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Editorial |

Atrial Fibrillation Begets Myocardial Infarction

Jonathan W. Dukes, MD1; Gregory M. Marcus, MD, MAS1
[+] Author Affiliations
1Division of Cardiology, Section of Electrophysiology, University of California, San Francisco
JAMA Intern Med. 2014;174(1):5-7. doi:10.1001/jamainternmed.2013.11392.
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For decades, stroke has been the principally recognized and most clinically relevant sequelae of atrial fibrillation (AF).1 However, a recent analysis demonstrated that AF may also lead to worsening renal function, a particularly important observation given that chronic kidney disease has been primarily considered a risk factor for the development of AF.2 While coronary artery disease and myocardial infarction (MI) have been demonstrated to increase AF risk,1 Soliman et al,3 in this issue of JAMA Internal Medicine, show that AF itself may also lead to an increased risk of incident MI. These data therefore add to the growing recognition of important bidirectional relationships between AF and other cardiovascular comorbidities. Just as “AF begets AF,”4 we are learning it may also lead to kidney disease, heart failure, and now MI. As we consider these new findings and their implications, we must first carefully examine the strengths and limitations of this recent study as well as the mechanisms through which these observed associations might occur.

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Figure.
Meta-analysis of Anticoagulation Studies Comparing Anticoagulation With Antiplatelet Therapy or Placebo in Atrial Fibrillation

Results are presented as relative risk (RR) of myocardial infarction of warfarin vs placebo or warfarin vs antiplatelet therapy with 95% CI. An RR less than 1 favors anticoagulation use, while an RR greater than 1 favors placebo or antiplatelet therapy. The results for trials using placebo as a comparator alone and antiplatelet agents (including aspirin) as a comparator alone are shown by pale-shaded diamonds. The dark-shaded diamond shows the overall result for the meta-analysis of all studies.

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