Atrial Fibrillation May Double Risk of Heart Attack
Heart attack well established as risk for irregular
heartbeat, new study finds reverse also true; especially for women and
Nov. 5, 2013 - Atrial fibrillation (AF, an
irregular heartbeat) was associated with a nearly two-fold relative
increase in the risk of myocardial infarction (MI, heart attack),
especially in women and blacks, according to a study published by
JAMA Internal Medicine, a JAMA Network publication.
MI is an established risk factor for AF but the
extent to which AF is a risk factor for MI has not previously been
investigated, according to the study.
Elsayed Z. Soliman, M.D., M.Sc., M.S., of the Wake
Forest School of Medicine, Winton Salem, N.C., and colleagues examined
the association between AF and the risk of MI in participants who were
part of the Reasons for Geographic and Racial Differences in Stroke
(REGARDS) study. Among 23,928 participants, AF was present in 1,631.
The study reports 648 MI events occurred over
nearly seven years of follow-up. The relative rate of MI was nearly two
times that for participants without AF, an association which remained
after adjusting for total cholesterol, smoking, systolic blood pressure,
blood pressure-lowering drugs, body mass index, diabetes, and use of
anticoagulant and statin medications. The risk of MI associated with AF
also was higher in women and in blacks.
“These findings add to the growing concerns of the
seriousness of AF as a public health burden: in addition to being a
well-known risk factor for stroke, it is also associated with increased
risk of MI,” the authors comment.
Researchers suggest their findings indicate a
bidirectional relationship between MI and AF, with each leading to the
“A bidirectional relationship between AF and MI
could be partially explained by the fact that AF and MI share similar
risk factors, and therefore, common pathophysiologic processes might
drive both outcomes,” the authors note.
Editor’s Note: The REGARDS study is
supported by a cooperative agreement from the National Institute of
Neurological Disorders and Stroke, National Institutes of Health,
Department of Health and Human Services, with additional funding
provided by a grant from the National Heart, Lung and Blood Institute.
In a related editorial, Jonathan W. Dukes, M.D.,
and Gregory M. Marcus, M.D., M.A.S., of the University of California,
San Francisco, write: “While coronary artery disease and myocardial
infarction (MI) have been demonstrated to increase AF risk, Soliman et
al, in this issue of JAMA Internal Medicine, show that AF itself
may also lead to an increased risk of incident MI. These data therefore
add to the growing recognition of important bidirectional relationships
between AF and other cardiovascular comorbidities.”
“Although the findings of the study provided by
Soliman et al are informative, they do not suggest a change in our AF
treatment strategies,” they continue.
“Soliman and colleagues are to be commended for
producing this thought-provoking research that broadens our
understanding of AF. In short, AF begets many problems. … Our regular
clinical practice must extend beyond the common question ‘why does this
patient have AF?’ to ‘could this current problem have occurred due
to AF?’” the authors conclude.
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