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Introduction:Asthma and atrial fibrillation (AF) share an underlying inflammatory pathophysiology. We hypothesized that persistent asthmatics are at higher risk for developing AF and that increased AF risk in asthmatics is mediated by markers of systemic inflammation.Methods:The Multi-Ethnic Study of Atherosclerosis is a prospective longitudinal study of adults free of cardiovascular disease at baseline. Presence of asthma was determined at exam 1. Persistent asthma was defined as asthma requiring use of controller medications. Intermittent asthma was defined as asthma without use of controller medications. Participants were followed for a median of 12.9 (interquartile range 10-13.6) years for incident AF. Multivariable Cox regression models were used to assess associations of asthma subtype and AF.Results:The 6,615 participants were a mean (standard deviation) 62.0 (10.2) years old, (47% male, 27% African-American, 12% Chinese, 22% Hispanic). AF incidence rates were 0.11 [95% CI 0.01, 0.12] events/10 person-years for non-asthmatics, 0.11 [95% CI 0.08, 0.14] events/10 person-years for intermittent asthmatics, and 0.19 [95% CI 0.12, 0.49] events/10 person-years for persistent asthmatics (log-rank p=0.008). In risk-factor adjusted models, persistent asthmatics had a greater risk of incident AF (hazard ratio [HR] 1.49 [95% CI 1.03-2.14], p=0.03). Interleukin 6 (IL-6, HR 1.26 [95% CI 1.13-1.42]), tumor necrosis factor-? receptor 1 (TNF-? R1, HR 1.09 [95% CI 1.08-1.11]) and D-Dimer (HR 1.10 [95% CI 1.02-1.20]) predicted incident AF, but the relationship between asthma and incident AF was not attenuated by adjustment for any inflammation marker (IL-6, C-reactive protein, TNF-? R1, D-dimer, fibrinogen).Conclusions:In a large multiethnic cohort with nearly 13 years follow-up, persistent asthma was associated with increased risk for incident AF. This association did not appear to be mediated by inflammatory biomarkers. |
