PAD significantly increases risk of AFib, new meta-analysis confirms
Patients with peripheral artery disease (PAD) face a significantly higher risk of developing new-onset atrial fibrillation (NOAF), according to a new meta-analysis published in JACC: Advances.[1]
The study’s authors reviewed data from more than 1,500 studies, landing on seven they wanted to focus on for this research. All studies were associated with a low risk of bias. The oldest study was performed in 2013 and the most recent was performed in 2022. All five studies were observational; five were prospective and the other two were retrospective. One study enrolled only women.
In total, this meta-analysis included data from 763,919 patients. Approximately 56,000 of those patients had PAD as determined by ankle-brachial index (ABI) or a clinical diagnosis. In addition, there were approximately 26,000 cases of NOAF during follow-up.
Overall, researchers noted, PAD was linked to a 34% higher risk of developing NOAF. The hazard ratio was 1.34.
“This is the first meta-analysis quantifying the risk of atrial fibrillation (AFib) in patients with PAD,” wrote first author Daniele Pastori, MD, a researcher with Sapienza University of Rome in Italy, and colleagues. “Available data from observational studies suggest that PAD may be associated with a 34% higher risk of developing NOAF. Notably, while PAD as a comorbidity in patients with established AFib has been previously described, the present meta-analysis specifically evaluates PAD as an exposure and its association with the risk of incident AFib. This distinction allows for a more precise assessment of PAD as a potential risk factor for AFib, rather than as a coexisting condition influencing outcomes in patients with already diagnosed AFib.”
The authors did note that one of the seven studies Pastori et al. focused on with their meta-analysis included a coronary artery disease (CAD) rate of 50.6%. Because many of those patients were treated with statin therapy, which has been shown to reduce NOAF risk, it is possible that high CAD rate actually ended up reducing the hazard ratio for that specific study.
“Another factor that should be considered is the relatively low mean age of patients, not exceeding 65 years of age in most studies,” the authors wrote. “Indeed, the association between PAD and NOAF may be stronger in older patients. Our analysis also shows that studies using ICD codes or clinical history to define PAD showed the highest association with NOAF (40% increased risk), suggesting that a definition including only clinically overt PAD may reveal a stronger association than asymptomatic PAD by ABI.”
The study’s authors concluded that care teams may want to take a more proactive approach when it comes to managing PAD patients who present with such comorbidities as arterial hypertension, dyslipidemia and obesity. In addition, they added, these findings provide even more evidence that unhealthy lifestyle choices such as smoking and alcohol use should be avoided due to their known association with AFib.
“Among other interventions, statin treatment in AFib patients diagnosed with PAD may reduce mortality, cardiovascular events, and major adverse limb events,” the authors added.
Click here to read the full analysis in JACC: Advances, an American College of Cardiology journal.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.