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Chronic obstructive pulmonary disease and the development of atrial fibrillation

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Abstract
Background: Chronic obstructive pulmonary disease (COPD) has been associated with atrial fibrillation (AF). More insight into the epidemiology and underlying mechanisms is required to optimize management. Methods: The Rotterdam Study is a large, population-based cohort study with long-term follow-up. Time dependent Cox proportional hazard models were constructed to study the effect of COPD on incident AF, adjusted for age, sex and pack years of cigarette smoking, and additionally stratified according to exacerbation frequency, left atrial size and baseline systemic inflammatory levels. Results: 1369 of 10,943 subjects had COPD, of whom 804 developed AF. The AF incidence rate was 14 per 1000 person years in COPD and 8 per 1000 person years in subjects without COPD. The adjusted hazard ratio (HR) for COPD subjects to develop AF as compared to subjects without COPD was 1.28 (95% CI [1.04, 1.57]). COPD subjects with frequent exacerbations had a twofold increased AF risk (HR 1.99 [1.42, 2.79]) and COPD subjectswith a left atrial size >= 40 mm also had an elevated AF risk (HR 1.77 [1.07, 2.94]). COPD subjects with baseline systemic inflammatory levels above the median had significantly increased AF risks (hsCRP=1.83 mg/L: HR 1.51 [1.13, 2.03] and IL6 >= 1.91 ng/L: HR 2.49 [1.18, 5.28]), whereas COPD subjects below the median had in both analyses no significantly increased AF risk. Conclusions: COPD subjects had a 28% increased AF risk, which further increased with frequent exacerbations and an enlarged left atrium. The risk was driven by COPD subjects having elevated systemic inflammatory levels.
Keywords
REDUCED LUNG-FUNCTION, C-REACTIVE PROTEIN, RISK, EPIDEMIOLOGY, PREVALENCE, PATHOPHYSIOLOGY, ATHEROSCLEROSIS, INTERLEUKIN-6, ASSOCIATION, MORTALITY, Incident atrial fibrillation, COPD exacerbation, Systemic inflammation, Atrial enlargement, Epidemiology, Pathophysiological mechanisms

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Chicago
Grymonprez, Maxim, Vincent Vakaet, Maryam Kavousi, Bruno H Stricker, M Arfan Ikram, Jan Heeringa, Oscar H Franco, Guy Brusselle, and Lies Lahousse. 2019. “Chronic Obstructive Pulmonary Disease and the Development of Atrial Fibrillation.” International Journal of Cardiology 276: 118–124.
APA
Grymonprez, M., Vakaet, V., Kavousi, M., Stricker, B. H., Ikram, M. A., Heeringa, J., Franco, O. H., et al. (2019). Chronic obstructive pulmonary disease and the development of atrial fibrillation. INTERNATIONAL JOURNAL OF CARDIOLOGY, 276, 118–124.
Vancouver
1.
Grymonprez M, Vakaet V, Kavousi M, Stricker BH, Ikram MA, Heeringa J, et al. Chronic obstructive pulmonary disease and the development of atrial fibrillation. INTERNATIONAL JOURNAL OF CARDIOLOGY. 2019;276:118–24.
MLA
Grymonprez, Maxim et al. “Chronic Obstructive Pulmonary Disease and the Development of Atrial Fibrillation.” INTERNATIONAL JOURNAL OF CARDIOLOGY 276 (2019): 118–124. Print.
@article{8601234,
  abstract     = {Background: Chronic obstructive pulmonary disease (COPD) has been associated with atrial fibrillation (AF). More insight into the epidemiology and underlying mechanisms is required to optimize management. 
Methods: The Rotterdam Study is a large, population-based cohort study with long-term follow-up. Time dependent Cox proportional hazard models were constructed to study the effect of COPD on incident AF, adjusted for age, sex and pack years of cigarette smoking, and additionally stratified according to exacerbation frequency, left atrial size and baseline systemic inflammatory levels. 
Results: 1369 of 10,943 subjects had COPD, of whom 804 developed AF. The AF incidence rate was 14 per 1000 person years in COPD and 8 per 1000 person years in subjects without COPD. The adjusted hazard ratio (HR) for COPD subjects to develop AF as compared to subjects without COPD was 1.28 (95\% CI [1.04, 1.57]). COPD subjects with frequent exacerbations had a twofold increased AF risk (HR 1.99 [1.42, 2.79]) and COPD subjectswith a left atrial size {\textrangle}= 40 mm also had an elevated AF risk (HR 1.77 [1.07, 2.94]). COPD subjects with baseline systemic inflammatory levels above the median had significantly increased AF risks (hsCRP=1.83 mg/L: HR 1.51 [1.13, 2.03] and IL6 {\textrangle}= 1.91 ng/L: HR 2.49 [1.18, 5.28]), whereas COPD subjects below the median had in both analyses no significantly increased AF risk. 
Conclusions: COPD subjects had a 28\% increased AF risk, which further increased with frequent exacerbations and an enlarged left atrium. The risk was driven by COPD subjects having elevated systemic inflammatory levels.},
  author       = {Grymonprez, Maxim and Vakaet, Vincent and Kavousi, Maryam and Stricker, Bruno H and Ikram, M Arfan and Heeringa, Jan and Franco, Oscar H and Brusselle, Guy and Lahousse, Lies},
  issn         = {0167-5273},
  journal      = {INTERNATIONAL JOURNAL OF CARDIOLOGY},
  language     = {eng},
  pages        = {118--124},
  title        = {Chronic obstructive pulmonary disease and the development of atrial fibrillation},
  url          = {http://dx.doi.org/10.1016/j.ijcard.2018.09.056},
  volume       = {276},
  year         = {2019},
}

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