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Relation of Systolic, Diastolic, and Pulse Pressures and Aortic Distensibility With Atrial Fibrillation (from the Multi-Ethnic Study of Atherosclerosis)

      Previous research suggests that elevated pulse pressure (PP) is a risk factor for atrial fibrillation (AF) independently of mean arterial pressure (MAP). PP may serve as an indirect measure of aortic stiffness (reduced distensibility), but whether directly measured aortic distensibility is related to risk for AF has not yet been studied. This analysis included 6,630 participants aged 45 to 84 years from the Multi-Ethnic Study of Atherosclerosis. At baseline, blood pressure and other relevant covariates were measured using standardized protocols. Magnetic resonance imaging–based aortic distensibility was measured in 3,441 participants. Incident AF was identified from hospitalization discharge codes and Medicare claims. Multivariate Cox models were used to estimate the association of blood pressure components and aortic distensibility with AF risk. During a mean follow-up of 7.8 years, 307 AF events (137 among those with aortic distensibility measurements) were identified. In multivariate-adjusted models simultaneously including MAP and PP, each 1-SD increase in PP was associated with a 29% increased risk of AF (95% confidence interval 5% to 59%, p = 0.02), with MAP not being associated with increased AF risk. Overall, aortic distensibility was not consistently associated with AF risk: after removing outliers, each 1-SD increase in aortic distensibility was associated with a 9% increased risk of AF (95% confidence interval −22% to 51%, p = 0.63). In conclusion, in this large community-based cohort, we found that PP, but not MAP or aortic distensibility, was a significant risk factor for AF, emphasizing the importance of PP when assessing the risk for developing AF. Our results cast doubt on the clinical utility of aortic distensibility as a predictor for the development of AF.
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      References

        • Kannel W.B.
        • Wolf P.A.
        • Benjamin E.J.
        • Levy D.
        Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates.
        Am J Cardiol. 1998; 82: 2N-9N
        • Psaty B.M.
        • Manolio T.A.
        • Kuller L.H.
        • Kronmal R.A.
        • Cushman M.
        • Fried L.P.
        • White R.
        • Furberg C.D.
        • Rautaharju P.M.
        Incidence of and risk factors for atrial fibrillation in older adults.
        Circulation. 1997; 96: 2455-2461
        • Conen D.
        • Tedrow U.B.
        • Koplan B.A.
        • Glynn R.J.
        • Buring J.E.
        • Albert C.M.
        Influence of systolic and diastolic blood pressure on the risk of incident atrial fibrillation in women.
        Circulation. 2009; 119: 2146-2152
        • Benjamin E.J.
        • Levy D.
        • Vaziri S.M.
        • D'Agostino R.B.
        • Belanger A.J.
        • Wolf P.A.
        Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study.
        JAMA. 1994; 271: 840-844
        • Krahn A.D.
        • Manfreda J.
        • Tate R.B.
        • Mathewson F.A.
        • Cuddy T.E.
        The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study.
        Am J Med. 1995; 98: 476-484
        • Mitchell G.F.
        • Vasan R.S.
        • Keyes M.J.
        • Parise H.
        • Wang T.J.
        • Larson M.G.
        • D'Agostino Sr., R.B.
        • Kannel W.B.
        • Levy D.
        • Benjamin E.J.
        Pulse pressure and risk of new-onset atrial fibrillation.
        JAMA. 2007; 297: 709-715
        • Abhayaratna W.P.
        • Barnes M.E.
        • O'Rourke M.F.
        • Gersh B.J.
        • Seward J.B.
        • Miyasaka Y.
        • Bailey K.R.
        • Tsang T.S.M.
        Relation of arterial stiffness to left ventricular diastolic function and cardiovascular risk prediction in patients > or =65 years of age.
        Am J Cardiol. 2006; 98: 1387-1392
        • Vaziri S.M.
        • Larson M.G.
        • Lauer M.S.
        • Benjamin E.J.
        • Levy D.
        Influence of blood pressure on left atrial size. The Framingham Heart Study.
        Hypertension. 1995; 25: 1155-1160
        • Bild D.E.
        • Bluemke D.A.
        • Burke G.L.
        • Detrano R.
        • Diez Roux A.V.
        • Folsom A.R.
        • Greenland P.
        • Jacob Jr., D.R.
        • Kronmal R.
        • Liu K.
        • Nelson J.C.
        • O'Leary D.
        • Saad M.F.
        • Shea S.
        • Szklo M.
        • Tracy R.P.
        Multi-ethnic study of atherosclerosis: objectives and design.
        Am J Epidemiol. 2002; 156: 871-881
        • Jensen P.N.
        • Johnson K.
        • Floyd J.
        • Heckbert S.R.
        • Carnahan R.
        • Dublin S.
        A systematic review of validated methods for identifying atrial fibrillation using administrative data.
        Pharmacoepidemiol Drug Saf. 2012; 21: 141-147
        • Alonso A.
        • Soliman E.Z.
        • Chen L.Y.
        • Bluemke D.A.
        • Heckbert S.R.
        Association of blood pressure and aortic distensibility with P wave indices and PR interval: the multi-ethnic study of atherosclerosis (MESA).
        J Electrocardiol. 2013; 46: 359.e1-359.e6
        • Alonso A.
        • Krijthe B.P.
        • Aspelund T.
        • Stepas K.A.
        • Pencina M.J.
        • Moser C.B.
        • Sinner M.F.
        • Sotoodehnia N.
        • Fontes J.D.
        • Janssens A.C.J.W.
        • Kronmal R.A.
        • Magnani J.W.
        • Witteman J.C.
        • Chamberlain A.M.
        • Lubitz S.A.
        • Schnabel R.B.
        • Agarwal S.K.
        • McManus D.D.
        • Ellinor P.T.
        • Larson M.G.
        • Burke G.L.
        • Launer L.J.
        • Hofman A.
        • Levy D.
        • Gottdiener J.S.
        • Kääb S.
        • Couper D.
        • Harris T.B.
        • Soliman E.Z.
        • Stricker B.H.C.
        • Gudnason V.
        • Heckbert S.R.
        • Benjamin E.J.
        Simple risk model predicts incidence of atrial fibrillation in a racially and geographically diverse population: the CHARGE-AF consortium.
        J Am Heart Assoc. 2013; 2: e000102
        • Huxley R.R.
        • Lopez F.L.
        • Folsom A.R.
        • Agarwal S.K.
        • Loehr L.R.
        • Soliman E.Z.
        • Maclehose R.
        • Konety S.
        • Alonso A.
        Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the Atherosclerosis Risk in Communities (ARIC) study.
        Circulation. 2011; 123: 1501-1508
        • Verdecchia P.
        • Dagenais G.
        • Healey J.
        • Gao P.
        • Dans A.L.
        • Chazova I.
        • Binbrek A.S.
        • Iacobellis G.
        • Ferreira R.
        • Holwerda N.
        • Karatzas N.
        • Keltai M.
        • Mancia G.
        • Sleight P.
        • Teo K.
        • Yusuf S.
        • Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint TrialTelmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease Investigators
        Blood pressure and other determinants of new-onset atrial fibrillation in patients at high cardiovascular risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease studies.
        J Hypertens. 2012; 30: 1004-1014
        • Larstorp A.C.K.
        • Ariansen I.
        • Gjesdal K.
        • Olsen M.H.
        • Ibsen H.
        • Devereux R.B.
        • Okin P.M.
        • Dahlöf B.
        • Kjeldsen S.E.
        • Wachtell K.
        Association of pulse pressure with new-onset atrial fibrillation in patients with hypertension and left ventricular hypertrophy: the Losartan Intervention For Endpoint (LIFE) reduction in hypertension study.
        Hypertension. 2012; 60: 347-353
        • Ciaroni S.
        • Bloch A.
        • Lemaire M.-C.
        • Fournet D.
        • Bettoni M.
        Prognostic value of 24-hour ambulatory blood pressure measurement for the onset of atrial fibrillation in treated patients with essential hypertension.
        Am J Cardiol. 2004; 94: 1566-1569
        • Valbusa F.
        • Bonapace S.
        • Bertolini L.
        • Zenari L.
        • Arcaro G.
        • Targher G.
        Increased pulse pressure independently predicts incident atrial fibrillation in patients with type 2 diabetes.
        Diabetes Care. 2012; 35: 2337-2339