Hemostatic markers are associated with the risk and prognosis of atrial fibrillation: the ARIC study.
BACKGROUND
Various hemostatic markers are associated with the risk of cardiovascular disease; however, limited information exists on their relationship with the occurrence and prognosis of atrial fibrillation (AF).


OBJECTIVE
To assess whether hemostatic markers are associated with the incidence and prognosis of AF.


METHODS
We studied 14,858 men and women in the Atherosclerosis Risk in Communities cohort, aged 45-64 and free of AF at baseline (1987-1989). Fibrinogen, von Willebrand factor (vWf), factor VII activity (VIIc), factor VIII activity (VIIIc), protein C, antithrombin III (ATIII), and activated partial thromboplastin time (aPTT) were measured in blood samples at baseline. AF and other cardiovascular outcomes through 2005 were determined following standardized protocols.


RESULTS
During a median follow-up of 16.8 years, 1209 cases of AF were identified. In multivariable Cox models, the hazard ratios (HR) and 95% confidence intervals (CI) of incident AF associated with a 1-standard deviation (SD) increase in each marker were 1.13 (1.07-1.20) for fibrinogen, 1.17 (1.11-1.23) for vWf, 1.17 (1.11-1.24) for factor VIIIc, 0.93 (0.88-1.00) for factor VIIc, 0.98 (0.92-1.04) for protein C, 1.00 (0.94-1.06) for aPTT and 1.00 (0.95-1.06) for ATIII. Greater factor VIIIc, fibrinogen and vWf were consistently associated with a higher risk of cardiovascular outcomes and mortality in those with and without incident AF, while greater protein C was associated with a lower risk of ischemic stroke.


CONCLUSIONS
Several hemostatic markers are associated with the incidence of AF independently of other cardiovascular risk factors. Their role in the risk stratification of AF patients should be further studied.
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA. alonso@umn.edu
Alvaro
A
Alonso
Weihong
W
Tang
Sunil K
SK
Agarwal
Elsayed Z
EZ
Soliman
Alanna M
AM
Chamberlain
Aaron R
AR
Folsom
D000990:Antithrombin III / Q000378:metabolism; D001281:Atrial Fibrillation / Q000097:blood* / Q000453:epidemiology*; D015415:Biomarkers / Q000378:metabolism; D002545:Brain Ischemia / Q000097:blood / Q000453:epidemiology; D005167:Factor VII / Q000378:metabolism; D005169:Factor VIII / Q000378:metabolism; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011379:Prognosis; D011486:Protein C / Q000378:metabolism; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000453:epidemiology; D014841:von Willebrand Factor / Q000378:metabolism*
D015415:Biomarkers; D011486:Protein C; D014841:von Willebrand Factor; D000990:Antithrombin III; D005167:Factor VII; D005169:Factor VIII; D005340:Fibrinogen