Atherogenic Index of Plasma and Residual Risk in Anticoagulated Atrial Fibrillation Patients

Journal of the American Heart Association, Volume 15, Issue 6 , March 17, 2026. BackgroundPatients with atrial fibrillation (AF) remain exposed to residual thromboembolic and cardiovascular risk despite oral anticoagulation.

The Atherogenic Index of Plasma (AIP) reflects atherogenic burden, but its prognostic value in anticoagulated AF is uncertain.MethodsThis prospective cohort study included consecutive outpatients with AF initiating oral anticoagulation between January 2016 and November 2021. AIP was calculated from baseline triglyceride and high‐density lipoprotein cholesterol levels.

Patients were stratified into low and high AIP groups using an outcome‐driven cut‐off. Primary outcomes were thromboembolic events and major adverse cardiovascular events.

Secondary outcomes included cardiovascular and all‐cause death. Associations were assessed using restricted cubic spline models and multivariable Cox regression analyses adjusted for AF‐related comorbidities and concomitant therapies.ResultsAmong 2535 patients (52.4% women; median age, 76 years [interquartile range, 69–82 years]) followed up for 1.81±0.50 years, thromboembolic events occurred in 187 (7.4%) and major adverse cardiovascular events in 254 (10.0%).

Restricted cubic spline models showed significant nonlinear associations with thromboembolic events (overallP<0.001; nonlinearP=0.007) and major adverse cardiovascular events (overallP<0.001; nonlinearP=0.040).