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For decades, stroke has been the principally recognized and most clinically relevant sequelae of atrial fibrillation (AF).1 However, a recent analysis demonstrated that AF may also lead to worsening renal function, a particularly important observation given that chronic kidney disease has been primarily considered a risk factor for the development of AF.2 While coronary artery disease and myocardial infarction (MI) have been demonstrated to increase AF risk,1 Soliman et al,3 in this issue of JAMA Internal Medicine, show that AF itself may also lead to an increased risk of incident MI. These data therefore add to the growing recognition of important bidirectional relationships between AF and other cardiovascular comorbidities. Just as “AF begets AF,”4 we are learning it may also lead to kidney disease, heart failure, and now MI. As we consider these new findings and their implications, we must first carefully examine the strengths and limitations of this recent study as well as the mechanisms through which these observed associations might occur.
Dukes JW, Marcus GM. Atrial Fibrillation Begets Myocardial Infarction. JAMA Intern Med. 2014;174(1):5-7. doi:10.1001/jamainternmed.2013.11392