Transsulfuration metabolites and the association with incident atrial fibrillation – An observational cohort study among Norwegian patients with stable angina pectoris. (15th October 2020)

• Record Type: Journal Article
• Authors: Svenningsson, Mads M.; Svingen, Gard F.T.; Lysne, Vegard; Ueland, Per M.; Tell, Grethe S.; Pedersen, Eva R.; Dhar, Indu; Nilsen, Dennis W.; Nygård, Ottar
• Is Part Of: International journal of cardiology. Volume 317(2020)
• Page Start: 75
• Page End: 80
• Publication Date: 2020-10-15
• Subjects: Atrial fibrillation -- Biomarkers -- Homocysteine -- Cystathionine -- Cysteine -- Transsulfuration; AF atrial fibrillation -- BMI body mass index -- CBS cystathionine beta-synthase -- CRP c-reactive protein -- CVD cardiovascular disease -- CVDNOR cardiovascular disease in Norway -- Cys cysteine -- Cysta cystathionine -- eGFR estimated glomerular filtration rate -- Hcy homocysteine -- LVEDP left ventricular end-diastolic pressure -- LVEF left ventricular ejection fraction -- NO nitric oxide -- PLP pyridoxal 5-phosphate -- ROS reactive oxygen species -- SAM s-adenosylmethionine -- tHcy total plasma homocysteine -- tCys total plasma cysteine -- WENBIT Western Norway B-vitamin intervention trial; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.05.010
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background/aim: Plasma total homocysteine (tHcy) is elevated in patients with persistent vs. paroxysmal atrial fibrillation (AF), and has been related to increased risk of new-onset AF. Homocysteine is degraded to cystathionine (Cysta) and cysteine (Cys). All three metabolites have been linked to potential proarrhythmic traits such as inflammation and atrial fibrosis. We evaluated the prospective association between these metabolites and new-onset AF among patients with suspected stable angina pectoris. Methods: Information regarding AF was obtained by linking patient data to national health registries. Risk associations were explored by Cox regression and potential improvements in risk reclassification were calculated by the continuous net reclassification index (NRI > 0). Results: At baseline, 3535 patients without any prior history of AF were included. During median follow-up of 7.4 years, 392 patients (10.2%) were registered with incident AF. Higher plasma tHcy and tCys were associated with increased risk of incident AF [age and gender adjusted HRs (95% CI) per 1 log transformed SD 1.23 (1.12–1.35) and 1.23 (1.11–1.38)]; multivariate adjustment yielded similar results. Plasma tHcy and tCys also improved reclassification of patients (NRI > 0 (95% CI)) for tHcy 0.118 (0.02–0.22) and tCys 0.107 (0.002–0.21). No association was seen between plasma Cysta and incident AF. Conclusion: Plasma tHcy and tCys, but not Cysta, were associated with, and improved risk classification of, new-onset AF among patients with stable angina pectoris. Our results motivate further studies to explore the relationship between homocysteine metabolism and cardiac arrhythmias. Highlights: Atrial fibrillation (AF) is a common arrhythmia with increasing incidence. Biomarkers have a minor role in evaluating risk of developing AF. In this study we find a link between homocysteine and cysteine and new-onset AF. This association remains after adjusting for traditional AF risk factors.