Atrial Fibrillation and the Risk of Myocardial Infarction | Acute Coronary Syndromes | JAMA Internal Medicine | JAMA Network
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Author Elsayed Z. Soliman, MD, MSc, MS, discusses Atrial Fibrillation and the Risk of Myocardial Infarction.

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Original Investigation
January 2014

Atrial Fibrillation and the Risk of Myocardial Infarction

Author Affiliations
  • 1Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina
  • 2Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
  • 3Division of Preventive Medicine, University of Alabama at Birmingham
  • 4Department of Epidemiology, University of Alabama at Birmingham
  • 5Department of Medicine, University of Vermont, Burlington
  • 6Department of Biostatistics, University of Alabama at Birmingham
JAMA Intern Med. 2014;174(1):107-114. doi:10.1001/jamainternmed.2013.11912
Abstract

Importance  Myocardial infarction (MI) is an established risk factor for atrial fibrillation (AF). However, the extent to which AF is a risk factor for MI has not been investigated.

Objective  To examine the risk of incident MI associated with AF.

Design, Setting, and Participants  A prospective cohort of 23 928 participants residing in the continental United States and without coronary heart disease at baseline were enrolled from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort between 2003 and 2007, with follow-up through December 2009.

Main Outcomes and Measures  Expert-adjudicated total MI events (fatal and nonfatal).

Results  Over 6.9 years of follow-up (median 4.5 years), 648 incident MI events occurred. In a sociodemographic-adjusted model, AF was associated with about 2-fold increased risk of MI (hazard ratio [HR], 1.96 [95% CI, 1.52-2.52]). This association remained significant (HR, 1.70 [95% CI, 1.26-2.30]) after further adjustment for total cholesterol, high-density lipoprotein cholesterol, smoking status, systolic blood pressure, blood pressure–lowering drugs, body mass index, diabetes, warfarin use, aspirin use, statin use, history of stroke and vascular disease, estimated glomerular filtration rate, albumin to creatinine ratio, and C-reactive protein level. In subgroup analysis, the risk of MI associated with AF was significantly higher in women (HR, 2.16 [95% CI, 1.41-3.31]) than in men (HR, 1.39 [95% CI, 0.91-2.10]) and in blacks (HR, 2.53 [95% CI, 1.67-3.86]) than in whites (HR, 1.26 [95% CI, 0.83-1.93]); for interactions, P = .03 and P = .02, respectively. On the other hand, there were no significant differences in the risk of MI associated with AF in older (≥75 years) vs younger (<75 years) participants (HR, 2.00 [95% CI, 1.16-3.35] and HR, 1.60 [95% CI, 1.11-2.30], respectively); for interaction, P = .44.

Conclusions and Relevance  AF is independently associated with an increased risk of incident MI, especially in women and blacks. These findings add to the growing concerns of the seriousness of AF as a public health burden: in addition to being a well-known risk factor for stroke, AF is also associated with increased risk of MI.

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