Dyslipidemia and Risk of Cardiovascular Events in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Therapy: Insights From the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) Trial

Abstract

BackgroundDyslipidemia is a major risk factor for cardiovascular events. The prognostic importance of lipoproteins in patients with atrial fibrillation is not well understood. We aimed to explore the association between apolipoprotein A1 (ApoA1) and B (ApoB) and cardiovascular events in patients with atrial fibrillation receiving oral anticoagulation.Methods and ResultsUsing data from the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial, ApoA1 and ApoB plasma levels were measured at baseline in 14 884 atrial fibrillation patients. Median length of follow‐up was 1.9 years. Relationships between continuous levels of ApoA1 and ApoB and clinical outcomes were evaluated using Cox models adjusted for cardiovascular risk factors, medication including statins, and cardiovascular biomarkers. A composite ischemic outcome (ischemic stroke, systemic embolism, myocardial infarction, and cardiovascular death) was used as the primary end point. Median (25th, 75th) ApoA1 and ApoB levels were 1.10 (0.93, 1.30) and 0.70 g/L (0.55, 0.85), respectively. In adjusted analyses, higher levels of ApoA1 were independently associated with a lower risk of the composite ischemic outcome (hazard ratio, 0.81; P<0.0001). Similar results were observed for the individual components of the composite outcome. ApoB was not significantly associated with the composite ischemic outcome (P=0.8240). Neither apolipoprotein was significantly associated with major bleeding. There was no interaction between lipoproteins and randomized treatment for the primary outcome (both P values ≥0.2448).ConclusionsIn patients with atrial fibrillation on oral anticoagulation, higher levels of ApoA1 were independently associated with lower risk of ischemic cardiovascular outcomes. Investigating therapies targeting dyslipidemia may thus be useful to improve cardiovascular outcomes in patients with atrial fibrillation.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00412984.

Risk factors for death by acute ischaemic stroke in patients from West-Pomerania, Poland

“…The relationship between dyslipidemia and ischaemic stroke is a complex issue in light of current research. In some studies, dyslipidemia has been associated with a worse prognosis, while other reports refute this [32][33][34][35][36][37]. Also, in our study, univariable analyses showed that the concurrence of dyslipidemia in ischaemic stroke patients was associated with higher mortality; however, this was not confirmed by multivariable analyses, which probably results from heterogeneity of strokes.…”

Risk Factor Management in Atrial Fibrillation

“…ischaemic stroke, systemic embolism, MI and cardiovascular death, suggesting that interventions increasing HDL levels could have a beneficial effect. 145 Data on the effect of lipid-lowering therapy on AF predominantly come from retrospective and small randomised studies investigating statins in patients with post-operative AF (POAF) and their results are mixed. 146 A large randomised, controlled trial of rosuvastatin in patients with POAF did not show any beneficial effect of statin treatment in AF prevention.…”

Cardiac troponin is associated with cardiac outcomes in men and women with atrial fibrillation, insights from the ARISTOTLE trial

“…We also employed sex‐specific cut‐offs for hs‐cTnI previously reported as 36 ng L −1 for men and 15 ng L −1 for women [14]. We measured C‐reactive protein (CRP), N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP), growth differentiation factor‐15 (GDF‐15) and apolipoprotein A1 (ApoA1) as previously reported [15‐18]. Estimated creatinine clearance was calculated by the Cockcroft–Gault formula [19].…”