What is the clinical evidence from this study?

Study design: Cohort. Population: Incident atrial fibrillation (n=10744). Intervention: NT-proBNP and inflammatory cytokines vs. Lower concentrations. Primary outcome: Incident atrial fibrillation (HR 1.58, 95% CI 1.45-1.71).

February 17, 2023Open Access

Inflammatory proteomics profiling for prediction of incident atrial fibrillation

CBChristin S. BörschelGerman Centre for Cardiovascular Research AOAlfredo Ortega‐AlonsoUniversity of Helsinki AHAki S. HavulinnaPreventive Cardiology

Key Result

Higher concentrations of NT-proBNP were strongly associated with an increased risk of incident atrial fibrillation (HR 1.58), whereas associations with inflammatory cytokines were primarily explained by clinical risk factors.

Study Design

Type

Cohort (n=10,744)

Multicenter

Yes

Structured PICO

Does inflammatory proteomics profiling predict incident atrial fibrillation in a community-based cohort?

Population

10,744 adults aged 25 to 74 years from the Finnish population-based FINRISK cohorts, free of prevalent atrial fibrillation, myocardial infarction, and heart failure, followed for a median of 20.8 years.

Exposure

Inflammatory proteomics profiling (46 cytokines), C reactive protein (CRP), and N-terminal pro B-type natriuretic peptide (NT-proBNP) measurement

Outcome

Incident atrial fibrillationhard clinical

NT-proBNP is a strong predictor of incident atrial fibrillation, whereas circulating inflammatory cytokines do not add predictive value beyond standard clinical risk factors.

Main Result

Hazard Ratio: 1.58 (95% CI 1.45–1.71)

Limitations

Results may not be generalizable to other ethnicities as the FINRISK study is mainly composed of participants of European ancestry.
If cytokines have a modest predictive capacity, even larger sample sizes would be necessary.
Systemic measurement using multiplex techniques may not permit identifying small differences related to localized cardiac inflammation.

Abstract

OBJECTIVE: Atrial fibrillation (AF) has emerged as a common condition in older adults. Cardiovascular risk factors only explain about 50% of AF cases. Inflammatory biomarkers may help close this gap as inflammation can alter atrial electrophysiology and structure. This study aimed to determine a cytokine biomarker profile for this condition in the community using a proteomics approach. METHODS: This study uses cytokine proteomics in participants of the Finnish population-based FINRISK cohort studies 1997/2002. Risk models for 46 cytokines were developed to predict incident AF using Cox regressions. Furthermore, the association of participants' C reactive protein (CRP) and N-terminal pro B-type natriuretic peptide (NT-proBNP) concentrations with incident AF was examined. RESULTS: In 10 744 participants (mean age of 50.9 years, 51.3% women), 1246 cases of incident AF were observed (40.5% women). The main analyses, adjusted for participants' sex and age, suggested that higher concentrations of macrophage inflammatory protein-1β (HR=1.11; 95% CI 1.04, 1.17), hepatocyte growth factor (HR=1.12; 95% CI 1.05, 1.19), CRP (HR=1.17; 95% CI 1.10, 1.24) and NT-proBNP (HR=1.58; 95% CI 1.45, 1.71) were associated with increased risk of incident AF. In further clinical variable-adjusted models, only NT-proBNP remained statistically significant. CONCLUSION: Our study confirmed NT-proBNP as a strong predictor for AF. Observed associations of circulating inflammatory cytokines were primarily explained by clinical risk factors and did not improve risk prediction. The potential mechanistic role of inflammatory cytokines measured in a proteomics approach remains to be further elucidated.

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