Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. A total of 7 medium- and long-chain acylcarnitines were associated with higher risk of atrial fibrillation (AF).

2. Caffeine and acisoga were associated with increased risk of incident AF while beta carotene was associated with a lower risk.

Evidence Rating Level: 2 (Good)

Atrial fibrillation (AF) is the most common cardiac arrhythmia, being noted on 175,326 death certificates in 2018 according to the CDC. However, its pathogenesis is not fully understood and the answers may lie in metabolomics. A total of 3,770 participants of the Malmö Diet and Cancer Study had 112 baseline fasting metabolites measured to investigate metabolic pathways in the development of AF (M [SD] = 58.0 [6.0] years, 59% female). Profiling was performed using liquid chromatography-mass spectrometry. Follow-ups occurred for a median of 23.2 years and 650 (17%) AF cases were identified (incidence rate = 8.6 per 1,000 person-years) with a mean age of 60.0 years (SD = 5.4 years). Adjusting for known AF risk factors, a total of 7 medium- and long-chain acylcarnitines were found to be associated with higher risk of AF (smallest HR = 1.09, 95% CI 1.00 to 1.18, largest HR = 1.14, 95% CI 1.05 to 1.24, per 1 SD increment of acylcarnitines). Beta carotene was associated with a lower risk of incident AF (HR = 0.90, 95% CI 0.82 to 0.99) while acisoga (HR = 1.08, 95% CI 1.00 to 1.18) and caffeine (HR = 1.17, 95% CI 1.06 to 1.28) were associated with an increased risk of incident AF. Overall, this study suggests alterations in acylcarnitine metabolism among those with incident AF, independent of known AF risk factors. With these metabolic changes occurring prior to AF diagnosis, there is potential to treat and prevent this condition before AF onset.

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