Brachial Flow-Mediated Dilation and Risk of Atrial Fibrillation in Older Adults: The Cardiovascular Health Study

Abstract

Parveen K Garg,1 Traci M Bartz,2 Gregory Burke,3 John S Gottdiener,4 David Herrington,5 Susan R Heckbert,6 Jorge R Kizer,7,8 Nona Sotoodehnia,9 Kenneth J Mukamal10 1Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA; 2Department of Biostatistics, University of Washington, Seattle, WA, USA; 3Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA; 4Cardiology Division, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; 5Departments of Cardiology, Epidemiology and Prevention, Wake Forest University, Winston-Salem, NC, USA; 6Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle, WA, USA; 7Cardiology Section, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; 8Departments of Medicine, and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; 9Cardiovascular Health Research Unit, Division of Cardiology, University of Washington, Seattle, WA, USA; 10Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USACorrespondence: Parveen K GargDivision of Cardiology, University of Southern California Keck School of Medicine, 1510 San Pablo St. Suite 322, Los Angeles, CA, 90033, USATel [phone]Fax [phone]Email [email protected]: Endothelial dysfunction is associated with common risk factors for AF and has been implicated in the pathophysiology of atrial fibrillation (AF) through a variety of mechanisms. We determined the prospective association of brachial flow-mediated dilation (FMD) with incident AF among older adults.Methods: We included 2027 Cardiovascular Health Study participants (mean age=78.3 years, male=39%, Black=17%) who underwent brachial FMD measurement at the 1997 to 1998 clinic visit. Incident AF was ascertained by study electrocardiograms, hospital discharge diagnosis coding and Medicare claims data. Cox regression models were used to examine the association between FMD and incident AF.Results: We identified 754 incident of AF cases (37%) over a median follow-up of 11.0 years. After adjusting for age, sex, race, height, weight, cardiovascular disease, cigarette smoking, hypertension, diabetes, kidney function, c-reactive protein, physical activity, alcohol consumption, and statins, the risk of AF did not differ according to brachial FMD response (4th vs 1st quartile hazard ratio (HR)=1.01, 95% confidence interval (CI): 0.81, 1.26; per FMD unit increment HR=1.01, 95% CI: 0.97, 1.05).Conclusion: We found no relationship between brachial FMD and the risk of developing AF in this elderly cohort. Our findings suggest that the utility of brachial FMD as a risk marker for AF in older individuals is minimal.Keywords: atrial fibrillation, arrhythmia, endothelium, flow-mediated dilation, subclinical disease

Keywords

• atrial fibrillation
• arrhythmia
• endothelium
• flow-mediated dilation
• subclinical disease