Atrial fibrillation was associated with a higher prevalence of subclinical atheromatosis compared to controls (36% vs. 18%, OR 2.56; 95% CI 1.62-4.03; p≤0.0001).
Observational (n=450)
No
Does atrial fibrillation associate with a higher prevalence of subclinical atheromatosis in middle-aged patients with low-intermediate cardiovascular risk?
Middle-aged patients with atrial fibrillation and low-to-intermediate cardiovascular risk have a significantly higher prevalence of subclinical carotid and femoral atheromatosis compared to matched controls.
Odds Ratio: 2.56 (95% CI 1.62–4.03)
Absolute Event Rate: 36% vs 18%
p-value: p=≤0.0001
Abstract Introduction Atherosclerosis (ATC) is a chronic systemic disease with a prolonged subclinical phase, only becoming symptomatic in advanced stages or after adverse cardiovascular events. Identifying subclinical atheromatosis is crucial for early intervention. Atrial fibrillation (AF) is the most common sustained arrhythmia in adults and a major cause of morbidity and mortality. AF and ATC share several risk factors for atherosclerotic disease (AD). Purpose This study hypothesizes that middle-aged patients with AF and low-intermediate cardiovascular risk have a higher prevalence of carotid and/or femoral atheromatosis than those without AF. Methods A retrospective observational study included patients from an Arrhythmia Clinic in our city, Argentina. Two groups were formed: AF (paroxysmal, persistent, or permanent) and controls (without AF or documented arrhythmias on ECG or 24-hour Holter). Inclusion criteria: a) age 40–65 years, b) vascular Doppler of carotid and/or femoral arteries, c) cardiovascular risk ≤ 10% (HEARTS SCORE, PAHO-Argentina). Exclusion criteria: diabetes mellitus, known vascular disease, coronary heart disease, cerebrovascular disease, or chronic renal failure. Each AF subject was matched with two control subjects. The primary objective was to compare AD prevalence in at least one vascular territory between groups. Secondary objectives included separate analyses of carotid and femoral disease prevalence. Results Between 2019 and 2022, 150 AF subjects met the eligibility criteria, matched with 300 controls. Patients with AF had higher body mass index (29.39±0.45 vs 26.59±0.27, p≤0.001), waist circumference (96±1.68 vs 89.29±0.78 cm, p≤0.001), as well as a higher prevalence of hypertension (29.33% vs 18.67%, p≤0.01). Echocardiographic, vascular Doppler and laboratory comparisons showed higher left atrial (LA) dilation in AF subjects (53.52% vs 16.55%, p≤0.001), increased LA indexed volume (35.97±12.65 vs. 26.55±6.92, p≤0.001), and lower Peak Atrial Longitudinal Strain (PALS) (25.59±10.33 vs. 30.61±8.17, p≤0.001). The prevalence of atheromatosis in at least one vascular territory was significantly higher in AF subjects (36% vs. 18%, OR 2.56 1.62-4.03, p≤0.0001). Carotid (33% vs.13.6%, OR 3.15 1.94-5.13, p≤0.0001) and femoral (32% vs. 12.69%, OR 3.25 1.59- 6.6, p≤0.0001) atheromatosis were significantly higher in the AF group (Figura 1). Increased pulse wave velocity (PWV), a marker of arterial stiffness, was also more frequent (8.53% vs. 2.08%, p=0.005). Multivariate analysis (Table 1) confirmed the association between AF and atherosclerosis, though statistical significance was not reached OR 12.79 (0.82- 19.88), p=0.06. Conclusion Patients with AF and low/intermediate cardiovascular risk exhibited a higher prevalence of subclinical vascular lesions. Further research is needed to establish a causal relationship. If confirmed, these findings may impact clinical management.
Recalde et al. (2025) conducted an observational in Atrial fibrillation and low-intermediate cardiovascular risk (n=450). Atrial fibrillation vs. Without atrial fibrillation was evaluated on Prevalence of atheromatosis in at least one vascular territory (OR 2.56, 95% CI 1.62-4.03, p=≤0.0001). Atrial fibrillation was associated with a higher prevalence of subclinical atheromatosis compared to controls (36% vs. 18%, OR 2.56; 95% CI 1.62-4.03; p≤0.0001).