| Title: | Inflammation and heart failure risk in atrial fibrillation: Prospective evidence from UK Biobank |
| Journal: | Heart Rhythm |
| Published: | 13 Nov 2025 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/41241110/ |
| DOI: | https://doi.org/10.1016/j.hrthm.2025.11.014 |
Publication 18939
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Abstract
BACKGROUND: Although atrial fibrillation (AF) raises heart failure (HF) risk and inflammation is associated with cardiovascular disease, the role of inflammation in linking AF to HF remains unclear.</p>
OBJECTIVE: This study aimed to assess whether systemic inflammation, measured by high-sensitivity C-reactive protein (hs-CRP), elevates HF risk in patients with AF.</p>
METHODS: This prospective study included 32,502 AF participants from the UK Biobank without baseline HF, significant mitral valve disease, or inflammatory conditions. Hs-CRP was analyzed both as quartiles and using a clinical cutoff value of ≥2 mg/dL. The association with incident HF was evaluated using Cox models and Fine-Gray regression. Sensitivity analyses included sequential exclusion of comorbidities and early events, as well as propensity score matching.</p>
RESULTS: Over a median follow-up of 13.3 years, 6805 incident HF cases were documented. The cumulative incidence of HF increased significantly across hs-CRP quartiles, from 16.5% (1386 of 8419) in quartile 1 to 26.9% (2096 of 7786) in quartile 4 (log-rank P < .001). In fully adjusted models, quartile 4 had 61% higher HF risk than quartile 1 (hazard ratio [HR] 1.61; 95% confidence interval [CI] 1.51-1.73). Elevated hs-CRP (≥2 mg/dL) (HR 1.39; 95% CI 1.33-1.46) and per-standard-deviation increase (HR 1.12; 95% CI 1.10-1.15) were consistently associated with higher HF risk. These findings remained robust across all sensitivity analyses, subgroup comparisons, propensity score matching cohorts, and competing risk models.</p>
CONCLUSION: Elevated hs-CRP is an independent predictor of increased HF risk in patients with AF, supporting its potential role in improving HF risk stratification.</p>
18 Keywords
- Aged
- Atrial Fibrillation
- Biological Specimen Banks
- Biomarkers
- C-Reactive Protein
- Female
- Follow-Up Studies
- Heart Failure
- Humans
- Incidence
- Inflammation
- Male
- Middle Aged
- Prospective Studies
- Risk Assessment
- Risk Factors
- UK Biobank
- United Kingdom
14 Authors
- Le Li
- Sheng Su
- Lingmin Wu
- Zhicheng Hu
- Limin Liu
- Likun Zhou
- Xi Peng
- Mengtong Xu
- Tao Zhang
- Yulong Xiong
- Zhenhao Zhang
- Lihui Zheng
- Ligang Ding
- Yan Yao
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