Elevated coronary artery calcium (CAC) score, as assessed by the Agatston method,
is associated with incident atrial fibrillation (AF). We aimed to evaluate the associations
of CAC volume and density with incident AF. Participants from the Multiethnic Study
of Atherosclerosis without baseline AF and CAC >0 were included. The associations
between baseline and progression (average annual change) of CAC measures and incident
AF were evaluated using Cox proportional hazards models. CAC volume and Agatston scores
were natural log (ln)-transformed, and hazard ratios (HRs) were calculated per standard
deviation increment. The baseline analysis included 3,332 participants; 2,643 were
included in the progression analysis. In multivariable models adjusted for cardiovascular
risk factors, volume (HR 1.24, 95% confidence interval [CI] 1.14 to 1.36), density
(HR 1.14, 95% CI 1.05 to 1.25), and Agatston score (HR 1.24, 95% CI 1.14 to 1.35)
were associated with increased risk of incident AF. In models including both volume
and density, the magnitude of association between volume and incident AF was unchanged,
whereas the density association was eliminated (HR 0.99, 95% CI 0.89 to 1.11). Median
time to follow-up CAC assessment was 1.9 (interquartile range 1.3, 3.0) years. Similar
results were observed for the association of incident AF with annual change in volume
and Agatston score. CAC volume, but not density, is associated with risk for incident
AF when adjusting for both. In conclusion, our findings suggest that, although CAC
may be a risk marker for AF, the association between CAC and AF appears to be independent
of plaque density.
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Article Info
Publication History
Published online: July 14, 2022
Received in revised form:
May 24,
2022
Received:
April 4,
2022
Footnotes
This research was supported by R01 HL116395; the Multiethnic Study of Atherosclerosis was supported by contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, 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 grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from the National Center for Advancing Translational Sciences (Bethesda, Maryland). The study of incident atrial fibrillation in Multiethnic Study of Atherosclerosis was supported by R01 HL127659 from the National Heart, Lung, and Blood Institute. Dr. Bhatia is partially supported by the National Institutes of Health ((Bethesda, Maryland), grant 5T32HL079891, as part of the University of California, San Diego (San Diego, California) Integrated Cardiovascular Epidemiology Fellowship.
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