title: Coronary artery calcium and risk of atrial fibrillation (from the multi-ethnic study of atherosclerosis).
abstract: Calcified coronary arteries are associated with the development of cardiovascular disease and stroke. It is currently unknown whether coronary artery calcium (CAC) is associated with an increased risk for atrial fibrillation (AF). The aim of this study was to address this question in 6,641 participants (mean age 62 ± 10 years, 53% women, 62% nonwhites) from the Multi-Ethnic Study of Atherosclerosis (MESA) who were free of baseline clinical cardiovascular disease and AF. CAC measurements were assessed by cardiac computed tomography at study baseline. AF was ascertained by review of hospital discharge records and from Medicare claims data until December 31, 2010. Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the association between CAC and AF. During a median follow-up period of 8.5 years, 308 participants (4.6%) developed AF. In a model adjusted for sociodemographics, cardiovascular risk factors, and potential confounders, higher CAC scores were associated with increased risk for AF (CAC = 0: HR 1.0, referent; CAC = 1 to 100: HR 1.4, 95% CI 1.01 to 2.0; CAC = 101 to 300: HR 1.6, 95% CI 1.1 to 2.4; CAC >300: HR 2.1, 95% CI 1.4 to 2.9). The addition of CAC to the Framingham Heart Study and Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) AF risk scores yielded integrated discrimination improvement of 0.0033 (95% CI 0.0015 to 0.0066) and 0.0028 (95% CI 0.0012 to 0.0057), with relative integrated discrimination improvement of 0.10 (95% CI 0.061 to 0.15) and 0.077 (95% CI 0.040 to 0.11), respectively. In conclusion, CAC is independently associated with increased risk for AF.
authors.affiliation: Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Wesley T
authors.initials: WT
authors.lastname: O'Neal
authors.affiliation: Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
authors.forename: Jimmy T
authors.initials: JT
authors.lastname: Efird
authors.affiliation: Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Farah Z
authors.initials: FZ
authors.lastname: Dawood
authors.affiliation: Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Joseph
authors.initials: J
authors.lastname: Yeboah
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.affiliation: Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle, Washington.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.affiliation: Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina. Electronic address: esoliman@wakehealth.edu.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001213:Asian / Q000706:statistics & numerical data; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000208:ethnology; D055424:Cardiac-Gated Imaging Techniques; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000208:ethnology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D016016:Proportional Hazards Models; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data