Peripheral Artery Disease and Atrial Fibrillation

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Peripheral artery disease (n=763919). Intervention: Peripheral artery disease vs. No peripheral artery disease. Primary outcome: Incident new-onset atrial fibrillation (HR 1.34, 95% CI 1.18-1.50).

Q: What does this research mean for the field?

Peripheral artery disease is associated with a 34% increased risk of new-onset atrial fibrillation, although the certainty of evidence is low. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Daniele Pastori; Danilo Menichelli; Gianluca Gazzaniga; Vito Maria Cormaci; Daniele Malatesta; Francesco Violi; Pasquale Pignatelli; Gregory Y.H. Lip

doi:10.1016/j.jacadv.2026.103111

August 7, 2026JACC AdvancesOpen Access

Peripheral Artery Disease and Atrial Fibrillation

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Key result

PAD is linked to ~34% higher risk of new-onset AF.

HR 1.34
95% CI 1.18-1.50
n=763,919

Figures

Graphical abstract published by JACC Advances — Graphical abstract · Published by JACC Advances · CC BY-NC-ND

Why the study?

Several cardiovascular risk factors are linked to new-onset atrial fibrillation, but the relationship between peripheral artery disease and new-onset atrial fibrillation has been less extensively investigated.

Does peripheral artery disease increase the risk of incident new-onset atrial fibrillation in adult patients?

Key Points

To evaluate and estimate the risk of incident new-onset atrial fibrillation in patients diagnosed with peripheral artery disease.
Systematic review of MEDLINE and EMBASE through January 2026 identifying 7 observational studies (5 prospective and 2 retrospective) encompassing 763,919 individuals, including 56,207 with peripheral artery disease.
Stratified outcomes according to peripheral artery disease diagnostic method, comparing ankle-brachial index cutoffs (<1.0 vs >1.4) and clinical or International Classification of Diseases coding, with certainty assessed using GRADE.
Peripheral artery disease was associated with an increased risk of new-onset atrial fibrillation (HR: 1.34; 95% CI: 1.18-1.50; I2 = 85%; 26,064 incident cases), evaluated as low certainty evidence by GRADE.
In subgroup analyses by diagnostic criteria, risk remained elevated for ankle-brachial index <1.00 (HR: 1.18; 95% CI: 1.09-1.28; P < 0.001; I2 = 37%) and clinical diagnosis (HR: 1.40; 95% CI: 1.19-1.66; P < 0.001; I2 = 81%), but was not statistically significant for ankle-brachial index >1.4 (HR: 1.14; 95% CI: 0.99-1.32; P = 0.07; I2 = 33%).

Study Design

Type

Meta-Analysis (n=763,919)

Structured PICO

Does peripheral artery disease increase the risk of incident new-onset atrial fibrillation in adult patients?

P

Population

763,919 adults from 7 observational studies comparing the risk of incident new-onset atrial fibrillation in patients with and without peripheral artery disease.

E

Exposure

Peripheral artery disease (PAD) defined by abnormal ankle-brachial index (ABI) or clinical/ICD-9 diagnosis

C

Comparator

Adult populations without PAD

O

Outcome

Incident new-onset atrial fibrillation (NOAF)hard clinical

Main Result

Hazard Ratio: 1.34 (95% CI 1.18–1.5)

Absolute Event Rate: 2% vs 1.6%

Peripheral artery disease is associated with a significantly increased risk of new-onset atrial fibrillation, suggesting ABI could serve as a risk marker for incident AF.

Limitations

Substantial heterogeneity across studies
Different clinical PAD definitions used
Different methods of NOAF diagnosis
Small number of included studies
Observational nature does not permit causal inference

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

PAD may mark higher incident AF risk; extends vascular comorbidity data but should not yet change practice.

Abstract

BACKGROUND: Several cardiovascular risk factors and comorbidities have been linked to an increased risk of new-onset atrial fibrillation (NOAF). However, the relationship between peripheral artery disease (PAD) and NOAF has been less extensively investigated. OBJECTIVES: The purpose of this study was to estimate the risk of NOAF in PAD patients. METHODS: We performed a systematic review of MEDLINE (via PubMed) and EMBASE from inception to January 2026 and a meta-analysis of observational studies reporting risk of NOAF in PAD patients. For studies using the ankle-brachial index (ABI), we stratified results according to ABI <1.0 or >1.4. The certainty of the evidence according to GRADE (Grading of Recommendations, Assessment, Development and Evaluations) was low. CONCLUSIONS: Data from observational studies suggest that PAD may be associated with a 34% increased risk of NOAF. In patients diagnosed with PAD (ie, low ABI), proactive management of common atherosclerotic risk factors may be considered to potentially reduce the risk of NOAF.

Discussion

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Cite This Study

Pastori et al. (2026) conducted a meta-analysis in Peripheral artery disease (n=763,919). Peripheral artery disease vs. No peripheral artery disease was evaluated on Incident new-onset atrial fibrillation (HR 1.34, 95% CI 1.18-1.50). Peripheral artery disease was associated with a 34% increased risk of new-onset atrial fibrillation compared to patients without peripheral artery disease (HR 1.34).

synapsesocial.com/papers/6a797ce09c20a9bbd3184011 https://doi.org/10.1016/j.jacadv.2026.103111

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Peripheral Artery Disease and Atrial Fibrillation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Peripheral Artery Disease and Atrial Fibrillation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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