The CHADS and CHADS-VASc scores predict atrial fibrillation in dyslipidemic individuals: Role of incorporating low high-density lipoprotein cholesterol levels.

AIM

To investigate the value of CHADS and CHADS-VASc scores in predicting atrial fibrillation (AF) among dyslipidemic individuals and assess the additional value of incorporating low levels of high-density lipoprotein cholesterol (HDL-C).

METHODS

This observational study included 1241 individuals attending a lipid clinic. Models including clinical and laboratory parameters were constructed to test the predictive value of CHADS and CHADS-VASc scores as well as low HDL-C levels for incident AF. Low HDL-C levels were defined as <40 and <50mg/dL for male and female subjects, respectively.

RESULTS

After excluding 18 patients with AF at baseline, 1223 subjects were followed-up for a median period of 6years (IQR: 4-10), and 34 (2.8%) developed AF. Baseline CHADS (OR: 1.71; 95% CI: 1.28-2.29, p<0.001) and CHADS-VASc scores (OR: 1.56; 95% CI: 1.26-1.92, p<0.001) as well as low HDL-C levels (OR: 3.79; 95% CI: 1.85-7.75, p<0.001) were significantly associated with new-onset AF. ROC curve analyses showed that both CHADS and CHADS-VASc scores were significant predictors for new-onset AF (C-Statistic: CHADS 0.679, p<0.001; CHADS-VASc 0.698, p<0.001). Higher CHADS scores were associated with reduced event-free survival from AF (log-rank=10.62, p=0.001) with differences potentiated if stratified by CHADS-VASc score (log-rank=22.29, p<0.001). After incorporating low HDL-C levels, both scores achieved slightly higher C-Statistic for AF prediction (0.690 and 0.707, respectively, p<0.001).

CONCLUSIONS

CHADS and CHADS-VASc scores predict new AF in dyslipidemic patients. Risk prediction improved modestly when low HDL-C levels were included.