Hazard ratios for incident atrial fibrillation according to drinker status with never drinkers as the reference group.

<p>Hazard ratios are shown unadjusted (white square) and adjusted (black square) for study site, age, sex, race, body mass index, smoking status, cigarette years, hypertension, diabetes mellitus, coronary artery disease, and heart failure. Y error bars denote 95% confidence intervals.</p

Kaplan-Meier curves for incident atrial fibrillation (AF) in Atherosclerosis Risk in Communities (ARIC) study participants by baseline drinking status.

<p>Differences in proportions with and without AF are compared using the log-rank test.</p

Risk of incident atrial fibrillation according to past alcohol consumption among former drinkers (N = 2,886).

<p>Risk of incident atrial fibrillation according to past alcohol consumption among former drinkers (N = 2,886).</p

Baseline characteristics in the Atherosclerosis Risk in Communities (ARIC) study by drinking status.

<p>Baseline characteristics in the Atherosclerosis Risk in Communities (ARIC) study by drinking status.</p

Summary of alcohol consumption patterns among former drinkers (N = 2,886) stratified by the development of incident atrial fibrillation.

<p>Values are reported as medians for numeric responses. Y error bars denote interquartile ranges.</p

Low Heart Rate Variability in a 2-Minute Electrocardiogram Recording Is Associated with an Increased Risk of Sudden Cardiac Death in the General Population: The Atherosclerosis Risk in Communities Study

<div><p>Low heart rate variability (HRV) has been linked to increased total mortality in the general population; however, the relationship between low HRV and sudden cardiac death (SCD) is less well-characterized. The goal of this study was to evaluate the relationship between low HRV and SCD in a community-based cohort. Our cohort consisted of 12,543 participants from the Atherosclerosis Risk in Communities (ARIC) study. HRV measures were derived from 2-minute electrocardiogram recordings obtained during the baseline exam (1987–89). Time domain measurements included the standard deviation of all normal RR intervals (SDNN) and the root mean squared successive difference (r-MSSD). Frequency domain measurements included low frequency power (LF) and high frequency (HF) power. During a median follow-up of 13 years, 215 SCDs were identified from physician adjudication of all coronary heart disease deaths through 2001. In multivariable adjusted Cox proportional hazards models, each standard deviation decrement in SDNN, LF, and HF were associated with 24%, 27% and 16% increase in SCD risk, respectively. Low HRV is independently associated with increased risk of SCD in the general population.</p></div

Predictors of sudden cardiac death in atrial fibrillation: The Atherosclerosis Risk in Communities (ARIC) study

<div><p>We previously reported that incident atrial fibrillation (AF) is associated with an increased risk of sudden cardiac death (SCD) in the general population. We now aimed to identify predictors of SCD in persons with AF from the Atherosclerosis Risk in Communities (ARIC) study, a community-based cohort study. We included all participants who attended visit 1 (1987–89) and had no prior AF (n = 14,836). Incident AF was identified from study electrocardiograms and hospitalization discharge codes through 2012. SCD was physician-adjudicated. We used cause-specific Cox proportional hazards models, followed by stepwise selection (backwards elimination, removing all variables with p>0.10) to identify predictors of SCD in participants with AF. AF occurred in 2321 (15.6%) participants (age 45–64 years, 58% male, 18% black). Over a median of 3.3 years, SCD occurred in 110 of those with AF (4.7%). Predictors of SCD in AF included higher age, body mass index (BMI), coronary heart disease, hypertension, diabetes, current smoker, left ventricular hypertrophy, increased heart rate, and decreased albumin. Predictors associated only with SCD and not other cardiovascular (CV) death included increased BMI (HR per 5-unit increase, 1.15, 95% CI, 0.97–1.36, p = 0.10), increased heart rate (HR per SD increase, 1.18, 95% CI 0.99–1.41, p = 0.07), and low albumin (HR per SD decrease 1.23, 95% CI 1.02–1.48, p = 0.03). In the ARIC study, predictors of SCD in AF that are not associated with non-sudden CV death included increased BMI, increased heart rate, and low albumin. Further research to confirm these findings in larger community-based cohorts and to elucidate the underlying mechanisms to facilitate prevention is warranted.</p></div

Heart Rate Variability Measures and Sudden Cardiac Death Risk.

<p>Association between heart rate variability measures and sudden cardiac death incidence presented as hazard ratios (solid line) and 95% confidence intervals (shaded area). Results from Cox proportional hazards model with heart rate variability measures modeled using restricted cubic splines, adjusted for age, sex, and race. Median value of heart rate variability measures was considered the reference (HR = 1). The x-axis is presented using an inverted scale.</p

Association of Sick Sinus Syndrome with Incident Cardiovascular Disease and Mortality: The Atherosclerosis Risk in Communities Study and Cardiovascular Health Study

<div><p>Background</p><p>Sick sinus syndrome (SSS) is a common indication for pacemaker implantation. Limited information exists on the association of sick sinus syndrome (SSS) with mortality and cardiovascular disease (CVD) in the general population.</p><p>Methods</p><p>We studied 19,893 men and women age 45 and older in the Atherosclerosis Risk in Communities (ARIC) study and the Cardiovascular Health Study (CHS), two community-based cohorts, who were without a pacemaker or atrial fibrillation (AF) at baseline. Incident SSS cases were validated by review of medical charts. Incident CVD and mortality were ascertained using standardized protocols. Multivariable Cox models were used to estimate the association of incident SSS with selected outcomes.</p><p>Results</p><p>During a mean follow-up of 17 years, 213 incident SSS events were identified and validated (incidence, 0.6 events per 1,000 person-years). After adjustment for confounders, SSS incidence was associated with increased mortality (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.14–1.70), coronary heart disease (HR 1.72, 95%CI 1.11–2.66), heart failure (HR 2.87, 95%CI 2.17–3.80), stroke (HR 1.56, 95%CI 0.99–2.46), AF (HR 5.75, 95%CI 4.43–7.46), and pacemaker implantation (HR 53.7, 95%CI 42.9–67.2). After additional adjustment for other incident CVD during follow-up, SSS was no longer associated with increased mortality, coronary heart disease, or stroke, but remained associated with higher risk of heart failure (HR 2.00, 95%CI 1.51–2.66), AF (HR 4.25, 95%CI 3.28–5.51), and pacemaker implantation (HR 25.2, 95%CI 19.8–32.1).</p><p>Conclusion</p><p>Individuals who develop SSS are at increased risk of death and CVD. The mechanisms underlying these associations warrant further investigation.</p></div

Hazard Ratios of Sudden Cardiac Death for Heart Rate Variability Measures, Atherosclerosis Risk in Communities Study, 1987–2001.

<p>Hazard Ratios of Sudden Cardiac Death for Heart Rate Variability Measures, Atherosclerosis Risk in Communities Study, 1987–2001.</p