Remnant cholesterol and new-onset atrial fibrillation: The Atherosclerosis Risk in Communities study

Xiaolan Ouyang; Xixiang Tang; Long Peng; Hongxing Wu; Jiafu Wang; Zhuoshan Huang; Bingyuan Wu; Yue Li; Yan Lu; Xiaodong Zhuang; Yesheng Ling; Suhua Li

doi:10.1016/j.hrthm.2024.10.030

Remnant cholesterol and new-onset atrial fibrillation: The Atherosclerosis Risk in Communities study

Heart Rhythm. 2024 Oct 19:S1547-5271(24)03456-8. doi: 10.1016/j.hrthm.2024.10.030. Online ahead of print.

Authors

Xiaolan Ouyang¹, Xixiang Tang², Long Peng¹, Hongxing Wu¹, Jiafu Wang¹, Zhuoshan Huang¹, Bingyuan Wu¹, Yue Li³, Yan Lu³, Xiaodong Zhuang⁴, Yesheng Ling¹, Suhua Li⁵

Affiliations

¹ Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
² VIP Medical Service Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
³ The Second Affiliated Hospital, Guangdong Provincial Key Laboratory of Allergy & Clinical Immunology, Guangzhou Medical University, Guangzhou, China.
⁴ Department of Cardiovascular Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
⁵ Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. Electronic address: lisuhua3@mail.sysu.edu.cn.

PMID: 39433075
DOI: 10.1016/j.hrthm.2024.10.030

Abstract

Background: The relationship between remnant cholesterol (RC) and atrial fibrillation (AF) remains unclear.

Objective: The purpose of this study was to comprehensively explore the association between RC characteristics and new-onset AF.

Methods: Data from 5 follow-up visits of the ARIC (Atherosclerosis Risk in Communities) study were analyzed. RC were multidimensionally evaluated in 4 characteristics: baseline level, variability, cumulative exposure, and trajectory. Baseline RC was obtained from the initial visit (V1), and new-onset AF was monitored in V2 to V5 (cohort 1, n = 14,450). RC variability, cumulative RC, and RC trajectory were calculated by RC values gathered from V1 to V3, and new-onset AF was monitored in V4 and V5 (cohort 2, n = 11,012). Participants were divided into 4 groups based on quartiles or trajectories. Cox proportional hazards analyses were used to investigate the relationship between RC characteristics and AF.

Results: Following median follow-up of 22.39 years in cohort 1 and 16.71 years in cohort 2, a total of 1993 AF events in cohort 1 and 1571 in cohort 2 were identified. Participants with the highest quartile exhibited an elevated risk of new-onset AF, with the multivariable-adjusted hazard ratios of 1.16 (P = .039) for baseline RC and 1.30 (P < .001) for RC variability. Although the highest quartile of cumulative RC (P = .241) and the high-increasing trajectory (P = .210) did not demonstrate a statistically significant association with AF occurrence, they indicate a trend toward heightened risk.

Conclusion: Our findings reveal that higher levels of RC, particularly at baseline and in variability, are associated with an increased risk of AF.

Keywords: ARIC study; Atrial fibrillation; Change trajectory; Cholesterol variability; Cumulative exposure; Remnant cholesterol.