Adhesion pathway proteins and risk of atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis

Israel J. Mendez, Sheila M. Manemann, Elizabeth J. Bell, Nicholas B. Larson, Paul A. Decker, Marco A. Guerrero, Naomi Q. Hanson, Susan R. Heckbert, James S. Pankow, Michael Y. Tsai, Suzette J. Bielinski

Research output: Contribution to journalArticlepeer-review


BACKGROUND: The cellular adhesion pathway has been suggested as playing an important role in the pathogenesis of atrial fibrillation (AF). However, prior studies that have investigated the role of adhesion pathway proteins in risk of AF have been limited in the number of proteins that were studied and in the ethnic and racial diversity of the study population. Therefore we aimed to study the associations of fifteen adhesion pathway proteins with incident AF in a large, diverse population.

METHODS: Multi-Ethnic Study of Atherosclerosis participants from four races/ethnicities (n = 2504) with protein levels measured were followed for incident AF (n = 253). HGF protein was measured on Exam 1 samples (N = 6669; AF n = 851). Cox proportional hazards regression was used to assess the association of AF with 15 adhesion pathway proteins. Bonferroni correction was applied to account for multiple comparisons.

RESULTS: After adjusting for potential confounding variables (age, sex, race/ethnicity, height, body mass index, systolic blood pressure, antihypertension therapy, diabetes status, current smoker, current alcohol use, and total and HDL cholesterol), and accounting for multiple testing (P < 0.05/15 = 0.0033), circulating levels of the following proteins were positively associated with a higher risk of AF: MMP-2 (HR per standard deviation increment, 1.27; 95% CI 1.11‒1.45), TIMP-2 (HR 1.28; 95% CI 1.12‒1.46), VCAM-1 (HR 1.32; 95% CI 1.16‒1.50), and SLPI (HR 1.22; 95% CI 1.07‒1.38). The association between proteins and AF did not differ by race/ethnicity.

CONCLUSIONS: Circulating levels of MMP-2, TIMP-2, VCAM-1, and SLPI were positively associated with an increased risk of incident AF in a diverse population. Our findings suggest that adhesion pathway proteins may be important risk predictors of AF.

Original languageEnglish (US)
Article number436
JournalBMC Cardiovascular Disorders
Issue number1
StatePublished - Sep 14 2021

Bibliographical note

Funding Information:
This work was supported by the National Institutes of Health Grants N01HC95159, N01 HC95160, N01 HC95161, N01 HC95162, N01 HC95163, N01 HC95164, N01 HC95165, N01 HC95166, N01 HC95167, and N01 HC95168, R01 HL127659, N01 HC95169, R01 HL98077, T32 HL07111-40, UL1 TR000040, and UL1 TR001079). Role of the Funding Source The funding source had no involvement in the study design, collection, analysis, or interpretation of data, in the writing of the report, or in the decision to submit the manuscript for publication.

Publisher Copyright:
© 2021, The Author(s).


  • Adhesion molecules
  • Atrial fibrillation
  • Inflammation
  • Risk factors


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