Cumulative burden of metabolic syndrome and its components on the risk of atrial fibrillation: a nationwide population-based study

Abstract

Background The metabolic syndrome (MetS) and its components are associated with the development of atrial fibrillation (AF). However, the impact of time-burden of MetS on the risk of AF is unknown. We investigated the effect of the cumulative longitudinal burden of MetS on the development of AF. Methods We included 2 885 189 individuals without AF who underwent four annual health examinations during 2009–2013 from the database of the Korean national health insurance service. Metabolic burdens were evaluated in the following three ways: (1) cumulative number of MetS diagnosed at each health examination (0–4 times); (2) cumulative number of each MetS component diagnosed at each health examination (0–4 times per MetS component); and (3) cumulative number of total MetS components diagnosed at each health examination (0 to a maximum of 20). The risk of AF according to the metabolic burden was estimated using Cox proportional-hazards models. Results Of all individuals, 62.4%, 14.8%, 8.7%, 6.5%, and 7.6% met the MetS diagnostic criteria 0, 1, 2, 3, and 4 times, respectively. During a mean follow-up of 5.3 years, the risk of AF showed a positive association with the cumulative number of MetS diagnosed over four health examinations: adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of 1, 2, 3, and 4 times compared to 0 times were 1.18 (1.13–1.24), 1.31 (1.25–1.39), 1.46 (1.38–1.55), and 1.72 (1.63–1.82), respectively; P for trend < 0.001. All five components of MetS, when diagnosed repeatedly, were independently associated with an increased risk of AF: adjusted HR (95% CI) from 1.22 (1.15–1.29) for impaired fasting glucose to 1.96 (1.87–2.07) for elevated blood pressure. As metabolic components were accumulated from 0 to 20 counts, the risk of AF also gradually increased up to 3.1-fold (adjusted HR 3.11, 95% CI 2.52–3.83 in those with 20 cumulative components of MetS), however, recovery from MetS was linked to a decreased risk of AF. Conclusions Given the positive correlations between the cumulative metabolic burdens and the risk of incident AF, maximal effort to detect and correct metabolic derangements even before MetS development might be important to prevent AF and related cardiovascular diseases.

Prevention and Treatment of Atrial Fibrillation via Risk Factor Modification

“…37 Metabolic syndrome is also strongly correlated with an increased risk of AF. 38 Sodium-glucose cotransporter (SGLT)-2 inhibitors and glucagon-like peptide (GLP)-1 agonists are glucose-lowering medications that induce weight loss in those with and without diabetes. 39 Both of these classes of drugs have been shown to reduce the risk of AF.…”

Obesity phenotypes and their relationships with atrial fibrillation

“…Although the pathogenesis of metabolic unhealthy-associated Afib is not well understood, it is believed to be a complex interaction among metabolic, mechanical, and environmental factors ( Watanabe et al, 2008 ). Low high-density lipoprotein levels related to the pro-inflammatory milieu have been suggested to increase Afib susceptibility ( Ahn et al, 2021 ). Thus, a mechanism related to inflammation and oxidative stress has been proposed to have a common etiology and has been implicated in the pathogenesis ( Watanabe et al, 2008 ).…”

Peer Review #1 of "Obesity phenotypes and their relationships with atrial fibrillation (v0.1)"

“…Although the pathogenesis of metabolic unhealthy-associated Afib is not well understood, it is believed to be a complex interaction among metabolic, mechanical, and environmental factors (Watanabe et al 2008). Low high-density lipoprotein levels related to the proinflammatory milieu have been suggested to increase Afib susceptibility (Ahn et al 2021). Thus, a mechanism related to inflammation and oxidative stress has been proposed to have a common etiology and has been implicated in the pathogenesis (Watanabe et al 2008).…”