Brachial flow-mediated dilation and incident atrial fibrillation the multi-ethnic study of atherosclerosis

Wesley T. O'Neal, Jimmy T. Efird, Joseph Yeboah, Saman Nazarian, Alvaro Alonso, Susan R. Heckbert, Elsayed Z. Soliman

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Objective-It is unknown whether endothelial dysfunction precedes atrial fibrillation (AF) development. The objective of this study was to examine the association of brachial flow-mediated dilation (FMD) with incident AF.

Approach and Results-A total of 2936 participants (mean age, 61±9.9 years; 50% women; 66% nonwhites) from the Multi-Ethnic Study of Atherosclerosis with available ultrasound brachial FMD measurements who were free of baseline AF were included in this analysis. Baseline (2000-2002) FMD was computed from the percentage difference (%FMD) in brachial artery diameter and maximum diameter during measured vasodilator response. AF was ascertained from hospitalization data including Medicare claims during a median follow-up of 8.5 years. Probability-weighted Cox proportional-hazards regression was used to compute hazard ratios and 95% confidence intervals for the association between FMD as a continuous variable (%FMD values per 1-SD increase) and incident AF. Incident AF was detected in 137 (4.7%) participants. Those with %FMD values below the sex-specific median value (median %FMD; men, 3.6%; women, 4.2%; incidence rate per 1000 person-years, 7.3; 95% confidence interval, 5.9-9.0) were more likely to develop AF than people whose %FMD values were above the median value (incidence rate per 1000 person-years, 4.5; 95% confidence interval, 3.4-5.8; log-rank P=0.0043). In a multivariable Cox regression analysis, each 1-SD increase in %FMD values (SD, 2.8%) was associated with less incident AF (hazard ratio, 0.84; 95% confidence interval, 0.70-0.99). These results were consistent across subgroups stratified by age, sex, and race/ethnicity.

Conclusions-Smaller brachial FMD values are associated with higher rates of AF, suggesting a role for endothelial dysfunction in AF pathogenesis.

Original languageEnglish (US)
Pages (from-to)2717-2720
Number of pages4
JournalArteriosclerosis, thrombosis, and vascular biology
Volume34
Issue number12
DOIs
StatePublished - Dec 11 2014

Keywords

  • Atrial fibrillation
  • Endothelium
  • Epidemiology

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    O'Neal, W. T., Efird, J. T., Yeboah, J., Nazarian, S., Alonso, A., Heckbert, S. R., & Soliman, E. Z. (2014). Brachial flow-mediated dilation and incident atrial fibrillation the multi-ethnic study of atherosclerosis. Arteriosclerosis, thrombosis, and vascular biology, 34(12), 2717-2720. https://doi.org/10.1161/ATVBAHA.114.304560