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

Long, Deyong; Tong, Xue-Ying; Lin, Jing; Sun, Zhaoqing; Qian, He; Zhan, Yu; Jiang, Chen-Xi; Tang, Ribo; Sang, Caihua; Ning, Man; Jia, Chang-Qi; Feng, Li; WANG, WEI; Zhao, Xin; Li, Chang-Yi; Li, Songnan; Guo, Xueyuan; Liu, Tong; Li, Meng-Meng; Yang, Na; Hao, Yongchen; Liu, Jun; Liu, Jing; Xie, Jin; Dong, Jianzeng; Zhao, Dong; Ma, Changsheng

doi:10.3389/fcvm.2025.1574796

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 Long^1*

Xue-Ying Tong¹

Jing Lin¹

Yu Zhan³

Man Ning¹

Chang-Qi Jia¹ Li Feng

Li Feng¹

Chang-Yi Li¹

Tong Liu¹

Meng-Meng Li¹

Na Yang⁴

Yongchen Hao⁴ Jun Liu

Jun Liu⁴

Jing Liu⁴ Jin Xie

Jin Xie⁵

Jianzeng Dong¹

Dong Zhao⁴

Changsheng 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

The final, formatted version of the article will be published soon.

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

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