Atherogenic Index of Plasma and Residual Risk in Anticoagulated Patients With Atrial Fibrillation: The Prospective Murcia Atrial Fibrillation Project III Cohort

Abstract

BACKGROUND: Patients with atrial fibrillation (AF) remain exposed to residual thromboembolic and cardiovascular risk despite oral anticoagulation. The Atherogenic Index of Plasma (AIP) reflects atherogenic burden, but its prognostic value in anticoagulated AF is uncertain. METHODS: This prospective cohort study included consecutive outpatients with AF initiating oral anticoagulation between January 2016 and November 2021. AIP was calculated from baseline triglyceride and high-density lipoprotein cholesterol levels. Patients were stratified into low and high AIP groups using an outcome-driven cut-off. Primary outcomes were thromboembolic events and major adverse cardiovascular events. Secondary outcomes included cardiovascular and all-cause death. Associations were assessed using restricted cubic spline models and multivariable Cox regression analyses adjusted for AF-related comorbidities and concomitant therapies. RESULTS: Among 2535 patients (52.4% women; median age, 76 years [interquartile range, 69-82 years]) followed up for 1.81±0.50 years, thromboembolic events occurred in 187 (7.4%) and major adverse cardiovascular events in 254 (10.0%). Restricted cubic spline models showed significant nonlinear associations with thromboembolic events (overall P<0.001; nonlinear P=0.007) and major adverse cardiovascular events (overall P<0.001; nonlinear P=0.040). High AIP was independently associated with an increased risk of thromboembolic events after adjustment for conventional comorbidities (model 1: adjusted hazard ratio [aHR], 1.47 [95% CI, 1.07-2.02]), with the association remaining significant after further adjustment for commonly prescribed concomitant treatments (model 2: aHR, 1.38 [95% CI, 1.01-1.88]). Similar results were observed for major adverse cardiovascular events (model 1: aHR, 1.40 [95% CI, 1.07-1.84]; model 2: aHR, 1.35 [95% CI, 1.03-1.76]). No significant associations were found for mortality outcomes. CONCLUSIONS: Elevated AIP identifies anticoagulated patients with AF at increased residual thromboembolic and cardiovascular risk.