Weight change and the risk of incident atrial fibrillation: a systematic review and meta-analysis

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p>The prevalence of obesity is increasing globally and this could partly explain the worldwide increase in the prevalence of atrial fibrillation (AF), as both overweight and obesity are established risk factors. However, the relationship between weight change and risk of incident AF, independent of starting weight, remains uncertain.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>MEDLINE, Embase, Pubmed, Web of Science, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Trials Register—<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="http://clinicaltrials.gov" ext-link-type="uri">clinicaltrials.gov</jats:ext-link>, CINAHL and the WHO ICTRP were searched from inception to July 2018.</jats:p><jats:p>We included randomised controlled trials and cohort studies across all healthcare settings but excluded studies of bariatric surgery. A random effects model was used to calculate pooled hazard ratios. The primary outcome was the risk of incident AF in relation to weight change.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Ten studies, including 108 996 people, met our inclusion criteria. For a 5% gain in weight, the incidence of AF increased by 13% (HR 1.13, 95% CI 1.04 to 1.23, I<jats:sup>2</jats:sup>=70%, n&gt;20 411 in five studies; study size was unknown for one study). A 5% loss in body weight was not associated with a significant change in the incidence of AF (HR 1.04, 95% CI 0.94 to 1.16, I<jats:sup>2</jats:sup>=73%, n=40 704 in five studies).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Weight gain may increase the risk of AF, but there was no clear evidence that non-surgical weight loss altered AF incidence. Strategies to prevent weight gain in the population may reduce the global burden of AF. Given the lack of studies and methodological limitations, further research is needed.</jats:p></jats:sec>

Weight, height, weight change, and risk of incident atrial fibrillation in middle‐aged men and women

“…Our finding that weight loss was not associated with AF risk is in line with the results of several prior studies 9,12–15,26 . An intensive lifestyle intervention study that included individuals with type 2 diabetes reported no association between weight loss and risk of AF 15 .…”

“…8 The mean weight change in that study was 4%, A meta-analysis showed an association between a weight gain of 5% and increased risk of AF. 26 Differences in studied populations and age of onset of AF might explain the differences between the results of our study compared to the previous studies.…”

“…Our finding that weight loss was not associated with AF risk is in line with the results of several prior studies. 9,[12][13][14][15]26…”

Prediction models for atrial fibrillation applicable in the community: a systematic review and meta-analysis

“…Previous systematic reviews have focused on individual predictors for AF, 58 , 59 on AF as a risk factor for other outcomes, 60 , 61 or on risk models for adverse outcomes in AF patients. 62 , 63 However, to our knowledge, this is the first systematic review and meta-analysis on performance of incident AF risk prediction models, and the first with a focus on such risk models validated in and applicable to the community.…”

Metabolic surgery: A clinical update

“…In a propensity‐matched cohort study evaluating 5044 patients, there was an AF incidence rate of 0.8% versus 2.9% after metabolic surgery compared with conventional treatment 92 . Substantial weight loss seems to be a key factor in reduction of incident AF or reversal, and studies have shown modest weight loss to be less successful 93,94 …”