Depression linked to double risk of new-onset atrial fibrillation

Depression is associated with a significant increase in the cumulative incidence and risk of atrial fibrillation (AF), according to new research.

In a cohort study of more than five million adults, the cumulative incidence of new-onset AF doubled for people with depression compared to those without — to 4.37 to 1 .86 per 1000 person-years, respectively.

The adjusted analysis also showed that depression was linked to a 25% increased risk of recent-onset AF.

Taken together, the results suggest “the need for adequate screening for AF in people with depression,” Yun Gi Kim, MD, Division of Cardiology, Department of Internal Medicine, University of Korea and Korea Anam University Hospital, Seoul, Republic of Korea, and colleagues write. They add that this is particularly important for young people and women.

The results were published online on January 4 in JAMA network open.

Psychological stress a culprit?

Although AF can profoundly affect patients’ quality of life and significantly increase the incidence of major cardiac events, little research has attempted to identify risk factors, the researchers note.

Nevertheless, it is possible that psychological stress aggravates or induces tachyarrhythmias through the activation of sympathetic tone. In fact, previous research has shown a link between depression and increased sympathetic activity.

Additionally, although previous studies have linked depression to an increased risk of cardiovascular events in patients with myocardial infarction, any potential association between depression and the risk of new-onset AF is unknown. has not yet been established, write the researchers.

“Depression is a disease that can be controlled; therefore, evaluating the association between depression and atrial fibrillation is important from a public health care perspective,” they add.

As part of the cohort study, researchers searched the Korean National Health Insurance Service database for all people who underwent a national health checkup in 2009. Patients were excluded if they had fewer 20 years old or had a history of heart valve surgery, had a previous diagnosis of mitral valve stenosis, or had been diagnosed with AF between January 2002 and December 2008.

The researchers compared the risk of recent-onset AF, defined as AF that occurred between 2009 and 2018, in people who were or were not diagnosed with depression within one year of the 2009 health check. In the study, the incidence of new-onset AF was calculated as the number of events per 1000 person-years of follow-up.

Risk doubled

The final analysis included 5,031,222 individuals (mean age, 47 years; 55.1% male). Of these, 148,882 (3%) had been diagnosed with depression in the year before the 2009 health check.

People with depression were older than their counterparts without depression (56.7 versus 46.7 years) and were more likely to be female (64.8% versus 44.3%). Interestingly, hypertension, diabetes, dyslipidemia and heart failure were all more common among participants with depression.

The cumulative incidence of new-onset AF was 4.37 per 1000 person-years in people with depression compared to 1.86 per 1000 person-years in people without depression (relative risk [HR], 2.36; 95% CI, 2.3, 2.4; P

A multivariate analysis adjusted for a multitude of confounders showed that depression was associated with a 25.1% increased risk of recent-onset AF (HR, 1.25; 95% CI, 1.22 – 1 .29; P

The results also showed that 56,951 of 148,882 people with depression had recurring episodes. Among this subpopulation, the incidence of recent-onset AF was 5.55 per 1000 person-years, significantly higher than among those without recurrent episodes of depression (3.44 per 1000 person-years) and those no depression at all (1.86 per 1000 person-years). year).

Younger age or being female also had significant interactions with depression, suggesting that younger people and women with depression may be at higher risk for developing new-onset AF, the researchers report. .

They note that the study results add to the growing body of evidence examining the association between depression and new-onset AF, although these efforts have yielded conflicting results.

Previous studies have shown that patients with AF are at an increased risk of developing depression. However, “whether depression can cause the development of new atrial fibrillation” had not previously been “elucidated”.

In a prospective cohort study of 30,746 women with no history of cardiovascular disease, there was no significant association between overall psychological distress and specific depressive symptoms and the development of new-onset AF. The HUNT study, which included more than 35,000 adults in Norway, showed similar results.

On the other hand, a study of 6644 people in the United States showed a 34% increased risk of recent-onset AF, and a Danish nationwide study concluded that the use of antidepressants was associated at an increased risk of recent-onset AF.

Generalizable, Bidirectional

Commenting on the findings of Medscape Medical NewsParveen K. Garg, MD, associate professor of clinical medicine, Keck School of Medicine, University of Southern California, Los Angeles, said the generalizability of the findings to a US population is less important than the fact that they add a global flavor to Literature.

“I think one of the real strengths of this paper is not only that it includes more than five million South Koreans, but that it actually shows a relationship similar to that found in previous studies primarily focused on about North America and Europe,” said Garg, who was not involved in the research.

“Therefore, this demonstrates that previous findings are generalizable to other populations, not the other way around, which is very valuable,” he added.

The findings also help cement the bidirectional relationship between depression and AF, Garg noted.

“It is very clear that atrial fibrillation can lead to the development of depressive symptoms or depression due to the profound impact it has on patients’ quality of life,” he said.

He added that previous research has shown that patients with depression also have elevated levels of stress catecholamines – and these chronically elevated levels are believed to be involved in the pathophysiology of the development of AF.

“There are now a number of studies that provide more evidence for the bidirectional relationship between depression and atrial fibrillation,” Garg said.

However, more research is needed, especially to identify the mechanisms that might be responsible for the link between depression and AF, he added.

“If we can identify and treat depression before patients develop arrhythmias, does that really reduce the risk of developing atrial fibrillation later? This is the next key step to focus our efforts on if we are to continue to move this issue forward,” Garg concluded. .

The study was supported by grants from Korea University, Korea University Anam Hospital and the National Research Foundation of Korea. Investigators and Garg have disclosed no relevant financial relationship.

JAMA Netw Open. Published online January 4, 2022. Full article

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