Autoimmune Disorders Associated with New-onset AF and More Distinct in Women, Shows New Study

Various autoimmune disorders were associated with new-onset atrial fibrillation (AF), particularly in women, in findings from a prospective population-based study including nearly half a million participants.

“Recent evidence suggests a role for inflammation and the innate immune system in cardiovascular disease development, including myocardial infarction, cerebrovascular events, and heart failure. However, evidence on the role of autoimmunity in AF development is scarce, at least partly due to the rarity of these disorders. In our present study, we identified a broad range of autoimmune diseases associated with incident AF in the general population,” Martijn J Tilly, MS, of the department of epidemiology at Erasmus MC, University Medical Center Rotterdam, the Netherlands, and colleagues wrote in EP Europace.

Using data from 494 072 participants (median age, 58 years; 54.8% women) from the UK Biobank who were without AF at baseline, Tilly and colleagues aimed to identify 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, the team analyzed potential differences in the role of inflammation in AF pathogenesis between men and women.

MSK disorders included rheumatoid arthritis, psoriatic and enteropathic arthropathies, systemic lupus erythematosus, dermatopolymyositis, systemic sclerosis, ankylosing spondylitis, and Paget disease. GI disorders included Crohn disease and ulcerative colitis.

Key Findings

After a median of 12.8 years, 5.5% (n=27 194) participants were diagnosed with new-onset AF. The incidence rate of new-onset AF in the total population was 4.49 per 1000 person-years and was 6.25 per 1000 person-years in men and 3.08 per 1000 person-years in 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).

“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,” concluded Tilly et al. “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.”

Reference: Tilly MJ, Geurts S, Zhu F, et al. Autoimmune diseases and new-onset atrial fibrillation: A UK Biobank study. Europace. Published online December 22, 2022. doi:10.1093/europace/euac244.