The Long- and Short-Term Impact of Elevated Body Mass Index on the Risk of New Atrial Fibrillation

Abstract

Objectives To characterize the relationship between changes in body mass index (BMI) and incident atrial fibrillation (AF) in a large cohort of women. Background Obesity and AF are increasing public health problems. The importance of dynamic obesity-associated AF risk is uncertain, and mediators are not well characterized. Methods Cases of AF were confirmed by medical record review in 34,309 participants in the Women’s Health Study. Baseline and updated measures of BMI were obtained from periodic questionnaires. Results Over 12.9 +/− 1.9 years of follow-up, 834 AF events were confirmed. BMI was linearly associated with AF risk, with a 4.7% (95% CI 3.4, 6.1, p<0.0001) increase in risk with each kg/m2. Adjustment for inflammatory markers minimally attenuated this risk. When updated measures of BMI were utilized to estimate dynamic risk, overweight (HR 1.22 95%CI 1.02, 1.45, p=0.03) and obesity (HR 1.65 95%CI 1.36, 2.00, p<0.0001) were associated with adjusted short term elevations in AF risk. Participants becoming obese during the first 60 months had a 41% adjusted increase in risk of developing AF (p=0.02) compared to those maintaining BMI <30 kg/m2. The prevalence of overweight and obesity increased over time. The adjusted proportion of incident AF attributable to short term elevations in BMI was substantial (18.3%). Conclusions In this population of apparently healthy women, BMI was associated with short and long term elevations in AF risk, accounting for a large proportion of incident AF independent of traditional risk factors. A strategy of weight control may reduce the increasing incidence of AF.

Early Life Risk Factors for Incident Atrial Fibrillation in the Helsinki Birth Cohort Study

“…Besides genetic and epigenetic factors, BMI could also be inherited in families through cultural factors resulting in women with high BMI transmitting habits to their offspring that result in high adult BMI. This theory is in agreement with the high importance of adult BMI as an AF risk factor 21. The association between adult obesity and AF appears to be mediated through left atrial enlargement,22 and it is possible that left atrial enlargement is a pathway between maternal BMI to offspring AF.…”

The significance of the left atrial volume index in cardioversion success and its relationship with recurrence in patients with non-valvular atrial fibrillation subjected to electrical cardioversion: a study on diagnostic accuracy

“…In our study, when the parameters of age, female sex, BMI and LVMI were individually evaluated, they were observed to be associated with the ECV success and/or the recurrence of AF after a successful ECV. Various clinical and echocardiographic studies have suggested that any diastolic dysfunction accompanying these parameters may affect the LA structure and function in a way to lead to atrial fibrillation and the recurrence of AF after the cardioversion (12)(13)(14). The echocardiographically determined LA size is known to be closely associated with the development of AF, and the LA size has been reported to be an independent predictor of the sinus rhythm restoration after the cardioversion (15,16).…”

Associations of Abdominal Obesity and New‐Onset Atrial Fibrillation in the General Population

“…Higher height, weight, and body mass index (BMI)4, 5, 6, 7 confer increased risk of AF. Importantly, general obesity, which is one of a limited number of modifiable risk factors for AF, and high BMI have been reported to be related to AF burden and severity 8, 9, 10, 11.…”