Daily Dose: Autoimmune Disorders Associated with New-onset Atrial Fibrillation

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On January 9, 2023, we reported on a study published in EP Europace that found various autoimmune disorders were associated with new-onset atrial fibrillation (AF), particularly in women.

The study

Using data from 494 072 participants (median age, 58 years; 54.8% women) from the UK Biobank who were without AF at baseline, researchers examined the association between a range of autoimmune diseases, including those targeting the metabolic and gastrointestinal (GI) systems; the musculoskeletal system and connective tissues (MSK); and the nervous system, with AF incidence. Also, researchers analyzed potential differences in the role of inflammation in AF pathogenesis between men and women.

Inflammatory conditions associated with a larger risk of AF included rheumatic fever without heart involvement (hazard ratio [HR], 1.47; 95% CI, 1.26-1.72), Crohn disease (HR, 1.23; 95% CI, 1.05-1.45), ulcerative colitis (HR, 1.17; 95% CI, 1.06-1.31), rheumatoid arthritis (HR, 1.39; 95% CI, 1.28-1.51), polyarteritis nodosa (HR, 1.82; 95% CI, 1.04-3.09), systemic lupus erythematosus (HR, 1.82; 95% CI, 1.41-2.35), and systemic sclerosis (HR, 2.32; 95% CI, 1.57-3.44).

In sex-stratified analyses, rheumatic fever without heart involvement (HR, 1.79; 95% CI, 1.45-2.20), multiple sclerosis (HR, 1.37; 95% CI, 1.07-1.75), Crohn disease (HR, 1.35; 95% CI, 1.05-1.73), seropositive rheumatoid arthritis (HR, 1.50; 95% CI, 1.35-1.67), psoriatic and enteropathic arthropathies (HR, 2.01; 95% CI, 1.32-3.05), systemic sclerosis (HR, 2.51; 95% CI, 1.64-3.85), and ankylosing spondylitis (HR, 1.53; 95% CI, 1.13-2.07) were significantly associated with larger AF risk in women, whereas only men showed a greater AF risk associated with ulcerative colitis (HR, 1.17; 95% CI, 1.01-1.35).

Clinical implications

"Our findings further elaborate on and contribute to the current knowledge of the pathophysiological differences in autoimmunity between men and women. This implies that various autoimmune diseases may modulate the propensity to develop AF, particularly in women. This information could also guide future preventive strategies. However, evidence on the role of autoimmunity in AF development is still scarce. Further evidence is required to support clinical translation of our findings.”

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