Metabolic syndrome and atrial fibrillation in patients with essential hypertension

doi:10.1016/j.numecd.2011.03.011

Nutrition, Metabolism and Cardiovascular Diseases

Volume 23, Issue 2, February 2013, Pages 109-114

https://doi.org/10.1016/j.numecd.2011.03.011 Get rights and content

Abstract

Background and Aim

Metabolic syndrome (MS) has been recently associated with an increased risk for the development of atrial fibrillation (AF) in the general population. Whether this relation is also apparent in patients with arterial hypertension remains to be clarified. In the present study we sought to investigate the independent association of the MS with the AF in a large cohort of hypertensive patients.

Material and methods

The study comprised 15,075 consecutive, non-diabetic patients with essential hypertension (age range: 40–95 years, 51.1% males). All subjects underwent a complete clinical and lipidemic profile assesment as well as a standard 12-lead ECG at drug free baseline. MS was diagnosed by using five different definitions, including the National Cholesterol Education Program Third Adult Treatment Panel (ATPIII) and the GISSI Score.

Results

The prevalence of the MS varied from 31.7% to 47.8% according to the each time definition used. In multiple logistic regression analysis, MS was associated with the presence of AF (odds ratio from 1.61 to 1.99, p < 0.001 for all), independenty of the definition used. All ATPIII MS components were found to be independently associated with an increased incidence of AF. The prevalence of AF increased progressively with the severity of the metabolic syndrome as assessed by the number of the metabolic syndrome components (p < 0.001).

Conclusion

In non-diabetic patients with essential hypertension, the MS is directly and independently related to the AF prevalence.

Introduction

Atrial fibrillation (AF) is a common serious arrhythmia and it is associated with increased risk for heart failure [1], ischemic stroke [2] and all-cause mortality [3]. Many risk factors are associated with AF generation, including age, arterial hypertension, type II diabetes, dyslipidemia, obesity, and male gender [4], [5], [6]. The identification of these risk factors is of great clinical importance, since it may affect the therapeutic approach and the primary prevention of this common condition.

Metabolic syndrome (MS) on the other hand, is a cluster of cardiovascular and metabolic derangements and has been associated with severe cardiovascular risk [7], [8], [9]. Although definitions of MS may vary, it is of no doubt that its presence affects total cardiovascular profile and is related to adverse effects.

Accumulating data suggest that there is an important association between AF and MS in the general population [10], [11]. Recently, Watanabe et al., in a large prospective population based study, demonstrated that the presence of the MS is associated with a significant risk for new-onset AF. The severity of MS was also linearly associated with AF risk, while all MS components (with the exception of high triglycerides) were found to be independently related to the AF prevalence [11].

Whether the relation between MS and AF holds true in patients with arterial hypertension remained unknown. The aim of the present study was to investigate the association between AF prevalence and MS in a large scale cohort of hypertensive non-diabetic patients.

Section snippets

Study population

The hypertension outpatient clinics (Hippokration and Onassis Hospitals) of the Athens University offer comprehensive hemodynamic and metabolic evaluations to hypertensive patients, usually referred by their general practitioners. The present cohort comprises hypertensive patients who sought medical consultation to our clinics from 1988 to 2010. All patients signed the informed consent and the study protocol has been approved by the Ethics Committee of the Hippokration Hospital.

The initial

Statistical analysis

Data were stored in a personal computer system by using database manager software (FileMaker Pro, version 6.0, Santa Clara, US). Differences in non-continuous variables were detected by using Chi-square test. Unadjusted odds ratios were calculated by using binary logistic regression analysis. Adjusted odds ratios were estimated by performing multiple logistic regression analysis. In the constructed models the presence of AF (dichotomous variable) was used as the dependent variable; the

Characteristics of the study population

The final cohort comprised 15,075 consecutive, non-diabetic, hypertensive patients with a complete clinical and biochemical control. 43.3% of these patients were already under antihypertensive treatment at the time of their initial visit to our clinics. The major characteristics of the study population are presented in Table 1. We note the high prevalence of smoking (31.8%) and obesity in our population (28.6%). The diagnosis of the MS varied from 31.7% to 47.8% according to the each time

Discussion

The main new findings of the present study are: (1) MS, independently of the each time definition used, is associated with a higher incidence of AF in patients with arterial hypertension. This is in accordance with large scale prospective population based studies showing that patients with MS are in greater risk for developing AF [11]. (2) The severity of MS and the prevalence of AF in patients with arterial hypertension increase proportionally. (3) All MS components are independently

Study limitations

This is a non-random retrospective cohort study recruited from specialized hypertension clinics and thus results cannot be directly applied to the general population. A recruitment bias toward relatively health-conscious patients or toward patients with relatively severe hypertension cannot be excluded. The 15 days wash out period applied to all hypertensive patients already under antihypertensive treatment at the time of their first visit cannot exclude the potential protective effects from

Conflict of interest

None.

Acknowledgments

We thank all the medical and nurse employees of both hypertension Units of the Athens Medical School for their collaboration and support in our work.

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Citation Excerpt :
The risk of AF attributed to MS was 22% [18]. Vyssoulis et al. found that MS was an independent risk factor for AF in people with hypertension (n = 15,075), even after adjusting for traditional risk factors [19]. However, Hu et al. reported that MS did not increase AF risk in elderly hypertensive patients [20].
Some studies have reported that metabolic syndrome (MS) and a high inflammatory state are risk factors for atrial fibrillation (AF). However, the combined effect of MS and a high inflammatory state on AF is still unknown. We aimed to investigate the association of MS and high-sensitivity C-reactive protein (hs-CRP) levels with the risk of AF in a large community-based population.
A total of 81,092 subjects from the Kailuan Study with electrocardiogram examination and hs-CRP data at baseline (1st examination, 2006–2007) were included in this study. The enrolled population was divided into 4 groups according to the presence or absence of metabolic syndrome and high hs-CRP (>3 mg/L). The follow-up examinations were performed every two years (2nd examination, 2008–2009; 3rd examination, 2010–2011; 4th examination, 2012–2013; 5th examination, 2014–2015). All participants were followed until the occurrence of AF or the date of the last examination. After a mean time of 7.2 ± 2.0 years, a total of 271 individuals developed incident AF. MS or high hs-CRP alone was not associated with incident AF after multivariable adjustment. However, multiple Cox regression analysis showed that subjects with MS and hs-CRP > 3 mg/L had a greater risk for AF than those without MS and with hs-CRP ≤ 3 mg/L (hazard ratio, 1.61; 95% confidence interval 1.08–2.41; P = 0.019).
MS combined with a high hs-CRP level is associated with an increased risk for AF in the Chinese population. However, the mechanism is unknown and awaits further study.
http://www.chictr.org.cn/index.aspx.
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The association of AF and HTN based on both treatment resistance and BP level has not been previously investigated. Several studies have described a positive association of uncontrolled BP and AF.8,14,27,29 For example, Grundvold et al14 described higher AF risk among men with baseline uncontrolled SBP (≥140 mm Hg) or DBP (≥80 mm Hg) compared to those with controlled BP.
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For decades, vitamin K antagonists were the drugs available for management of patients requiring anticoagulation therapy. The so-called new oral blood thinners, with an apparently better safety profile, have been approved for some cases; however, Colombia still lacks the information on prescription patterns for these drugs.
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View all citing articles on Scopus

View full text

Metabolic syndrome and atrial fibrillation in patients with essential hypertension

Abstract

Background and Aim

Material and methods

Results

Conclusion

Introduction

Section snippets

Study population

Statistical analysis

Characteristics of the study population

Discussion

Study limitations

Conflict of interest

Acknowledgments

Am J Med

Int J Cardiol

Lifetime risk for development of atrial fibrillation: the Framingham Heart Study

Circulation

Impact of atrial fibrillation on the risk of death: the Framingham Heart Study

Circulation

Incidence of and risk factors for atrial fibrillation in older adults

Circulation

Obesity and the risk of new-onset atrial fibrillation

JAMA

Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey

JAMA

Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement

Circulation

Effect of metabolic syndrome on prognosis and clinical characteristics of revascularization in patients with coronary artery disease

Chin Med J (Engl)

The association of metabolic syndrome with atrial fibrillation: an emerging epidemiological and pathophysiological hypothesis

Cardiology

Metabolic syndrome and risk of development of atrial fibrillation: the Niigata preventive medicine study

Circulation

Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III)

JAMA

Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation

Diabet Med