Atrial Fibrillation and Lipid-related Indices in Japanese Men: An Age-matched Case-control Study

Q: What are the key findings of this study?

A high atrial fibrillation risk index was strongly associated with prevalent atrial fibrillation in Japanese men.

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: Atrial fibrillation (n=462). Intervention: High atrial fibrillation risk index (AFRI >= 22.8, calculated as [waist circumference x GGT] / LDL-C) and lipid-related indices (LDL-C/HDL-C, TG/HDL-C, LAP, CMI, GGT/HDL-C) vs. Low atrial fibrillation risk index (AFRI < 22.8) / men without AF. Primary outcome: Prevalent atrial fibrillation diagnosed by electrocardiogram (OR 3.93, 95% CI 2.41-6.43, p=<0.01).

Q: What does this research mean for the field?

A novel atrial fibrillation risk index incorporating waist circumference, gamma-glutamyltransferase, and low-density lipoprotein cholesterol is strongly associated with prevalent atrial fibrillation in Japanese men. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To examine the associations between atrial fibrillation and various lipid-related indices, and to evaluate a novel composite index for discriminating atrial fibrillation risk in men.

Ichiro Wakabayashi

doi:10.21873/invivo.14390

June 30, 2026In VivoOpen Access

Atrial Fibrillation and Lipid-related Indices in Japanese Men: An Age-matched Case-control Study

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Key result

High AF risk index linked to ~3.9-fold higher odds of prevalent AF in Japanese men.

OR 3.93
95% CI 2.41-6.43
P<0.01
n=462

Figures

Why the study?

Although certain lipid-related indices are known to predict cardiovascular disease, their relationship with AF remains unclear.

Are lipid-related indices and the novel atrial fibrillation risk index (AFRI) associated with prevalent atrial fibrillation in age-matched Japanese men?

Key Points

To examine the associations between atrial fibrillation and various lipid-related indices, and to evaluate a novel composite index for discriminating atrial fibrillation risk in men.
Age-matched case-control study comparing 154 men with atrial fibrillation (median age: 66 years) to 308 age-matched control men without atrial fibrillation.
Evaluated cardiovascular risk factors and lipid indices—including LDL-C/HDL-C, TG/HDL-C, lipid accumulation product (LAP), cardiometabolic index (CMI), and GGT/HDL-C—using multivariable regression and receiver operating characteristic (ROC) analyses.
LAP and GGT/HDL-C were significantly higher, whereas LDL-C/HDL-C was significantly lower in the atrial fibrillation group than in controls; TG/HDL-C and CMI showed no significant differences.
The newly developed atrial fibrillation risk index (AFRI: waist circumference × GGT / LDL-C) was significantly higher in participants with atrial fibrillation [median: 39.4 vs. 24.4, p < 0.01; AUC = 0.655 (95% CI=0.603-0.708)].
Using an AFRI cutoff value of 22.8, the multivariable adjusted odds ratio for atrial fibrillation in participants with high AFRI versus those without was 3.93 (95% CI=2.41-6.43).

Study Design

Type

Case-Control (n=462)

Structured PICO

Are lipid-related indices and the novel atrial fibrillation risk index (AFRI) associated with prevalent atrial fibrillation in age-matched Japanese men?

P

Population

462 Japanese men (median age 66 years, 0% female) from workplace health checkups, comprising 154 cases with atrial fibrillation and 308 age-matched controls without atrial fibrillation.

E

Exposure

Lipid-related indices including LDL-C/HDL-C ratio, TG/HDL-C ratio, lipid accumulation product (LAP), cardiometabolic index (CMI), GGT/HDL-C ratio, and a novel AF risk index (AFRI, defined as [waist circumference in cm x GGT in U/l] / LDL-C in mg/dl, with cutoff >= 22.8).

C

Comparator

308 age-matched male controls without atrial fibrillation (or participants without high AFRI, < 22.8, in logistic regression analysis).

O

Outcome

Prevalent atrial fibrillation diagnosed by cardiologists based on electrocardiogram examination at health checkup.hard clinical

Main Result

Odds Ratio: 3.93 (95% CI 2.41–6.43)

Absolute Event Rate: 39.4% vs 24.4%

p-value: p=<0.01

Limitations

Participants were exclusively Japanese men, limiting generalizability to women and other ethnicities.
Information on antithrombotic medications that may affect blood lipid levels and liver function was not available.
Unmeasured confounders such as diet, nutrition, and socioeconomic factors were not included in the analysis.
Cross-sectional case-control design precludes determination of causal relationships between AF and cardiovascular risk factors.
Participants were all Japanese men, requiring further studies in female participants and other ethnicities.
Potential unmeasured confounders such as diet, nutrition, and socioeconomic factors were not available for adjustment.
Cross-sectional design prevents establishing causal relationships between AF and cardiovascular risk factors.

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Implication

In age-matched Japanese men, prevalent atrial fibrillation is positively associated with LAP and GGT/HDL-C and inversely associated with LDL-C/HDL-C, and a novel composite index (AFRI: waist circumference x GGT / LDL-C) shows stronger association with AF than individual risk factors alone.

Abstract

Background/Aim: Atrial fibrillation (AF) is associated with cardiovascular risk factors. Although certain lipid-related indices, including the ratio of low-density lipoprotein (LDL) cholesterol to high-density lipoprotein (HDL) cholesterol (LDL-C/HDL-C), the ratio of triglycerides to HDL-C (TG/HDL-C), lipid accumulation product (LAP), cardiometabolic index (CMI) and the ratio of gamma-glutamyltransferase to HDL-C (GGT/HDL-C), are known to predict cardiovascular disease, their relationship with AF is unclear. Patients and Methods: The participants included 154 men (median of age: 66 years) with AF and 308 age-matched men without AF. Cardiovascular risk factors, including obesity indices, blood pressure, blood lipids and hemoglobin A1C, as well as lipid-related indices, were compared between the groups with and without AF. Results: Body mass index, waist circumference and GGT were significantly higher or larger in participants with AF than in those without AF, while LDL-C was significantly lower in the AF group than in the control group. TG, HDL-C and hemoglobin A1C were not significantly different between the two groups. LAP and GGT/HDL-C were significantly higher and LDL-C/HDL-C was significantly lower in the AF group than in the control group, whereas TG/HDL-C and CMI were not significantly different between the two groups. Then, a new lipid-related index (AF risk index: AFRI), defined as the product of waist circumference and GGT divided by LDL-C, was proposed and shown to be associated with AF more strongly than each cardiovascular risk factor alone. Conclusion: LAP and GGT/HDL-C were positively associated with AF, whereas LDL-C/HDL-C was inversely associated with AF. AFRI may be a useful marker for discriminating the risk of AF.

Discussion

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Cite This Study

Ichiro Wakabayashi (2026) conducted a case-control in Atrial fibrillation (n=462). High atrial fibrillation risk index (AFRI >= 22.8, calculated as [waist circumference x GGT] / LDL-C) and lipid-related indices (LDL-C/HDL-C, TG/HDL-C, LAP, CMI, GGT/HDL-C) vs. Low atrial fibrillation risk index (AFRI < 22.8) / men without AF was evaluated on Prevalent atrial fibrillation diagnosed by electrocardiogram (OR 3.93, 95% CI 2.41-6.43, p=<0.01). A high atrial fibrillation risk index was strongly associated with prevalent atrial fibrillation in Japanese men.

synapsesocial.com/papers/6a4750b55c29257aa257855c https://doi.org/10.21873/invivo.14390

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Atrial Fibrillation and Lipid-related Indices in Japanese Men: An Age-matched Case-control Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Atrial Fibrillation and Lipid-related Indices in Japanese Men: An Age-matched Case-control Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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