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LDL, total cholesterol predict new-onset atrial fibrillation in ASTEMI patients

09 Nov 2019

In patients with acute ST-segment elevation myocardial infarction (ASTEMI), the risk of new-onset atrial fibrillation (NOAF) appears to be linked with plasma levels of low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC), a recent China study has found.

Of the 985 ASTEMI patients (mean age, 63.4±12.6 years; 79.9 percent male) enrolled, 81 developed NOAF over 31 months of observation. The resulting incidence rate was 8.2 percent. These patients tended to present with significantly lower LDL-C, TC and triglyceride concentrations.

Multivariable logistic regression analysis found that, when grouped into tertiles of lipid concentrations, participants in the middle (odds ratio [OR], 0.46, 95 percent confidence intervals [CI], 0.22–0.98; p=0.044) and topmost (OR, 0.24, 95 percent CI, 0.1–0.58; p=0.002; p-trend=0.004) categories of TC benefited from significant protection against NOAF.

A similar and significant (p=0.001) trend was observed for LDL-C (middle tertile: OR, 0.23, 95 percent CI, 0.10–0.53; p=0.001; top tertile: OR, 0.38, 95 percent CI, 0.17–0.83; p=0.015).

In contrast, triglyceride levels and concentrations of high-density lipoprotein cholesterol were unrelated to the risk of developing NOAF.

In terms of outcomes, NOAF patients had an all-cause mortality rate of 19.8 percent. Kaplan-Meier analysis found that this was significantly higher than that in the sinus rhythm comparators (6.1 percent; log-rank p<0.001). Cardiogenic shock was likewise greater (17.3 percent vs 6.6 percent; p<0.001) and hospital stay was longer (10.1±5.3 vs 8.3±4.7 days; p=0.002) in the NOAF group.

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Routinely used for treating cardiovascular diseases, statins have been shown to benefit other conditions, and new evidence suggests that using the drug at high intensity reduces the risk of hip or knee replacement, an effect that may be specific to rheumatoid arthritis.
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