Association of individual plasma non-esterifired fatty acids with incident atrial fibrillation in older adults: the cardiovascular health study

Authors: PELLIGRINI, CARA - University Of California; KIZER, JORGE - University Of California; BUZKOVA, PETRA - University Of Washington; MATTHAN, NIRUPA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; SISCOVICK, DAVID - New York Academy Of Medicine; IX, JOACHIM - University Of California; HECKBERT, SUSAN - University Of Washington; MUKAMAL, KENNETH - Beth Israel Deaconess Medical Center; DJOUSSE, LUC - Brigham & Women'S Hospital

Submitted to: American Journal of Cardiology
Publication Type: Abstract Only
Publication Acceptance Date: 11/15/2019
Publication Date: 3/24/2020
Citation: Pelligrini, C.N., Kizer, J.R., Buzkova, P., Matthan, N., Lichtenstein, A.H., Siscovick, D.S., Ix, J.H., Heckbert, S.R., Mukamal, K.J., Djousse, L. 2020. Association of individual plasma non-esterifired fatty acids with incident atrial fibrillation in older adults: the cardiovascular health study. American Journal of Cardiology. 75(11):Suppl_1. Abstract 1271-235. https://doi.org/10.1016/S0735-1097(20)31031-7.
DOI: https://doi.org/10.1016/S0735-1097(20)31031-7

Interpretive Summary:

Technical Abstract: Background: Obesity is an independent risk factor for atrial fibrillation (AF) and is second only to hypertension in terms of attributable risk factors for AF. Expansion of visceral and cardiac fat depots is associated with increased circulating total non-esterified fatty acids (NEFAs), elevated levels of which are associated with incident AF. How different NEFA subtypes are associated with incident AF in older adults is unknown. Methods: The present study focused on 1,872 individuals with available plasma specimens and free of prevalent AF at baseline who participated in the Cardiovascular Health Study, a community-based longitudinal survey of US adults >/= 65 years. Thirty-five different NEFAs were measured by gas chromatography. Cox regression was used to assess the association of individual NEFAs with incident AF. Results: During a median follow-up of 11.3 years, 715 cases of incident AF occurred. After adjustment for demographic and clinical risk factors, 5 individual NEFAs showed nominally significant associations with incident AF, but none was significant when a false-discovery rate of 0.05 was applied. In a model that included all 35 NEFAs simultaneously, a partial likelihood ratio test did not show the hazard ratios (HRs) for individual NEFAs to differ from 1.0 (p=0.13). Two individual NEFAs, however, had significant nominal association with AF. Specifically, higher levels of non-esterified nervonic acid, a long-chain monounsaturated fatty acid, were associated with a higher AF risk (hazard ratio [HR] per 1-SD increment: 2.5; 95% CI: 1.5 - 4.0; p<0.001). Conversely, non-esterified y-linolenic acid, an omega-6 fatty acid, was inversely associated with incident AF (HR per 1-SD: 0.5; 95% CI: 0.3 -0.8; p = 0.004). Conclusion: Higher levels of non-esterified nervonic acid and lower levels of non-esterified y-linolenic acid were associated with increased incidence of AF in older adults. These findings are consistent with previous data detailing salutary and unfavorable associations of these individual NEFAs. If confirmed, these results could offer new strategies for AF prevention in this segment of the population at highest risk. Clinical implications: These findings extend and refine previous data linking higher levels of total NEFAs with increased AF incidence in elders. Notably non-esterified nervonic acid has previously been shown to be associated with incident heart failure, while none-esterified y-linolenic acid has been postulated to have anti-inflammatory properties, despite omega-6 fatty acids generally being considered pro-inflammatory. Better understanding of these associations could be relevant in the broader quest to identify modifiable risk factors for AF.