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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Article info
Publication history
Published online: June 07, 2014
Accepted:
May 13,
2014
Received in revised form:
May 13,
2014
Received:
March 31,
2014
Footnotes
This research was supported by contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland and by grants UL1-TR-000040 and UL1-RR-025005 from National Center for Research Resources, Bethesda, Maryland.
See page 591 for disclosure information.
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© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
