Munther K. Homoud, MD
Is new-onset atrial fibrillation (AF) associated with increased risks for mortality and cardiovascular (CV) events in initially healthy women? How do comorbid CV conditions affect risk?
Observational extension of a randomized controlled trial (Women's Health Study [WHS]) with a median 15.4 years of follow-up.
1011 women ≥ 45 years of age (median age 59 y at WHS entry, 72% with hypertension at onset of AF) who were health care professionals; developed new-onset AF during WHS follow-up; and did not have CV disease, cancer, or history of AF.
Age, height, body mass index, diabetes, hypertension, systolic blood pressure, hypercholesterolemia, smoking status, alcohol consumption, education level, race/ethnicity, and WHS randomized treatment assignment (aspirin, vitamin E, aspirin plus vitamin E, or placebo).
All-cause, CV, and non-CV mortality; and CV endpoints (congestive heart failure [CHF], myocardial infarction [MI], stroke, and a composite of CHF, MI, or stroke).
New-onset AF was associated with increased risks for all-cause, CV, and non-CV mortality (Table); risks were reduced but still significant when analyses were adjusted for intercurrent, nonfatal CHF, stroke, and MI (all-cause mortality, hazard ratio [HR] 1.7, 95% CI 1.3 to 2.2; CV mortality, HR 2.6, CI 1.6 to 4.1; non-CV mortality, HR 1.42, CI 1.02 to 1.98).
In initially healthy, middle-aged women, new-onset atrial fibrillation was associated with increased risk for mortality.
Risk for mortality and CV events associated with new-onset AF in healthy, middle-aged women*
*AF = atrial fibrillation; CV = cardiovascular; HR = hazard ratio; NR = not reported; CI defined in Glossary.
†Adjusted for age, height, body mass index, diabetes, hypertension, systolic blood pressure, hypercholesterolemia, smoking status, alcohol consumption, education level, race/ethnicity, and randomized treatment assignment for the Women's Health Study. HR > 1 indicates increased risk with new-onset AF.
‡Congestive heart failure, stroke, or myocardial infarction.
§Proportional hazards assumption was not met.
Homoud MK. New-onset atrial fibrillation was associated with increased risk for mortality in initially healthy, middle-aged women. Ann Intern Med. ;155:JC3–12. doi: 10.7326/0003-4819-155-6-201109200-02012
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Published: Ann Intern Med. 2011;155(6):JC3-12.
Cardiology, Rhythm Disorders and Devices.
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