👤 Gregory Y H Lip

Atrial fibrillation (AF) is a progressive condition characterized by atrial remodeling and dysfunction. This systematic review explores biomarkers that predict new-onset AF, highlighting their potential to improve early diagnosis and risk stratification in high-risk patients, and prevention of stroke and major adverse cardiovascular events. We conducted a literature search of studies published between January 2014-November 2025 in PubMed, Scopus, Web of Science, and Google Scholar, following PRISMA 2020 guidelines. Studies analysing specific populations and patients with prior or postoperative AF were excluded. Quality was assessed using the Newcastle-Ottawa scale. Effect sizes were expressed as HR with 95% CIs. We included 10 cohort studies comprising 472,581patients and 35,271 (7.5%) new-onset AF. Overall, 18 biomarkers were associated with an increased risk of AF, most notably NT-proBNP and sVCAM-1. Conversely, 9 biomarkers were associated with a lower AF incidence, such as ADAMTS13 (HR 0.78, 95%CI 0.70-0.88). A meta-analysis of NT-proBNP demonstrated its association with a higher incidence of AF (HR 1.37, 95%CI 1.19-1.59) with high heterogeneity (I2 = 80%, p<0.01) and Lp(a) was associated with a significant 3% increase in AF incidence per 20 mg/dL increment. Two networks were constructed according to whether biomarkers were associated with a higher or lower incidence of AF, visualising their connection with other biomarkers. Well-known biomarkers, such as NT-proBNP, and others not yet incorporated into clinical practice, such as Lp(a) and sVCAM-1, could play a role in the diagnosis and preventive management of AF. Large-scale prospective studies are needed to validate and optimise their diagnostic utility in predicting new-onset AF. Show less

To quantify international variations in lipid-lowering therapies (LLT) use among patients with coronary heart disease (CHD) and attainment of European guideline-recommended lipid goals. INTERASPIRE is an observational study (2020-23) covering 14 countries from all WHO regions. Patients (18-79 years) hospitalized in the preceding 6-36 months with CHD were invited for standardized interviews and examination, with central laboratory analyses for low-density lipoprotein cholesterol (LDL-C), non-HDL-C, and apolipoprotein B (apoB). Valid lipid data meeting quality control standards were available from 13 countries. Lipid goals followed the 2019 guidelines of the European Atherosclerosis Society and the European Society of Cardiology: LDL-C < 1.4 mmol/L, non-HDL-C < 2.2 mmol/L, and apoB <65 mg/dL.Among 4061 patients (78.8% male, mean age 60.3 years), between index event and interview, 66.3% had no change in treatment intensity. LLT use at interview was largely statin monotherapy: 49.6% high-intensity (inter-country range 5.3%-77.3%) and 24.1% low/moderate-intensity (inter-country range 5.1%-70.1%). Otherwise, 12.2% (inter-country range 0.2%-41.1%) were on combination therapy, and 12.7% on no LLT (inter-country range 3.5%-36.7%). Goal attainment for LDL-C was 17.5%. Corresponding non-HDL-C and apoB goals were achieved by 29.9% and 29.2%, respectively. Higher-income countries (defined by the World Bank's 2024-25 classification of income levels) did better in goal attainment than lower-middle-income countries. In this international study, contemporary lipid goals were not achieved in most CHD patients, with lower-middle-income countries having the worst goal attainment. Contributory factors include absence of any LLT use, low use of combinations and a failure to up-titrate LLT to achieve guideline targets. Show less