Elevated Lipoprotein(a) Levels Linked to New-Onset Atrial Fibrillation: Insights from a Retrospective Cohort Study

Atrial fibrillation (AF) is the most common cardiac arrhythmia. Although lipoprotein(a) [Lp(a)] is known to be a well-established risk factor for atherosclerotic cardiovascular disease (ASCVD), its role in development of AF, independent of this association, remains unclear. Adult patients from the three Mayo Clinic sites with a baseline Lp(a) and without AF history were included. Patients were categorized into two groups based on their Lp(a) levels: high Lp(a) (≥50 mg/dL) and low Lp(a) (<50 mg/dL). Survival probabilities free from incident AF were compared between Lp(a) groups, during a follow-up period up to 15 years, using the Kaplan-Meier curve and the Log-Rank test. Multivariable Cox regression analysis was also conducted. A total of 75,376 patients were included (median age: 55 years, 59% males), with a median follow-up duration of 8.8 [inter quartile range (IQR): 3.4, 14.8] years. Incident AF was detected in 5738 (7.6%) patients. Survival probability free from incident AF was significantly lower in patients with elevated Lp(a) (86%) compared with those with low Lp(a) (88%, log rank P<0.001). Multivariable analysis adjusted for potential risk factors of AF showed a statistically significant association of elevated Lp(a) with a 11% increase in AF risk (adjusted HR: 1.11, 95% CI: 1.05 to 1.18). Our study suggests that elevated Lp(a) (≥50 mg/dL) is an independent risk factor for incident AF. Future prospective studies are warranted to validate our results and to test the if reducing Lp(a) could mitigate the burden of AF.