International Journal of Cardiology 171 (2014) e46

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Letter to the Editor

Risk factors for new-onset atrial fibrillation Sevket Balta a,⁎, Ertugrul Kurtoglu b, Mustafa Demir a, Sait Demirkol a, Zekeriya Arslan a, Murat Unlu a a b

Department of Cardiology, Gulhane Medical Academy Ankara, Turkey Department of Cardiology, Malatya State Hospital, Malatya, Turkey

a r t i c l e

i n f o

Article history: Received 5 September 2013 Accepted 30 November 2013 Available online 6 December 2013 Keywords: Atrial fibrillation Risk factors Serum potassium

Dear Editor, We have read with great enthusiasm the recently published article entitled “Serum potassium levels and the risk of atrial fibrillation” by Krijthe and coworkers [1]. In that very well-designed and presented study Krijthe and coworkers tried to investigate the association of serum potassium and the risk of atrial fibrillation in a population based setting. They concluded that low serum levels of potassium were associated with a higher risk of atrial fibrillation. Atrial fibrillation contributes to substantial increases in morbidity and mortality, and is expected to affect millions of people worldwide. AF is responsible for considerable morbidity and mortality, making identification of modifiable risk factors a priority. Left atrium (LA) enlargement has an important role of increased risk in AF. The higher risk of AF is also associated with age besides LA enlargement [2]. The presence of an unrecognized MI was associated with a double increased risk of atrial fibrillation in men, independent of known cardiovascular risk factors [3]. On the other hand, elevated transaminase concentrations are related to increased risk of AF [4]. Also, hyperthyroidism is a relative uncommon but important cause of atrial fibrillation [5]. Additionally, in the previous large population-based study, greater levels of serum phosphorus were associated with an increased risk of AF [6]. Hyperuricemia was also associated with several cardiovascular diseases. Elevated serum level of uric acid was associated with an

⁎ Corresponding author at: Department of Cardiology, Gulhane School of Medicine, Tevfik Saglam St., Etlik, 06018 Ankara, Turkey. Tel.: + 90 312 3044281; fax: +90 312 3044250. E-mail address: [email protected] (S. Balta). 0167-5273/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved.

increased systemic inflammation. Hyperuricemia was a significant risk factor of new-onset AF based on inflammation [7]. There is an increasing body of literature in which the authors showed the pleiotropic effects of statin therapy in relation to AF. Statin treatment is associated with a lower prevalence and incidence of AF after adjustment for potential confounders [8]. Some medications such as bisphosphonate increased the risk of AF [9]. Another interesting study aimed at investigating whether or not exposure to non-steroidal anti-inflammatory drugs (NSAID) was a risk factor for AF. They found that recent NSAID use may predispose patients to AF [10]. In conclusion, low serum levels of potassium were associated with a higher risk of atrial fibrillation as presented in the current study. However risk factors for incident AF are very complex [11] and the principal roles of those risk factors deserve further large-scale prospective randomized clinical trials.

References [1] Krijthe BP, Heeringa J, Kors J a, et al. Serum potassium levels and the risk of atrial fibrillation. Int J Cardiol Aug 2013;168(6):5411–5, (Elsevier B.V.). [2] Conen D, Glynn RJ, Sandhu RK, Tedrow UB, Albert CM. Risk factors for incident atrial fibrillation with and without left atrial enlargement in women. Int J Cardiol Jan 2013;168(3):1894–9. [3] Krijthe BP, Leening MJG, Heeringa J, et al. Unrecognized myocardial infarction and risk of atrial fibrillation: the Rotterdam Study. Int J Cardiol Jan 2013;168(2): 1453–7. [4] Sinner MF, Wang N, Fox CS, et al. Relation of circulating liver transaminase concentrations to risk of new-onset atrial fibrillation. Am J Cardiol Jan 15 2013; 111(2):219–24. [5] Balta S, Demirkol S, Celik T, Cakar M, Unlu M, Iyisoy A. Pivotal roles of risk factors for incident atrial fibrillation in patients with newly diagnosed hyperthyroidism. Am J Geriatr Cardiol Mar 2013;10(1):119–20. [6] Lopez FL, Agarwal SK, Grams ME, et al. Relation of serum phosphorus levels to the incidence of atrial fibrillation (from the Atherosclerosis Risk In Communities [ARIC] study). Am J Cardiol Dec 27 2012;111(6):857–62. [7] Chao T-F, Hung C-L, Chen S-J, et al. The association between hyperuricemia, left atrial size and new-onset atrial fibrillation. Int J Cardiol Jul 17 2013;168(4):4027–32. [8] Pellegrini CN, Vittinghoff E, Lin F, Hulley SB, Marcus GM. Statin use is associated with lower risk of atrial fibrillation in women with coronary disease: the HERS trial. Heart May 2009;95(9):704–8. [9] Bhuriya R, Singh M, Molnar J, Arora R, Khosla S. Bisphosphonate use in women and the risk of atrial fibrillation: a systematic review and meta-analysis. Int J Cardiol Jul 23 2010;142(3):213–7. [10] Chao T-F, Liu C-J, Chen S-J, et al. The association between the use of non-steroidal anti-inflammatory drugs and atrial fibrillation: a nationwide case–control study. Int J Cardiol Oct 6 2012;168(1):312–6. [11] Balta S, Demirkol S, Unlu M, Celik T, Cakar M, Iyisoy A. The pivotal roles of risk factors for incident atrial fibrillation: interweaving pieces of puzzle. Int J Cardiol May 10 2013;168(3):2937–8.

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