Association Between Markers of Atrial Cardiopathy and Cognitive Impairment Risk Among Adults with No Suggestive History of Atrial Fibrillation

Background: Clinical atrial fibrillation (AF) is often preceded by substantive structural and electrical remodelling, termed atrial cardiopathy. This cohort study aims to investigate associations between markers of atrial cardiopathy and the risk of cognitive impairment among aging adults without a suggestive history or documentation of AF. Methods: This analysis included 21,856 participants from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study who were free of AF and cognitive impairment (2003-2007). Markers of atrial cardiopathy included atrial premature complexes (APCs) and N-terminal pro-brain natriuretic peptide (NT-proBNP). Cognitive status was measured using the 6-item screener. Cox proportional hazards regression was used to examine the association between markers of atrial cardiopathy and risk of cognitive impairment (primary outcome) and stroke during the follow-up period (secondary outcomes), separately. Results: During a mean follow-up of 9.9 years, 6058 participants had incident cognitive impairment, and 876 had a stroke. APCs increased the hazard of cognitive impairment by 8% (hazard ratio [HR], 1.08, 95% confidence interval [CI]: 1.01-1.15) and stroke by 10% (HR, 1.10, 95% CI: 1.04-1.17). The highest NTpro-BNP-level quintile ( > 235.2 pg/mL) increased the hazard of cognitive impairment by 53% (HR, 1.53, 95% CI: 1.36-1.72) and stroke by 54% (HR, 1.54, 95% CI: 1.39-1.71). Conclusions: Markers of left atrial cardiopathy, including presence of APCs and a high level of NT-proBNP, may be associated with an increased risk of cognitive impairment and stroke with no suggestive history or documentation of AF.