title: Blood lipids and the incidence of atrial fibrillation: the Multi-Ethnic Study of Atherosclerosis and the Framingham Heart Study.
abstract: BACKGROUND
  Dyslipidemia is a major contributor to the development of atherosclerosis and coronary disease. Its role in the etiology of atrial fibrillation (AF) is uncertain.
  
  
  RESULTS
  We studied 7142 men and women from the Multi-Ethnic Study of Atherosclerosis (MESA) and the Framingham Heart Study who did not have prevalent AF at baseline and were not on lipid-lowering medications. Total cholesterol, high-density lipoprotein and low-density lipoprotein cholesterol, and triglycerides were measured using standard procedures. Incident AF during follow-up was identified from hospital discharge codes; review of medical charts; study electrocardiograms; and, in MESA only, Medicare claims. Multivariable Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals of AF by clinical categories of blood lipids in each cohort. Study-specific results were meta-analyzed using inverse of variance weighting. During 9.6 years of mean follow-up, 480 AF cases were identified. In a combined analysis of multivariable-adjusted results from both cohorts, high levels of high-density lipoprotein cholesterol were associated with lower AF risk (hazard ratio 0.64, 95% CI 0.48 to 0.87 in those with levels ≥60 mg/dL versus <40 mg/dL), whereas high triglycerides were associated with higher risk of AF (hazard ratio 1.60, 95% CI 1.25 to 2.05 in those with levels ≥200 mg/dL versus <150 mg/dL). Total cholesterol and low-density lipoprotein cholesterol were not associated with the risk of AF.
  
  
  CONCLUSIONS
  In these 2 community-based cohorts, high-density lipoprotein cholesterol and triglycerides but not low-density lipoprotein cholesterol or total cholesterol were associated with the risk of AF, accounting for other cardiometabolic risk factors.
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (A.A., N.S.R.).
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.affiliation: Department of Biostatistics, Boston University, Boston, MA (X.Y.) NHLBI and Boston University's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.D.M.M., E.J.B.).
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Yin
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (A.A., N.S.R.).
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Roetker
authors.affiliation: NHLBI and Boston University's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.D.M.M., E.J.B.) Section of Cardiovascular Medicine, Department of Medicine, Boston University, Boston, MA (J.W.M., E.J.B.).
authors.forename: Jared W
authors.initials: JW
authors.lastname: Magnani
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA (R.A.K., R.L.M.C.).
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kronmal
authors.affiliation: Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA (P.T.E., S.A.L.) Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA (P.T.E., S.A.L.).
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Ellinor
authors.affiliation: Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN (L.Y.C.).
authors.forename: Lin Y
authors.initials: LY
authors.lastname: Chen
authors.affiliation: Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA (P.T.E., S.A.L.) Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA (P.T.E., S.A.L.).
authors.forename: Steven A
authors.initials: SA
authors.lastname: Lubitz
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA (R.A.K., R.L.M.C.).
authors.forename: Robyn L
authors.initials: RL
authors.lastname: McClelland
authors.affiliation: NHLBI and Boston University's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.D.M.M., E.J.B.) Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA (D.D.M.M.).
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
authors.affiliation: Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.).
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.affiliation: School of Population Health, University of Queensland, Brisbane, Queensland, Australia (R.R.H.).
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Huxley
authors.affiliation: Department of Cardiology/Medicine, Johns Hopkins University, Baltimore, MD (S.N.) Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (S.N., M.S.).
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (S.N., M.S.).
authors.forename: Moyses
authors.initials: M
authors.lastname: Szklo
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA (S.R.H.).
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.affiliation: NHLBI and Boston University's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.D.M.M., E.J.B.) Section of Cardiovascular Medicine, Department of Medicine, Boston University, Boston, MA (J.W.M., E.J.B.) Department of Epidemiology, Boston University School of Public Health, Boston, MA (E.J.B.).
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
mesh_terms: D017677:Age Distribution; D000368:Aged; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D050171:Dyslipidemias / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate; D014280:Triglycerides / Q000097:blood*
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides
keywords: atrial fibrillation; cholesterol; epidemiology; lipids; risk factors