Trajectories of Lipid Profile Changes and Cardiovascular Outcomes in Elderly Asian Patients With Atrial Fibrillation

Background

The relationship between baseline total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and cardiovascular outcomes is well established, but their trajectories over time in elderly Asian patients with atrial fibrillation (AF) remain unexplored.

Methods and Results

Using the Taipei Medical University Clinical Research Database from 2013 to 2020, we identified 823 AF patients aged above 75 with at least three annual lipid profile measurements. We used an accelerated failure time (AFT) model to examine the association of trajectories with the primary outcome of composite cardiovascular events (stroke, TIA, myocardial infarction, heart failure hospitalization and cardiovascular death).

During follow-up, 308 patients developed events (61.33 per 100 person-years). Three total cholesterol trajectory groups were identified: low (group 1), decreasing (group 2), and middle (group 3). Compared with group 1, individuals in group 3 exhibited a significantly longer event-free survival, with a mean increase of 2.74 years (95% confidence interval [CI]: 1.05–7.12; p = 0.0394).

For LDL trajectories, group 3 was associated with a mean increase of 2.35 years (95% CI: 1.11–4.98; p = 0.0252) in survival time from the primary outcome compared to group 1. Regarding HDL, participants in group 3—characterized by persistently higher HDL levels—had a 2.12-year longer survival time (95% CI: 1.01–4.43; p = 0.0456) compared to those in group 1. Triglyceride trajectories showed no significant association with the primary outcome.

Conclusion

In this hospital-based cohort study, total cholesterol, LDL, and HDL trajectories are associated with composite cardiovascular outcomes in elderly Asian AF patients.