OC 74.1 - Circulating Biomarkers and Mortality in Atrial Fibrillation: The Reasons for Geographic And Racial Differences in Stroke Study

Wednesday, June 28, 2023

10:15 – 10:30 ET

Room: 511

Session Available As: On-Demand

Presenting Author(s)

Erin M. Hald, MD, PhD (she/her/hers)

Postdoctoral research fellow
Department of Medicine, Larner College of Medicine at the University of Vermont, USA
Colchester, Vermont, United States

Co-Author(s)

KW

Katherine Wilkinson

Biostatistician
Department of Medicine, Larner College of Medicine at the University of Vermont, USA
Colchester, Vermont, United States
SS

Samuel A. P. Short

Medical Student
Larner College of Medicine at the University of Vermont, USA
Burlington, Vermont, United States
SJ

Suzanne E. Judd

Professor
Department of Biostatistics, University of Alabama at Birmingham, USA
Birmingham, Alabama, United States
VH

Virginia J. Howard

Professor
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, USA
Birmingham, Alabama, United States
EL

Emily B. Levitan

Professor
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, USA
Birmingham, Alabama, United States
ES

Elsayed Z. Soliman

Professor
Epidemiological Cardiology Research Center, Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, USA
Winston-Salem, North Carolina, United States
Mary Cushman, MD, MSc (she/her/hers)

Professor
Department of Medicine, Larner College of Medicine at the University of Vermont, USA
Colchester, Vermont, United States

Background: Atrial fibrillation (AF) remains an independent contributor to mortality. Clinical trial data suggest that markers of cardiac dysfunction, oxidative stress and inflammation are associated with AF mortality, warranting further study in a racially diverse, population-based cohort.

Aims: To study associations of circulating biomarkers with all-cause mortality in persons with AF in the United States national Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort.

Methods: REGARDS enrolled 30,239 adults aged ≥45 in 2003-7 and followed them every 6 months. Candidate biomarkers were measured in all participants with baseline AF and no prior stroke (n=2260), and deaths identified from inclusion through December 31, 2019. We estimated mortality rates by person-years (PY) at risk and calculated hazard ratios (HRs) with 95% confidence intervals (CI) for mortality by quartiles of biomarker levels using Cox proportional hazards models. Models were adjusted for demographics, cardiovascular risk factors and antithrombotic medication use.

Results: The mean age at inclusion was 67.5 years. Participants were 53.5% female and 46.5% male, 64.3% White, 53.7% Black, and 21.3% were taking an anticoagulant. Over 10.3 years, 1151 participants died. Age-adjusted mortality rates increased across quartiles of most biomarkers (Figure), while overall mortality was similar in White and Black individuals. In multivariable analyses (Figure), 8 of 9 biomarkers were associated with all-cause mortality (HR, 95% CI for 4th vs 1st quartile): N-terminal pro B-type natriuretic peptide (4.76; 3.63-6.22), galectin 3 (2.07; 1.68-2.55), growth differentiation factor 15 (4.00; 3.02-5.31), cystatin C (2.87; 2.26-3.64), interleukin-6 (2.60; 2.08-3.25), γ-glutamylransferase (1.46; 1.20-1.76), D-dimer (1.75; 1.41-2.17) and VIII antigen (2.02; 1.64-2.49). Associations were monotonic for several. There were no differences in associations by race, sex and anticoagulation use (all p for interaction > 0.10).

Conclusion(s): Several biomarkers were associated with all-cause mortality in AF, suggesting multiple domains of potential clinical relevance that might lead to interventions for reducing mortality

Learning Objectives:

Upon completion, participants will be able to identify biomarkers associated with adverse outcomes in atrial fibrillation
Upon completion, participants will be able to recognize how these biomarkers are associated with all-cause mortality in atrial fibrillation
Upon completion, participants will be able to recognize how sex and race impacts these associations