Are cardiovascular risk factors also associated with the incidence of atrial fibrillation?

Abstract

SummaryEstablished primary prevention strategies of cardiovascular diseases are based on understanding of risk factors, but whether the same risk factors are associated with atrial fibrillation (AF) remains unclear. We conducted a systematic review and field synopsis of the associations of 23 cardiovascular risk factors and incident AF, which included 84 reports based on 28 consented and four electronic health record cohorts of 20,420,175 participants and 576,602 AF events. We identified 3-19 reports per risk factor and heterogeneity in AF definition, quality of reporting, and adjustment. We extracted relative risks (RR) and 95 % confidence intervals [CI] and visualised the number of reports with inverse (RR [CI]<1.00), or direct (RR [CI]>1.00) associations. For hypertension (13/17 reports) and obesity (19/19 reports), there were direct associations with incident AF, as there are for coronary heart disease (CHD). There were inverse associations for non-White ethnicity (5/5 reports, with RR from 0.35 to 0.84 [0.82–0.85]), total cholesterol (4/13 reports from 0.76 [0.59–0.98] to 0.94 [0.90–0.97]; 8/13 reports with non-significant inverse associations), and diastolic blood pressure (2/11 reports from 0.87 [0.78–0.96] to 0.92 [0.85–0.99]; 5/11 reports with non-significant inverse associations), and direct associations for taller height (7/10 reports from 1.03 [1.02–1.05] to 1.92 [1.38–2.67]), which are in the opposite direction of known associations with CHD. A systematic evaluation of the available evidence suggests similarities as well as important differences in the risk factors for incidence of AF as compared with other cardiovascular diseases, which has implications for the primary prevention strategies for atrial fibrillation.

Atrial Fibrillation and Hypertension

“…16 Similarly, in an ancillary study from the ROCKET AF trial (rivaroxaban versus warfarin), the risk of stroke or systemic embolism increased by 7% for every 10 mm Hg increase in screening SBP. 2,18 The ARISTOTLE trial (apixaban versus warfarin) also confirmed the importance of good BP control in AF. Elevated BP at any time during the trial increased risk of stroke and systemic embolism (HR, 1.53; 95% CI, 1.25-1.86), hemorrhagic stroke (HR, 1.85; 95% CI, 1.26-2.72), and ischemic stroke (HR, 1.50; 95% CI, 1.18-1.90).…”

“…79,80 Similarly, increasing body mass index is related to increased risk of AF. 2 Interventions to reduce body weight have numerous positive health effects in AF patients, including BP reduction, decrease in glucose, total cholesterol, low-density cholesterol, and triglycerides, inhibition of inflammation (eg, reduction in C-reactive protein levels), attenuation of pathological LA remodeling (ie, decrease in LA volume) and LV remodeling (reduction of LV hypertrophy and E/eʹ ratio). The most prominent effects were seen in patients with ≥10% weight reduction.…”

“…Hypertension is very common in AF patients (Figure S1 in the online-only Data Supplement), and evidence points toward a significant contribution of high blood pressure (BP) to AF incidence 2 (Table S1). Patients with hypertension have 1.7-fold higher risk of developing AF than normotensive individuals, and 1 in 6 cases of AF has been attributed to hypertension.…”

Risk factor modification for the primary and secondary prevention of atrial fibrillation. Part 2

“…19 Dyslipidemia Dyslipidemia and the risk of atrial fibrillation Available studies showed inconsistent findings on association between dyslipidemia and incident AF. 59 The ARIC (Atherosclerosis Risk in Communities) study suggested a protective effect of hypercholesterolemia against AF, reporting a significant reduction of the 20-year incident AF risk by 12% and 16% among participants with baseline total cholesterol and low -density lipoprotein cholesterol level above 5.18 mmol/l and 2.59 mmol/l, respectively, compared with those who had lower plasma lipid levels. 60 Several studies presented discordant results on the impact of high -density lipoprotein cholesterol level on new -onset AF.…”

Comparação entre a rigidez vascular dos pacientes idosos com e sem fibrilação atrial

“…É verificável por exames como eletrocardiograma, ecocardiograma e ressonância magnética (SANTOS, SHAH, 2014). Nota-se que a HAS está frequentemente associada às alterações funcionais e estruturais, como a hipertrofia e fibrose miocárdicas, que desenvolvem a FA (HEERINGA et al, 2006;ALLAN, et al, 2017).…”