The CHADS(2) and CHA(2)DS(2)-VASc scores predict atrial fibrillation in dyslipidemic individuals: Role of incorporating low high-density lipoprotein cholesterol levels

作者：Barkas Fotios; Elisaf Moses; Korantzopoulos Panagiotis; Tsiara Stavroula; Liberopoulos Evangelos

来源：International Journal of Cardiology, 2017, 241: 194-199.

DOI：10.1016/j.ijcard.2017.04.062

• CHADS(2)
• CHA(2)DS(2)-VASc
• Atrial fibrillation
• Cholesterol
• High-density lipoprotein
• Statin

Aim: To investigate the value of CHADS(2) and CHA(2)DS(2)-VASc scores in predicting atrial fibrillation (AF) among dyslipidemic individuals and assess the additional value of incorporating low levels of high-density lipoprotein cholesterol (HDL-C).
Methods: This observational study included 1241 individuals attending a lipid clinic. Models including clinical and laboratory parameters were constructed to test the predictive value of CHADS(2) and CHA(2)DS(2)-VASc scores as well as low HDL-C levels for incident AF. Low HDL-C levels were defined as <40 and <50 mg/dL for male and female subjects, respectively.
Results: After excluding 18 patients with AF at baseline, 1223 subjects were followed-up for a median period of 6 years (IQR: 4-10), and 34 (2.8%) developed AF. Baseline CHADS(2) (OR: 1.71; 95% CI: 1.28-2.29, p < 0.001) and CHA(2)DS(2)-VASc scores (OR: 1.56; 95% CI: 1.26-1.92, p < 0.001) as well as low HDL-C levels (OR: 3.79; 95% CI: 1.85-7.75, p < 0.001) were significantly associated with new-onset AF. ROC curve analyses showed that both CHADS(2) and CHA(2)DS(2)-VASc scores were significant predictors for new-onset AF (C-Statistic: CHADS(2) 0.679, p < 0.001; CHA(2)DS(2)-VASc 0.698, p < 0.001). Higher CHADS(2) scores were associated with reduced event-free survival from AF (log-rank = 10.62, p = 0.001) with differences potentiated if stratified by CHA(2)DS(2)-VASc score (log-rank = 22.29, p < 0.001). After incorporating low HDL-C levels, both scores achieved slightly higher C-Statistic for AF prediction (0.690 and 0.707, respectively, p < 0.001).
Conclusions: CHADS(2) and CHA(2)DS(2)-VASc scores predict new AF in dyslipidemic patients. Risk prediction improved modestly when low HDL-C levels were included.

• 出版日期2017-8-15