Clinical and experimental data support a critical role for inflammation in cardiovascular
disease. The purpose of the current study was to examine the relation between an inflammatory
marker, neutrophil-to-lymphocyte ratio (NLR), and incident atrial fibrillation (AF)
in asymptomatic adults. We investigated 21,118 self-referred men and women who were
annually screened in a tertiary medical center. All subjects were free of AF at baseline
and had their serum NLR calculated at the first annual visit. Subjects were divided
into 2 groups based on their baseline NLR: Low (<2.83; n = 17,524) and high (≥2.83;
n = 3,594; Upper Sextile). The primary endpoint was new onset AF during follow-up.
Mean age of study population was 48 ± 10 years and 72% were men. A total of 563 (2.7%)
incident events occurred during an average follow-up of 7.5 ± 5 years. Unadjusted
Cox regression analysis demonstrated that each 1 unit increase in NLR was associated
with a significant 14% increase in risk of occurrence of a first AF event (95% confidence
interval 1.06 to 1.23, p < 0.001) and 20% increased risk of death. Kaplan-Meier's
survival analysis showed that the cumulative probability of incident AF was significantly
higher among subjects with high NLR compared with low NLR group (p = 0.006). Interaction
analysis with adjustment to clinical parameters showed that NLR-related risk was age-dependent,
such that in the younger age-group (< =50 years) high NLR group had two folds increased
risk for AF event compared with low NLR group (95% confidence interval 1.08 to 3.51;
p = 0.027) whereas among older subjects the rate of events was similar between both
NLR groups (p = NS; p for interaction = 0.024). In conclusion, our findings suggest
that high NLR is associated with increased risk of new onset AF. This finding is more
pronounced among young adults.
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References
- 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association.Eur Heart J. 2012; 33 (Available at:): 2719-2747http://www.ncbi.nlm.nih.gov/pubmed/22922413Date accessed: July 10, 2014
- Guidelines for the management of atrial fibrillation: the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC).Eur Heart J. 2010; 31 (Available at:): 2369-2429http://www.ncbi.nlm.nih.gov/pubmed/20802247Date accessed: July 10, 2014
Le S, Breithardt G, Campbell RWF, Camm AJ, Daubert J, Allessie M, Aliot E, Capucci A, Cosio F, Crijns H, Jordaens L, Hauer RNW, Lombardi F, Lu B. Working group report atrial fibrillation : current knowledge and recommendations for management. 1998;19:1294–1320.
- Inflammation as a risk factor for atrial fibrillation.Circulation. 2003; 108: 3006-3010
- Is atrial fibrillation an inflammatory disorder?.Eur Heart J. 2006; 27 (Available at:): 136-149http://www.ncbi.nlm.nih.gov/pubmed/16278230Date accessed: December 17, 2014
- Usefulness of neutrophil-to-lymphocyte ratio in risk stratification of patients with advanced heart failure.Am J Cardiol. 2015; 115 (Available at:): 57-61http://www.ncbi.nlm.nih.gov/pubmed/25456873Date accessed: December 25, 2014
- Neutrophil to lymphocyte ratio is predictor of atrial fibrillation recurrence after cardioversion with amiodarone.Clin Appl Thromb Hemost. 2015; 21 (Available at:): 5-9http://www.ncbi.nlm.nih.gov/pubmed/24431383Date accessed: December 26, 2014
- Body mass index and the risk of new-onset atrial fibrillation in middle-aged adults.Am Heart J. 2016; 173: 41-48
- Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia.Circulation. 1997; 96: 3542-3548
- C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease.N Engl J Med. 2004; 350 (Available at:): 1387-1397
- Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men.N Engl J Med. 1997; 336 (Available at:): 973-979
- C-reactive protein in ischemic stroke : an independent prognostic factor.Stroke. 2001; 32 (Available at:): 917-924
- C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation.Circulation. 2001; 104 (Available at:): 2886-2891
- Anti-inflammatory therapy with canakinumab for atherosclerotic disease.N Engl J Med. 2017; 377 (NEJMoa1707914. Available at:): 1119-1131
- Neutrophil to lymphocyte ratio and cardiovascular diseases: a review.Expert Rev Cardiovasc Ther. 2013; 11: 55-59
- Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients.Mod Rheumatol. 2016; 26: 372-376
- As a new inflammatory marker for familial mediterranean fever: neutrophil-to-lymphocyte ratio.Inflammation. 2013; 36: 1357-1362
- The relationship between neutrophil-to-lymphocyte ratio and inflammation in end-stage renal disease patients.Ren Fail. 2012; 34: 155-159
- 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation * Developed with the special contribution of the European Heart Rhythm Association.Eur Heart J. 2012; 33 (Available at:): 2719-2747
- Can neutrophil/lymphocyte ratio predict recurrence after electrical cardioversion in non-valvular atrial fibrillation?.Anadolu Kardiyol Derg. 2012; 34 (Available at:): 123-130
- Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting.Am J Cardiol. 2010; 105 (Available at:): 186-191http://www.ajconline.org/article/S0002-9149(09)02318-2/pdfDate accessed: April 23, 2014
Sahin S, Sarikaya S, Alcelik A, Erdem A, Tasliyurt T, Akyol L, Altunkas F, Aktas G, Karaman K. Neutrophil to lymphocyte ratio is a useful predictor of atrial fibrillation in patients with diabetes mellitus. Available at:http://www.actamedicamediterranea.com/archive/2013/medica-4/neutrophil-to-lymphocyte-ratio-is-a-useful-predictor-of-atrial-fibrillation-in-patients-with-diabetes-mellitus/pdf. Accessed April 23, 2018.
- Usefulness of neutrophil/lymphocyte ratio as a predictor of atrial fibrillation: a meta-analysis.Arch Med Res. 2015; 46 (Available at:): 199-206
Article info
Publication history
Published online: November 06, 2018
Received in revised form:
October 13,
2018
Received:
July 23,
2018
Footnotes
Statements: The Institutional Review Board of the Sheba Medical Center approved this study on the basis of strict maintenance of participants’ anonymity during database analyses (approval number 8995‐11‐SMC). Data from subjects were recorded anonymously. No individual consent was obtained.
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