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Health & Medicine for Senior Citizens

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 blacks

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.


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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 other.

 “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.

Editorial: Atrial Fibrillation Begets Myocardial Infarction

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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