Arrhythmias & electrophysiology
Cholesterol profiles and cholesterol-lowering medication in relation to the incidence of atrial fibrillation
Authors' conclusion
Cholesterol and lipoprotein subfractions were heterogeneously associated with AF risk, potentially reflecting the biological effects of the distribution of different lipoprotein carriers and their cholesterol cargo, whereas cholesterol-lowering medication was linked to higher AF incidence.
Study context
- Population
- UK Biobank participants without baseline CVDmedication cohort n = 394,718
- Participants
- 187,680 participants
- Exposure
- Cholesterol profiles, particle numbers, apolipoproteins and cholesterol-lowering medication vs atrial fibrillation (AF) incidence
- Outcome
- Incident AF
Methodological detailsUK Biobank, NMR spectroscopy lipid profiling, Cox and Fine-Gray competing risk models, restricted cubic spline analyses
- UK Biobank
- NMR spectroscopy lipid profiling
- Cox and Fine-Gray competing risk models
- Restricted cubic spline analyses
Main finding
As reported in the abstract
- Total, LDL, IDL, VLDL, remnant and TG-rich lipoprotein remnant cholesterol inversely associated with AF
- High-density lipoprotein cholesterol (HDL-C) positively associated with AF
- Small HDL-C associated with lower AF risk; large and very large HDL-C with higher risk
- Generally linear associations (restricted cubic splines)
- Particle numbers: small HDL particles inverse, large HDL particles positive associations
Observational data: associations, not effects.
Further findings
Adjustment for apolipoproteins
- LDL-C and IDL cholesterol associations attenuated or reversed; HDL-related associations persisted
Lecithin-cholesterol acyltransferase
- Correlated with higher small HDL-C vs lower large HDL-C, in line with their associations with AF
Cholesterol-lowering medication (mainly statins) and AF incidence
- Modestly associated with higher AF incidence
- Separate cohort n = 394,718
Original publication
Cholesterol profiles and cholesterol-lowering medication in relation to the incidence of atrial fibrillation. Heart Rhythm. Published 17 November 2025. doi:10.
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