence interval [CI] 0.40-0.85; P = .005). The baseline PAC burden was 2.10 times (95{\%} CI 1.57-2.83; P <.001) higher in whites than blacks. There was no detectable difference in premature ventricular contraction (PVC) burden by race. PAC burden mediated 19.5{\%} (95{\%} CI 6.3-52.5) of the adjusted association between race and AF. Conclusion: On average, whites exhibited more PACs than blacks, and this difference statistically explains a modest proportion of the differential risk of AF by race. The differential PAC burden, without differences in PVCs, by race suggests that identifiable common exposures or genetic influences might be important to atrial pathophysiology.",
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AU - Christensen, Matthew A.

AU - Nguyen, Kaylin T.

AU - Stein, Phyllis K.

AU - Fohtung, Raymond B.

AU - Soliman, Elsayed Z.

AU - Dewland, Thomas

AU - Vittinghoff, Eric

AU - Psaty, Bruce M.

AU - Heckbert, Susan R.

AU - Marcus, Gregory M.

PY - 2017

Y1 - 2017

N2 - Background: Blacks have a lower risk of atrial fibrillation (AF) despite having more AF risk factors, but the mechanism remains unknown. Premature atrial contraction (PAC) burden is a recently identified risk factor for AF. Objective: The purpose of this study was to determine whether the burden of PACs explains racial differences in AF risk. Methods: PAC burden (number per hour) was assessed by 24-hour ambulatory electrocardiographic (ECG) monitoring in a randomly selected subset of patients in the Cardiovascular Health Study. Participants were followed prospectively for the development of AF, diagnosed by study ECG and hospital admission records. Results: Among 938 participants (median age 73 years; 34% black; 58% female), 206 (22%) developed AF over a median follow-up of 11.0 years (interquartile range 6.1-13.4). After adjusting for age, sex, body mass index, coronary disease, congestive heart failure, diabetes, hypertension, alcohol consumption, smoking status, and study site, black race was associated with a 42% lower risk of AF (hazard ratio 0.58, 95% confidence interval [CI] 0.40-0.85; P = .005). The baseline PAC burden was 2.10 times (95% CI 1.57-2.83; P <.001) higher in whites than blacks. There was no detectable difference in premature ventricular contraction (PVC) burden by race. PAC burden mediated 19.5% (95% CI 6.3-52.5) of the adjusted association between race and AF. Conclusion: On average, whites exhibited more PACs than blacks, and this difference statistically explains a modest proportion of the differential risk of AF by race. The differential PAC burden, without differences in PVCs, by race suggests that identifiable common exposures or genetic influences might be important to atrial pathophysiology.

AB - Background: Blacks have a lower risk of atrial fibrillation (AF) despite having more AF risk factors, but the mechanism remains unknown. Premature atrial contraction (PAC) burden is a recently identified risk factor for AF. Objective: The purpose of this study was to determine whether the burden of PACs explains racial differences in AF risk. Methods: PAC burden (number per hour) was assessed by 24-hour ambulatory electrocardiographic (ECG) monitoring in a randomly selected subset of patients in the Cardiovascular Health Study. Participants were followed prospectively for the development of AF, diagnosed by study ECG and hospital admission records. Results: Among 938 participants (median age 73 years; 34% black; 58% female), 206 (22%) developed AF over a median follow-up of 11.0 years (interquartile range 6.1-13.4). After adjusting for age, sex, body mass index, coronary disease, congestive heart failure, diabetes, hypertension, alcohol consumption, smoking status, and study site, black race was associated with a 42% lower risk of AF (hazard ratio 0.58, 95% confidence interval [CI] 0.40-0.85; P = .005). The baseline PAC burden was 2.10 times (95% CI 1.57-2.83; P <.001) higher in whites than blacks. There was no detectable difference in premature ventricular contraction (PVC) burden by race. PAC burden mediated 19.5% (95% CI 6.3-52.5) of the adjusted association between race and AF. Conclusion: On average, whites exhibited more PACs than blacks, and this difference statistically explains a modest proportion of the differential risk of AF by race. The differential PAC burden, without differences in PVCs, by race suggests that identifiable common exposures or genetic influences might be important to atrial pathophysiology.

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KW - Race

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