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In Reply: We appreciate Dr Palatini's elaboration on a point that we raised in our article. Whereas we adjusted for several established risk factors for AF,¹ we acknowledged in our discussion that we were unable to account for all AF risk factors, including some known to have a genetic basis, such as C-reactive protein,² hemostatic factors,³ left atrial enlargement,⁴ Graves disease, alcohol use,⁵ and echocardiographic features that are associated with AF.⁴ Palatini et al⁶ have shown that left atrial size is heritable, and call for a similar analysis to be undertaken in the Framingham study. We concur that it would be informative to examine whether adjustment for left atrial size in our regression models would diminish the estimated risk of parental history for offspring AF; a diminished odds ratio might suggest that the genetic component of AF is partially mediated through left atrial size. Overall, we concur with Palatini that . . . [Full Text of this Article]

Caroline S. Fox, MD, MPH
foxca@nhlbi.nih.gov

Ramachandran S. Vasan, MD; Emelia J. Benjamin, MD, ScM
National Heart, Lung, and Blood Institute
Framingham Heart Study
Framingham, Mass

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