Open AccessAssociation of Peripheral Artery Disease With Incident Atrial Fibrillation: The ARIC (Atherosclerosis Risk in Communities) Study
Author(s) -
Bekwelem Wobo,
Norby Faye L.,
Agarwal Sunil K.,
Matsushita Kunihiro,
Coresh Josef,
Alonso Alvaro,
Chen Lin Y.
Publication year - 2018
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.117.007452
Subject(s) - medicine , hazard ratio , atrial fibrillation , cardiology , confidence interval , proportional hazards model , prospective cohort study , population , atherosclerosis risk in communities , environmental health
Background Although peripheral artery disease as defined by ankle‐brachial index ( ABI ) is associated with incident atrial fibrillation ( AF ), questions remain about the risk of AF in borderline ABI (>0.90 to <1.0) or noncompressible arteries (>1.4). We evaluated the association of borderline ABI and ABI >1.4 in the ARIC (Atherosclerosis Risk in Communities) study, a population‐based prospective cohort study. Methods and Results We included 14 794 participants (age, 54.2±5.8 years, 55% women, 26% blacks) with ABI measured at the baseline (1987–1989) and without AF . AF was identified from hospital records, death certificates, and ECGs. Using Cox proportional hazards, we evaluated the association between ABI and AF . During a median follow‐up of 23.3 years, there were 2288 AF cases. After adjustment for cardiovascular risk factors, hazard ratio ( HR ) (95% confidence interval) for AF among individuals with ABI <1.0 compared with ABI 1.0 to 1.4, was 1.13 (1.01–1.27). ABI >1.4 was not associated with increased AF risk. ABI ≤0.9 and borderline ABI were associated with a higher risk of AF compared with ABI 1.0 to 1.4. Demographics‐adjusted HR s (95% confidence interval) were 1.43 (1.17–1.75) and 1.32 (1.16–1.50), respectively. However, the associations of ABI ≤0.9 and borderline ABI with AF were attenuated after adjusting for cardiovascular risk factors ( HR [95% confidence interval], 1.10 [0.90–1.34] and 1.14 [1.00–1.30]), respectively. Conclusions Peripheral artery disease indicated by low ABI , including borderline ABI , is a weak risk factor for AF . ABI >1.4 is not associated with an increased AF risk. The relationship between peripheral artery disease and AF appears to be mostly explained by traditional atherosclerotic risk factors.