Key result
High homocysteine and low B12 linked to ~19% higher absolute AF prevalence in hypertensive patients.
Why the study?
High homocysteine and low vitamin B12 levels are associated with cardiovascular risk, but their combined effect on atrial fibrillation prevalence in hypertensive patients is unclear.
Do high homocysteine and low vitamin B12 levels increase the prevalence of atrial fibrillation in hypertensive patients?
Observational (n=32,800)
Yes
Do high homocysteine and low vitamin B12 levels increase the prevalence of atrial fibrillation in hypertensive patients?
Absolute Event Rate: 22.2% vs 3.2%
p-value: p=0.051
High homocysteine and low vitamin B12 levels are individually and synergistically associated with an increased prevalence of atrial fibrillation in hypertensive patients.
High homocysteine and low B12 levels were associated with higher AF prevalence in hypertension; hypothesis-generating for prospective trials.
Objective: Atrial fibrillation (AF) is common arrhythmia in hypertensive patients. Besides hypertension, several other conditions are deemed to be associated with AF. High blood homocysteine levels (hyperhomocysteinemia) is a known risk factor for cardiovascular disease and are associated with vitamin B12 deficiency that possibly increase cardiovascular risk, as well. The present study assessed the possible effect of high homocysteine and low B12 levels on AF prevalence in hypertensive patients. Design and method: This retrospective study comprised all hypertensives referred to our institutions and had a blood sample measurement of homocysteine and B12 (n = 32800). The presence of sustained AF (SAF; Long-standing/Persistent or Permanent AF) was recorded with a resting electrocardiogram (ECG). Paroxysms of AF (PAF) were confirmed with previous relevant ECGs provided by the patient. The population was divided in quartiles according to homocysteine levels (groups 1, 2, 3 and 4 for increasing levels) and B12 levels (groups 1, 2, 3 and 4 for decreasing levels). The prevalence of AF (SAF and PAF) was calculated for each homocysteine and B12 quartile group as well as for each of the 16 homocysteine/B12 combination quartile subgroups. Results: The mean values for homocysteine were 13.3 ± 7.2 ?mol/l and for B12 525 ± 196 pg/ml. The prevalence of SAF, PAF and all-type AF (SAF and PAF) was 5.0%, 6.1% and 11.1%, respectively. For homocysteine quartiles 1, 2, 3, 4, SAF prevalence was 2.9%, 5.3%, 11.7%, 24.3% (pfor trend 0.049), PAF prevalence was 0.6%, 0.9%, 4.6%, 14.0% (pfor trend 0.090) and all-type AF prevalence was 3.2%, 5.4%, 11.5%, 22.2% (pfor trend 0.051), respectively. For B12 quartiles 1, 2, 3, 4, SAF prevalence was 2.9%, 6.4%, 11.0%, 20.2% (pfor trend 0.030), PAF prevalence was 2.5%, 5.1%, 7.7%, 9.0% (pfor trend 0.009) and all type-AF prevalence was 2.4%, 7.1%, 16.8% 21.0% (pfor trend 0.019), respectively. The synergistic effect of increasing homocysteine and decreasing B12 values on SAF, PAF and all-type AF prevalence is presented in Figure. Conclusions: High homocysteine levels and low vitamin B12 levels are individually and synergistically associated with the prevalence of AF in hypertensive individuals. Underlying mechanisms merit further examination.
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Liakos et al. (2022) conducted an observational in Hypertension (n=32,800). High homocysteine and low vitamin B12 levels vs. Lower homocysteine and higher vitamin B12 levels was evaluated on Prevalence of all-type atrial fibrillation (p=0.051). In hypertensive patients, all-type AF prevalence increased from 3.2% to 22.2% across increasing homocysteine quartiles (P=0.051) and from 2.4% to 21.0% across decreasing B12 quartiles (P=0.019).
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