title: Coronary Artery Calcium Progression and Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis.
abstract: BACKGROUND
  Coronary artery calcium (CAC) measured at a single time point has been associated with an increased risk for atrial fibrillation (AF). It is unknown whether CAC progression over time carries a similar risk.
  
  
  RESULTS
  This analysis included 5612 participants (mean age: 62±10; 52% women; 39% whites; 27% blacks; 20% Hispanics; 12% Chinese Americans) from the Multi-Ethnic Study of Atherosclerosis. Phantom-adjusted Agatston scores for baseline and follow-up measurements were used to compute change in CAC per year (≤0, 1-100, 101-300, and >300 U/year). AF was ascertained by review of hospital discharge records and from Medicare claims data through December 31, 2010. Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association between CAC progression and AF. Over a median follow-up of 5.6 years (25th, 75th percentiles=5.1, 6.8), a total of 203 (3.6%) incident AF cases were detected. Any CAC progression (>0/year) was associated with an increased risk for AF (HR=1.55, 95% CI=1.10, 2.19), and the risk increased with higher levels of CAC progression (≤0/year: HR=1.0 [reference]; 1-100/year: HR=1.47, 95% CI=1.03, 2.09; 101-300/year: HR=1.92, 95%CI=1.15, 3.20; >300/year: HR=3.23, 95%CI=1.48, 7.05). An interaction was observed by age with the association of CAC progression with AF being stronger for younger (<61 years: HR=3.53, 95% CI=1.29, 9.69) compared with older (≥61 years: HR=1.42, 95% CI=0.99, 2.04) participants (P interaction=0.037).
  
  
  CONCLUSIONS
  CAC progression during an average of 5 to 6 years of follow-up is associated with an increased risk for AF.
authors.affiliation: From the Department of Internal Medicine (W.T.O.), Department of Internal Medicine, Section on Cardiology (W.T.Q., J.Y., E.Z.S.), and Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC (J.T.E.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.); Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle (S.R.H.); and Departments of Medicine and Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (S.N.). woneal@wakehealth.edu.
authors.forename: Wesley T
authors.initials: WT
authors.lastname: O'Neal
authors.affiliation: From the Department of Internal Medicine (W.T.O.), Department of Internal Medicine, Section on Cardiology (W.T.Q., J.Y., E.Z.S.), and Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC (J.T.E.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.); Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle (S.R.H.); and Departments of Medicine and Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (S.N.).
authors.forename: Jimmy T
authors.initials: JT
authors.lastname: Efird
authors.affiliation: From the Department of Internal Medicine (W.T.O.), Department of Internal Medicine, Section on Cardiology (W.T.Q., J.Y., E.Z.S.), and Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC (J.T.E.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.); Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle (S.R.H.); and Departments of Medicine and Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (S.N.).
authors.forename: Waqas T
authors.initials: WT
authors.lastname: Qureshi
authors.affiliation: From the Department of Internal Medicine (W.T.O.), Department of Internal Medicine, Section on Cardiology (W.T.Q., J.Y., E.Z.S.), and Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC (J.T.E.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.); Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle (S.R.H.); and Departments of Medicine and Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (S.N.).
authors.forename: Joseph
authors.initials: J
authors.lastname: Yeboah
authors.affiliation: From the Department of Internal Medicine (W.T.O.), Department of Internal Medicine, Section on Cardiology (W.T.Q., J.Y., E.Z.S.), and Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC (J.T.E.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.); Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle (S.R.H.); and Departments of Medicine and Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (S.N.).
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.affiliation: From the Department of Internal Medicine (W.T.O.), Department of Internal Medicine, Section on Cardiology (W.T.Q., J.Y., E.Z.S.), and Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC (J.T.E.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.); Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle (S.R.H.); and Departments of Medicine and Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (S.N.).
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.affiliation: From the Department of Internal Medicine (W.T.O.), Department of Internal Medicine, Section on Cardiology (W.T.Q., J.Y., E.Z.S.), and Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC (J.T.E.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.); Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle (S.R.H.); and Departments of Medicine and Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (S.N.).
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
authors.affiliation: From the Department of Internal Medicine (W.T.O.), Department of Internal Medicine, Section on Cardiology (W.T.Q., J.Y., E.Z.S.), and Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC (J.T.E.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.A.); Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle (S.R.H.); and Departments of Medicine and Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (S.N.).
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000706:statistics & numerical data*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000208:ethnology; D018450:Disease Progression; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data*
keywords: atherosclerosis; atrial fibrillation; coronary calcium; coronary vessels; epidemiology