Key result
Anemia is linked to ~6% higher incident AF risk, reflecting a U-shaped relationship with hemoglobin.
Why the study?
Anemia is a recognized risk factor for cardiovascular disease, but its impact on new-onset AF remains unclear.
Do abnormal hemoglobin levels or their dynamic changes increase the risk of incident atrial fibrillation in the general adult population?
Cohort (n=9,686,314)
Do abnormal hemoglobin levels or their dynamic changes increase the risk of incident atrial fibrillation in the general adult population?
Effect estimate: HR 1.06 (95% CI 1.05-1.08)
Absolute Event Rate: 4.39% vs 3.156%
p-value: p=<0.001
Both low and high hemoglobin levels, as well as dynamic changes outside normal ranges, are independently associated with an increased risk of incident atrial fibrillation in the general population.
Anemia is a risk factor for cardiovascular disease, but its impact on new-onset atrial fibrillation (AF) is unclear. In this study, we investigated the effect of hemoglobin (Hb) levels and their changes on the risk of AF development in the general population of Korea. We retrospectively analyzed a cohort from the Korean National Health Insurance Service database and identified 9,686,314 subjects (49.8% male) without a history of AF, aged ≥40 years, and with Hb levels available for both first (2009-2010) and second (2011-2012) health checkups. These subjects were followed up until 2017 to determine AF development. The presence of anemia (Hb level <13 g/dL in men and <12 g/dL in women) was a significant risk factor for AF development. However, Hb levels showed a U-shaped association with incident AF after adjustment for cardiovascular risk factors. AF incidence was lowest at Hb levels of 14-14.9 g/dL in men and 12-12.9 g/dL in women. Among individuals with Hb levels within normal ranges (13-15.9 g/dL in men and 12-14.9 g/dL in women), both decrease and increase in Hb levels at the second measurement outside the normal ranges showed an elevation of AF risk by 11% and 21% for men and 3% and 36% for women, respectively, compared with those who maintained normal Hb levels. In conclusion, low or high Hb levels are associated with an increased risk of incident AF. This study suggests that maintaining Hb levels within the normal ranges confers a low risk of AF development.
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Lim et al. (2020) conducted a cohort in Atrial Fibrillation Risk (n=9,686,314). Anemia (Hemoglobin levels) vs. No anemia (Normal hemoglobin levels) was evaluated on Newly diagnosed non-valvular atrial fibrillation (HR 1.06, 95% CI 1.05-1.08, p=<0.001). Anemia was associated with a 6% increased risk of incident atrial fibrillation compared to no anemia (HR 1.06), with both low and high hemoglobin levels demonstrating a U-shaped relationship with risk.
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