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Complejo Hospitalario de Jaén, Jaén, Spain Hospital Universitario Virgen de las Nieves, Granada, Spain
Correspondence to: Miguel A. Arias, MD, PhD, Pza del Zodiaco No. 8, 5°B, 23009 Jaén, Spain; e-mail: maapalomares{at}secardiologia.es
To the Editor:
We read with great interest the recent article by Amar et al (November 2005)1 on reduction in the incidence of postoperative atrial fibrillation with the preoperative use of statin independent of levels of early markers of inflammation. Obesity may influence the plasma levels of such markers, which are nowadays considered as an indicator of subclinical inflammation.23 Importantly, however, levels of the analyzed markers of inflammation are influenced by many variables, and they are not related to a single one.
The risk of postoperative atrial fibrillation has been significantly associated with rising body mass index in a large cohort4 of postoperative patients without a history of atrial fibrillation, and that association was independent of a broad range of clinical, surgical, and demographic factors known to influence the risk of atrial fibrillation. Some factors that have been linked to an increasing incidence of atrial fibrillation such as left atrial enlargement, enhanced neurohormonal activation, and left ventricular diastolic dysfunction are correlated with increasing body mass index or obesity.567 Indeed, those cardiac structural abnormalities, which are characterized by the presence of heart failure with preserved left ventricular systolic function, are also commonly observed in patients with diastolic heart failure.8 Preliminary work by Fukuta et al9 has shown that patients with diastolic heart failure might benefit from the use of statins, and the reported survival benefit might be explained by the effects of statins on cardiac hypertrophy,10 endothelial function and vascular tone,11 and systemic inflammation.12 Thus, it would be of interest to have the data on body mass index and body weight for patients with and without atrial fibrillation to further explain the results of the present study.
References
Memorial Sloan-Kettering Cancer Center, New York, NY
Correspondence to: David Amar, MD, Memorial Sloan-Kettering Cancer Center, Anesthesiology and CCM, 1275 York Ave, Room M-304, New York, NY 10021; e-mail: amard{at}mskcc.org
To the Editor:
The authors raise some important issues. Mean (± SD) body mass index did not differ in our patients who either did or did not develop atrial fibrillation (AF) [28 ± 5 vs 27 ± 4, respectively; p = 0.3]. We have previously found123 no difference in weight between patients with or without AF after noncardiac surgery. In two studies,34 male gender was significantly more prevalent among patients who developed postoperative AF. Men may have larger atria and hence a greater likelihood for AF. In contrast to the general population, however, the pathophysiology of our patients likely differs with respect to having obesity or diastolic dysfunction as important risk factors for postoperative AF.
References
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