CLINICAL TRIAL article

Front. Cardiovasc. Med.

Sec. Cardiac Rhythmology

Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1574796

This article is part of the Research TopicCardioimmunology and Arrhythmias: Mechanism, Diagnosis and Novel TherapyView all articles

Low-density lipoprotein cholesterol levels and in-hospital bleeding in patients with atrial fibrillation: Findings from CCC-AF project

Provisionally accepted
Deyong LongDeyong Long1*Xue-Ying TongXue-Ying Tong1Jing LinJing Lin1Zhaoqing SunZhaoqing Sun1He QianHe Qian2Yu ZhanYu Zhan3Chen-Xi JiangChen-Xi Jiang1Ribo TangRibo Tang1Caihua SangCaihua Sang1Man NingMan Ning1Chang-Qi JiaChang-Qi Jia1Li FengLi Feng1WEI WANGWEI WANG1Xin ZhaoXin Zhao1Chang-Yi LiChang-Yi Li1Songnan LiSongnan Li1Xueyuan GuoXueyuan Guo1Tong LiuTong Liu1Meng-Meng LiMeng-Meng Li1Na YangNa Yang4Yongchen HaoYongchen Hao4Jun LiuJun Liu4Jing LiuJing Liu4Jin XieJin Xie5Jianzeng DongJianzeng Dong1Dong ZhaoDong Zhao4Changsheng MaChangsheng Ma1
  • 1Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, China
  • 2Department of Cardiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
  • 3Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
  • 4Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University,, Beijing, China
  • 5Shiyan Hospital of Traditional Chinese Medicine, Shiyan, China

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Background and Aims: Emerging evidence indicates a relationship between low-density lipoprotein cholesterol (LDL-C) levels and bleeding. However, data regarding the relationship between LDL-C levels and bleeding events in patients with atrial fibrillation (AF) remain unfilled. This study is aimed to examine the relationship between LDL-C levels and the risk of in-hospital bleeding in patients with AF. Methods and results: In this multi-centered observational study, 25,380 patients with AF were enrolled; 14,071 (55.4%) and 11 309 (44.6%) were men and women, respectively, and the mean age was 69.51±11.88 years. After adjusting for covariates, with LDL-C ≥70 mg/dL as the reference, LDL-C <70 mg/dL was associated with a higher risk of any bleeding event (adjusted odds ratio [aOR]: 1.63, 95% confidence interval [CI]: 1.12-2.35; P=0.009), major bleeding events (aOR: 1.48, 95% CI: 0.99-2.20; P=0.05), and gastrointestinal bleeding events (aOR: 2.11, 95% CI: 1.27-3.50; P=0.004) in the multivariate logistic regression model. The restricted cubic spline model showed an L-shaped relationship for bleeding events, with a higher risk at lower LDL-C levels. The nonlinear relationship between LDL-C levels and the risk of bleeding persisted among the subgroups. CONCLUSIONS: This nationwide and multi-centered AF registry study found an L-shaped relationship between LDL-C levels at admission and in-hospital bleeding events, with a greater risk at lower LDL-C levels. Further studies are needed to establish LDL-C as a factor for risk stratification and management of bleeding events in patients with AF.

Keywords: Atrial Fibrillation, Low-density lipoprotein cholesterol, bleeding risk, nonlinear relationship，, CCC-AF project

Received: 11 Feb 2025; Accepted: 14 Apr 2025.

Copyright: © 2025 Long, Tong, Lin, Sun, Qian, Zhan, Jiang, Tang, Sang, Ning, Jia, Feng, WANG, Zhao, Li, Li, Guo, Liu, Li, Yang, Hao, Liu, Liu, Xie, Dong, Zhao and Ma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Deyong Long, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, China

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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