Elevated homocysteine and uric acid biomarkers associated with occurrence of subclinical atrial fibrillation

By Samar Mahmoud, MS
Published January 25, 2022

Key Takeaways

  • This study found that in patients with cardiac implantable electronic devices (CIED), there was a strong correlation between elevated plasma homocysteine and uric acid (UA) levels and incidence of subclinical atrial fibrillation (SCAF) in both men and women.  

  • These findings suggest that patients with heightened levels of these biomarkers can benefit from more intensive rhythm monitoring.

SCAF, which is often asymptomatic, accounts for 1 in 3 patients with AF.

Why This Study Matters

In patients with no history of AF, the presence of SCAF leads to increased risk of thromboembolism, heart failure, and cardiovascular mortality, highlighting the need for early detection and management strategies.  To address this need, this study evaluated the potential for homocysteine and UA biomarkers in improving prediction of SCAF in patients with CIEDs.

Study Design

This single-center, non-randomized, observational study enrolled 1224 patients who received a CIED between January 2013 and December 2019. Clinical data as well as blood samples were obtained from patients and examined for plasma concentrations of homocysteine and UA. 

Follow-up visits were performed at 1,3, and 6 months after CIED implantation as well as every 6 months since device placement. 

The primary outcome of this study was an occurrence of a SCAF event, which was defined as the presence of at least 1 episode of atrial tachyarrhythmia lasting more than 6 minutes. 

Results and Conclusions

Increased levels of homocysteine and UA biomarkers were significantly associated with heightened risk of SCAF.

In men and women, regardless of UA levels, a 1 standard deviation (SD) increase in homocysteine (5.7 μmol/L) was associated with increased risk of developing SCAF. 

When looking at UA levels, investigators found that a 1-SD increase in UA (91 μmol/L) increased risk of SCAF in patients with high levels of homocysteine. 

Investigators found that SCAF predictions could be significantly improved by adding homocysteine and UA biomarker levels to the atrial fibrillation risk factors recommended by the 2020 European Society of Cardiology.  

Related Research

Consider these findings from similar research studies:

  • Advanced age is significantly associated with increased homocysteine levels (Source). 

  • There is a dose-response association between homocysteine levels and ischemic stroke (Source).

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