The association between vitamin D deficiency (VDD) and incident atrial fibrillation/flutter (AF) remains controversial due to conflicting evidence from cross-sectional studies. This study assessed the association between VDD and incident AF using a large-scale, multi-institutional cohort with propensity score matching. This longitudinal cohort study utilized the TriNetX platform, analyzing individuals aged ≥40 years with 2 serum 25-hydroxyvitamin D measurements between 2010 and 2023. Patients with sustained VDD (<20 ng/mL) were compared to controls (≥30 ng/mL) using 1:1 propensity score matching. The primary outcome was incident AF within 3 years. Dose–response analysis across vitamin D categories and subgroup analyses were performed. After matching, 137,407 patients were analyzed in each group. VDD was significantly associated with higher AF risk (hazard ratio [HR]: 1.83, 95% confidence interval: 1.68–1.99, P < .001). A clear dose–response relationship emerged, with HRs of 1.90 for severe deficiency (<10 ng/mL), 1.94 for moderate deficiency (10–20 ng/mL), and 1.60 for insufficiency (20–30 ng/mL). The association persisted during 3 to 6 year follow-up and was consistent across all AF subtypes. VDD was also associated with increased ischemic stroke and pneumonia risk. Subgroup analyses revealed that dyslipidemia significantly modified the VDD–AF association (HR: 1.84 vs 1.50 without dyslipidemia, P = .017). VDD was significantly associated with increased incident AF risk in a dose-dependent manner. These findings support VDD as a potentially modifiable risk factor and highlight the importance of vitamin D status in comprehensive cardiovascular risk assessment. Further prospective and interventional studies are warranted to validate these associations and clarify the underlying mechanisms.

An abstract is unavailable. This article is available as a PDF only.

Patients with chronic obstructive pulmonary disease (COPD) have an elevated risk of postoperative pulmonary complications. This study investigated whether sugammadex use was associated with a reduced risk of postoperative pneumonia and COPD exacerbations compared to neostigmine in this high-risk population. This retrospective cohort study utilized the TriNetX database to identify COPD patients undergoing elective surgery under general anesthesia between 2015 and 2024. Patients receiving rocuronium with sugammadex reversal were compared to those receiving neostigmine reversal using 1:1 propensity score matching. The primary outcome was 30-day postoperative pneumonia. Secondary outcomes included risks of COPD exacerbations, mortality, and intensive care unit (ICU) admission. After matching, 34,031 patients were analyzed per group. Sugammadex was associated with a reduced 30-day pneumonia incidence (1.8% vs 2.1%; hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.75–0.94, P = .002) but increased ICU admissions (2.3% vs 1.9%; HR 1.22, 95% CI 1.10–1.36, P < .001). No significant differences were observed in COPD exacerbations (1.1% vs 1.3%; HR 0.90, 95% CI 0.79–1.04, P = .146) or mortality (0.89% vs 0.79%; HR 1.13, 95% CI 0.96–1.33, P = .147). Sensitivity and subgroup analyses revealed that benefits were more pronounced in academic centers (HR 0.64, 95% CI 0.57–0.73, P < .001) and elderly patients (HR 0.76, 95% CI 0.68–0.84, P < .001). Effects disappeared during the 30 to 90 day follow-up. Sugammadex use in COPD patients was associated with reduced 30-day postoperative pneumonia, particularly in elderly patients and academic settings. However, this benefit did not translate to fewer COPD exacerbations and was temporally limited. The increased ICU admissions likely reflect selection bias rather than causation.