Investigating the link between coronary artery calcification and atrial fibrillation: A systematic review and meta-analysis

Background:Both coronary artery calcification (CAC) and atrial fibrillation (AF) are associated with common risk factors, such as age, hypertension, diabetes, and dyslipidemia. Investigating their association may provide insights into shared pathophysiological mechanisms and overlapping risk profiles. Methods:A systematically search was performed covering various data bases including PubMed, Scopus, ISI, and Google Scholar from January 2000 until December 2023 for English-published articles. We focused on observational studies-cohort, case-control, and cross-sectional-that involved adult participants (aged 18 and older) and provided data on the any association between CAC and AF. We excluded studies if the full text was unavailable, the publication was not in English, there was insufficient numerical data or relative risk information. Results:All the included articles (n = 14), were observational studies (n = 5 case-control and n = 9 cohort). All of the included papers (100%), reported a link between CAC and higher rate of major adverse cardiovascular events such as stroke and mortality in AF patients. The overall prevalence of AF across 5 studies was estimated to be 9.00% (95% confidence intervals [CI]: 2.00, 16.00), and 60% of the AF population were male. The overall proportion of AF in individuals with a coronary artery calcification score (CACS) of 0 is relatively high at 0.48 (95% CI: 0.32, 0.64), followed by CACS (1-99) which was 0.22 (95% CI: 0.16, 0.28), CACS (100-399) which was 0.17 (95% CI: 0.07, 0.28), and CACS (>= 400) as 0.14 (95% CI: 0.07, 0.22). Conclusion:It can be concluded that there is a robust and consistent association between CAC and AF. Our systematic review underscores the importance of considering CAC as a potential factor in assessing the risk of AF, while also recognizing the multifactorial nature of this relationship.