TY - JOUR
T1 - Risk of Dementia Associated With Atrial Cardiopathy
T2 - The ARIC Study
AU - Johansen, Michelle C.
AU - Wang, Wendy
AU - Zhang, Michael
AU - Knopman, David S.
AU - Ndumele, Chiadi
AU - Mosley, Thomas H.
AU - Selvin, Elizabeth
AU - Shah, Amil M.
AU - Solomon, Scott D.
AU - Gottesman, Rebecca F.
AU - Chen, Lin Yee
N1 - Funding Information:
The ARIC study is performed as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, HHSN268201700005I). Neurocognitive data are collected by U01 2U01HL096812, 2U01HL096814, 2U01HL096899, 2U01HL096902, 2U01HL096917 from the National Institutes of Health (National Heart, Lung, and Blood Institute [NHLBI], National Institute of Neurological Disorders and Stroke [NINDS], National Institute on Aging, and National Institute on Deafness and Other Communication Disorders [NIDCD]), and with previous brain magnetic resonance imaging examinations funded by R01-HL70825 from the NHLBI. Dr Johansen receives funding from the NINDS (K23NS112459). Dr Gottesman is supported by the NINDS Intramural Research Program. Dr Chen receives funding from the NHLBI (R01 HL141288, R01 HL126637, K24 HL155813).
Publisher Copyright:
© 2022, American Heart Association Inc. All rights reserved.
PY - 2022/8/16
Y1 - 2022/8/16
N2 - BACKGROUND: The contribution of atrial cardiopathy to dementia risk is uncharacterized. We aimed to evaluate the association of atrial cardiopathy with incident dementia and potential mediation by atrial fibrillation (AF) and stroke. METHODS AND RESULTS: We conducted a prospective cohort analysis of participants in the ARIC (Atherosclerosis Risk in Communities) study attending visit 5 (2011– 2013). We used Cox regression to determine the association between atrial car-diopathy and risk of dementia. Structural equation modeling methods were used to determine potential mediation by AF and/or stroke. Atrial cardiopathy was defined if ≥1 of the following at visit 5: P-wave terminal force >5000 mV·ms in ECG lead V1, NT-proBNP (N-terminal pro– brain natriuretic peptide) >250 pg/mL or left atrial volume index ≥34 mL/m2 by transthoracic echocardiography. We repeated our analysis necessitating ≥2 markers to define atrial cardiopathy. The prevalence of atrial cardiopathy was 34% in the 5078 participants (mean age 75 years, 59% female, 21% Black adults), with 763 participants de-veloping dementia. Atrial cardiopathy was significantly associated with dementia (adjusted HR, 1.35 [95% CI, 1.16–1.58]), with strengthening of the effect estimate when necessitating ≥2 biomarkers (adjusted HR, 1.54 [95% CI, 1.25–1.89]). There was an increased risk of dementia among those with atrial cardiopathy when excluding those with AF (adjusted HR, 1.31 [95% CI, 1.12–1.55]) or stroke (adjusted HR, 1.28 [95% CI, 1.09–1.52]). The proportion of the effect mediated by AF was 4% (P=0.005), and 9% was mediated by stroke (P=0.048). CONCLUSIONS: Atrial cardiopathy was significantly associated with an increased risk of dementia, with only a small percent mediation of the effect by AF or stroke.
AB - BACKGROUND: The contribution of atrial cardiopathy to dementia risk is uncharacterized. We aimed to evaluate the association of atrial cardiopathy with incident dementia and potential mediation by atrial fibrillation (AF) and stroke. METHODS AND RESULTS: We conducted a prospective cohort analysis of participants in the ARIC (Atherosclerosis Risk in Communities) study attending visit 5 (2011– 2013). We used Cox regression to determine the association between atrial car-diopathy and risk of dementia. Structural equation modeling methods were used to determine potential mediation by AF and/or stroke. Atrial cardiopathy was defined if ≥1 of the following at visit 5: P-wave terminal force >5000 mV·ms in ECG lead V1, NT-proBNP (N-terminal pro– brain natriuretic peptide) >250 pg/mL or left atrial volume index ≥34 mL/m2 by transthoracic echocardiography. We repeated our analysis necessitating ≥2 markers to define atrial cardiopathy. The prevalence of atrial cardiopathy was 34% in the 5078 participants (mean age 75 years, 59% female, 21% Black adults), with 763 participants de-veloping dementia. Atrial cardiopathy was significantly associated with dementia (adjusted HR, 1.35 [95% CI, 1.16–1.58]), with strengthening of the effect estimate when necessitating ≥2 biomarkers (adjusted HR, 1.54 [95% CI, 1.25–1.89]). There was an increased risk of dementia among those with atrial cardiopathy when excluding those with AF (adjusted HR, 1.31 [95% CI, 1.12–1.55]) or stroke (adjusted HR, 1.28 [95% CI, 1.09–1.52]). The proportion of the effect mediated by AF was 4% (P=0.005), and 9% was mediated by stroke (P=0.048). CONCLUSIONS: Atrial cardiopathy was significantly associated with an increased risk of dementia, with only a small percent mediation of the effect by AF or stroke.
KW - atrial cardiopathy
KW - dementia
KW - left atrium
KW - population study
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U2 - 10.1161/JAHA.121.025646
DO - 10.1161/JAHA.121.025646
M3 - Article
C2 - 35946474
AN - SCOPUS:85136081475
SN - 2047-9980
VL - 11
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 16
M1 - e025646
ER -