Resting heart rate and incident atrial fibrillation: A stratified Mendelian randomization in the AFGen consortium

J E Siland, B Geelhoed, C Roselli, B Wang, H J Lin, S Weiss, S Trompet, M E van den Berg, E Z Soliman, L Y Chen, I Ford, J W Jukema, P W Macfarlane, J Kornej, H Lin, K L Lunetta, M Kavousi, J A Kors, M A Ikram, X GuoJ Yao, M Dörr, S B Felix, U Völker, N Sotoodehnia, D E Arking, B H Stricker, S R Heckbert, S A Lubitz, E J Benjamin, A Alonso, P T Ellinor, P van der Harst, M Rienstra

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Abstract

BACKGROUND: Both elevated and low resting heart rates are associated with atrial fibrillation (AF), suggesting a U-shaped relationship. However, evidence for a U-shaped causal association between genetically-determined resting heart rate and incident AF is limited. We investigated potential directional changes of the causal association between genetically-determined resting heart rate and incident AF.

METHOD AND RESULTS: Seven cohorts of the AFGen consortium contributed data to this meta-analysis. All participants were of European ancestry with known AF status, genotype information, and a heart rate measurement from a baseline electrocardiogram (ECG). Three strata of instrumental variable-free resting heart rate were used to assess possible non-linear associations between genetically-determined resting heart rate and the logarithm of the incident AF hazard rate: <65; 65-75; and >75 beats per minute (bpm). Mendelian randomization analyses using a weighted resting heart rate polygenic risk score were performed for each stratum. We studied 38,981 individuals (mean age 59±10 years, 54% women) with a mean resting heart rate of 67±11 bpm. During a mean follow-up of 13±5 years, 4,779 (12%) individuals developed AF. A U-shaped association between the resting heart rate and the incident AF-hazard ratio was observed. Genetically-determined resting heart rate was inversely associated with incident AF for instrumental variable-free resting heart rates below 65 bpm (hazard ratio for genetically-determined resting heart rate, 0.96; 95% confidence interval, 0.94-0.99; p = 0.01). Genetically-determined resting heart rate was not associated with incident AF in the other two strata.

CONCLUSIONS: For resting heart rates below 65 bpm, our results support an inverse causal association between genetically-determined resting heart rate and incident AF.

Original languageEnglish
Article numbere0268768
Pages (from-to)1-13
JournalPLoS ONE
Volume17
Issue number5
DOIs
Publication statusPublished - 20 May 2022

Keywords

  • Aged
  • Atrial Fibrillation
  • Electrocardiography
  • Female
  • Heart Rate/genetics
  • Humans
  • Male
  • Mendelian Randomization Analysis
  • Middle Aged
  • Random Allocation
  • Risk Factors

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