Arrhythmias & electrophysiology
Atrial Fibrillation and Coronary Events: Competing Risks and Bidirectional Mediation in a Longitudinal Swedish Cohort
Authors' conclusion
AF and CEs demonstrated divergent risk profiles and bidirectional mediation effects. These findings inform risk stratification for AF, CEs, and their co-occurrence, and highlight the need for integrated prevention strategies for the comorbidity of AF and CEs.
Study context
- Population
- Swedish subjects without preexisting atrial fibrillation (AF), coronary events (CEs), stroke, or heart failure (baseline: 1991–1996)aged 58.0±7.60 years, 62.0% women
- Participants
- 25,963 subjects
- Exposure
- Associations of baseline risk factors with incident AF vs incident CEs, and bidirectional mediation between AF and CEs
- Outcome
- Incident AF and incident CEs
- Follow-up
- Median 24.6 and 24.9 years, respectively
Methodological detailslongitudinal, multivariable-adjusted Cox models, competing risk analysis, mediation models for survival data
- Longitudinal
- Multivariable-adjusted Cox models
- Competing risk analysis
- Mediation models for survival data
Main finding
As reported in the abstract
median follow-up of 24.6 and 24.9 years, respectively
Incident AF
5447
Incident CEs
3462
Overlapped cases
1125
Observational data: associations, not effects.
Further findings
Associations of risk factors with AF vs CEs
- Various traditional risk factors were predominantly associated with CEs, whereas certain ones, particularly adiposity indices, demonstrated stronger associations with AF
apoA1 and apoB associations with AF and CEs
- P for equal associations
- <0.0001
- Higher apoA1 levels were associated with higher AF risk but lower CEs risk, whereas higher apoB showed opposite associations
Mediation of diabetes-associated AF risk by prior CEs
- Proportion mediated (highest degree of mediation among all risk factors analyzed)
- 41.5% (95% CI, 8.5%-84.4%; P =0.0031)
- Significant bidirectional mediation effects were found between AF and CEs
Mediation of adiposity indices' effects on subsequent CEs by prior AF
- Proportion mediated
- 26.1% (11.8%-48.2%; P <0.0001)
Original publication
Atrial Fibrillation and Coronary Events: Competing Risks and Bidirectional Mediation in a Longitudinal Swedish Cohort. Circ Popul Health Outcomes. Published 12 January 2026. doi:10.
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