Abstract
Atrial fibrillation (AF) is the most common chronic arrhythmia in adults and its prevalence is increasing. Due to its serious cardiovascular complications there is a strong need to understand predisposing risk factors to develop effective prevention strategies. There are a few established risk factors but a number of further risk factors have been suggested including obesity, metabolic syndrome, sleep-disordered breathing, and inflammation. The aim of this study was to investigate established and emerging risk factors for AF in a cohort study of 4,267 adults in Busselton, Western Australia, without a history of AF at baseline in 1994/95 who were followed for 15 years for incident AF events. Baseline measurement included questionnaire, clinical assessment and blood sample. A total of 343 (8 %) experienced AF during follow-up. Cox regression analysis confirmed advancing age, male sex, taller height, being on hypertension treatment and higher body mass index (BMI) as the major common risk factors (all p < 0.001). However, further modelling showed the effect of being on hypertension treatment may be stronger in women (p = 0.001) and the effect of BMI stronger in men (p = 0.004). After adjustment for these factors, no other factors were strongly related (p < 0.001) although short PR interval, history of valvular heart disease, stroke, chronic obstructive pulmonary disease, lung function and adiponectin level were marginally related (p < 0.05). This cohort study of predictors for incident AF has confirmed the major established risk factors. However, recently suggested potential novel risk factors for AF (inflammation, sleep-disordered breathing, glucose/metabolic disorders) were not confirmed in this study.
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References
Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol. 1998;82(7):2N–9N.
Greenlee RT, Vidaillet H. Recent progress in the epidemiology of atrial fibrillation. Curr Opin Cardiol. 2005;20(1):7–14.
Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998;98(10):946–52.
Chugh SS, Blackshear JL, Shen W-K, Hammill SC, Gersh BJ. Epidemiology and natural history of atrial fibrillation: clinical implications. J Am Coll Cardiol. 2001;37(2):371–8.
Stewart S, Hart CL, Hole DJ, McMurray JJV. A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley Study. Am J Med. 2002;113:359–64.
Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285(18):2370–5. doi:10.1001/jama.285.18.2370.
Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;114(2):119–25. doi:10.1161/circulationaha.105.595140.
Benjamin EJ, Chen P-S, Bild DE, Mascette AM, Albert CM, Alonso A, et al. Prevention of atrial fibrillation: report from a National Heart, Lung, and Blood Institute workshop. Circulation. 2009;119(4):606–18. doi:10.1161/circulationaha.108.825380.
Psaty BM, Manolio TA, Kuller LH, Kronmal RA, Cushman M, Fried LP, et al. Incidence of and risk factors for atrial fibrillation in older adults. Circulation. 1997;96(7):2455–61.
Benjamin EJ, Levy D, Vaziri SM, D’Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. JAMA. 1994;271(11):840–4. doi:10.1001/jama.1994.03510350050036.
Schoonderwoerd BA, Smit MD, Pen L, Van Gelder IC. New risk factors for atrial fibrillation: causes of ‘not-so-lone’ atrial fibrillation. Europace. 2008;10(6):668–73. doi:10.1093/europace/eun124.
Wang TJ, Parise H, Levy D, D’Agostino RB, Wolf PA, Vasan RS, et al. Obesity and the risk of new-onset atrial fibrillation. JAMA, J Am Med Assoc. 2004;292(20):2471–7. doi:10.1001/jama.292.20.2471.
Frost L, Hune LJ, Vestergaard P. Overweight and obesity as risk factors for atrial fibrillation or flutter: the Danish diet, cancer, and health study. Am J Med. 2005;118(5):489.
Dublin S, French B, Glazer NL, Wiggins KL, Lumley T, Psaty BM, et al. Risk of new-onset atrial fibrillation in relation to body mass index. Arch Intern Med. 2006;166(21):2322–8. doi:10.1001/archinte.166.21.2322.
Watanabe H, Tanabe N, Watanabe T, Darbar D, Roden DM, Sasaki S, et al. Metabolic syndrome and risk of development of atrial fibrillation: the Niigata preventive medicine study. Circulation. 2008;117(10):1255–60. doi:10.1161/circulationaha.107.744466.
Marott SCW, Nordestgaard BG, Zacho J, Friberg J, Jensen GB, Tybjaerg-Hansen A, et al. Does elevated C-reactive protein increase atrial fibrillation risk? A mendelian randomization of 47,000 individuals from the general population. J Am Coll Cardiol. 2010;56(10):789–95. doi:10.1016/j.jacc.2010.02.066.
Schnabel RB, Sullivan LM, Levy D, Pencina MJ, Massaro JM, D’Agostino RB Sr, et al. Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study. The Lancet. 2009;373(9665):739.
Chamberlain AM, Agarwal SK, Folsom AR, Soliman EZ, Chambless LE, Crow R, et al. A clinical risk score for atrial fibrillation in a biracial prospective cohort (from the Atherosclerosis Risk In Communities [ARIC] Study). Am J Cardiol. 2011;107(1):85–91.
Alonso A, Krijthe BP, Aspelund T, Stepas KA, Pencina MJ, Moser CB, et al. Simple risk model predicts incidence of atrial fibrillation in a racially and geographically diverse population: the CHARGE-AF consortium. J Am Heart Assoc. 2013;2(2):e000102. doi:10.1161/JAHA.112.000102.
Knuiman MW, Hung J, Divitini ML, Davis TM, Beilby JP. Utility of the metabolic syndrome and its components in the prediction of incident cardiovascular disease: a prospective cohort study. Eur J Cardiovasc Prevent Rehabil. 2009;16(2):235–41. doi:10.1097/HJR.0b013e32832955fc.
Knuiman MW, James AL, Divitini ML, Bartholomew HC. Correlates of habitual snoring and witnessed apnoeas in Busselton, Western Australia. Aust N Z J Public Health. 2005;29(5):412–5.
Beilby J, Divitini ML, Knuiman MW, Rossi E, Hung J. Comparison of cystatin C and creatinine as predictors of cardiovascular events in a community-based elderly population. Clin Chem. 2010;56(5):799–804. doi:10.1373/clinchem.2009.135962.
Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome—an American Heart Association/National Heart, Lung, and Blood Institute scientific statement—executive summary. Circulation. 2005;112(17):E285–90.
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment—insulin resistance and beta-cell function from fasting plasma-glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412–9.
Chambless LE, Diao GQ. Estimation of time-dependent area under the ROC curve for long-term risk prediction. Stat Med. 2006;25(20):3474–86. doi:10.1002/Sim.2299.
Pencina MJ, D’Agostino RB, D’Agostino RB, Vasan RS. Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med. 2008;27(2):157–72. doi:10.1002/Sim.2929.
Marcus GM, Alonso A, Peralta CA, Lettre G, Vittinghoff E, Lubitz SA, et al. European ancestry as a risk factor for atrial fibrillation in African Americans. Circulation. 2010;122(20):2009–15.
Mont L, Tamborero D, Elosua R, Molina I, Coll-Vinent B, Sitges M, et al. Physical activity, height, and left atrial size are independent risk factors for lone atrial fibrillation in middle-aged healthy individuals (vol 10, pg 15, 2008). Europace. 2008;10(3):386.
Rosengren A, Hauptman PJ, Lappas G, Olsson L, Wilhelmsen L, Swedberg K. Big men and atrial fibrillation: effects of body size and weight gain on risk of atrial fibrillation in men. Eur Heart J. 2009;30(9):1113–20.
Conen D, Tedrow UB, Cook NR, Buring JE, Albert CM. Birth weight is a significant risk factor for incident atrial fibrillation. Circulation. 2010;122(8):764–70.
Wanahita N, Messerli FH, Bangalore S, Gami AS, Somers VK, Steinberg JS. Atrial fibrillation and obesity—results of a meta-analysis. Am Heart J. 2008;155(2):310–5.
Everett BM, Conen D, Buring JE, Moorthy MV, Lee IM, Albert CM. Physical activity and the risk of incident atrial fibrillation in women. Circ-Cardiovasc Qual. 2011;4(3):321–7.
Healey JS, Connolly SJ. Atrial fibrillation: hypertension as a causative agent, risk factor for complications, and potential therapeutic target. Am J Cardiol. 2003;91(10):9G–14G.
Shibata Y, Watanabe T, Osaka D, Abe S, Inoue S, Tokairin Y, et al. Impairment of pulmonary function is an independent risk factor for atrial fibrillation: the Takahata Study. Int J Med Sci. 2011;8(7):514–22.
Buch P, Friberg J, Scharling H, Lange P, Prescott E. Reduced lung function and risk of atrial fibrillation in The Copenhagen City Heart Study. Eur Respir J. 2003;21(6):1012–6.
Rienstra M, Sun JX, Lubitz SA, Frankel DS, Vasan RS, Levy D, et al. Plasma resistin, adiponectin, and risk of incident atrial fibrillation: the Framingham Offspring Study. Am Heart J. 2012;163(1):119–24.
Fontes JD, Lyass A, Massaro JM, Rienstra M, Dallmeier D, Schnabel RB, et al. Insulin resistance and atrial fibrillation (from the Framingham Heart Study). Am J Cardiol. 2012;109(1):87–90.
Huxley RR, Alonso A, Lopez FL, Filion KB, Agarwal SK, Loehr LR, et al. Type 2 diabetes, glucose homeostasis and incident atrial fibrillation: the Atherosclerosis Risk in Communities study. Heart. 2012;98(2):133–8.
Smith JG, Newton-Cheh C, Almgren P, Struck J, Morgenthaler NG, Bergmann A, et al. Assessment of conventional cardiovascular risk factors and multiple biomarkers for the prediction of incident heart failure and atrial fibrillation. J Am Coll Cardiol. 2010;56(21):1713–9.
Schnabel RB, Larson MG, Yamamoto JF, Sullivan LM, Pencina MJ, Meigs JB, et al. Relations of biomarkers of distinct pathophysiological pathways and atrial fibrillation incidence in the community. Circulation. 2010;121(2):200–7.
Aviles RJ, Martin DO, Apperson-Hansen C, Houghtaling PL, Rautaharju P, Kronmal RA, et al. Inflammation as a risk factor for atrial fibrillation. Circulation. 2003;108(24):3006–10.
Gami AS, Pressman G, Caples SM, Kanagala R, Gard JJ, Davison DE, et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation. 2004;110(4):364–7.
Needleman M, Calkins H. The role of obesity and sleep apnea in atrial fibrillation. Curr Opin Cardiol. 2011;26(1):40–5.
Selmer C, Olesen JB, Hansen ML, Lindhardsen J, Olsen AMS, Madsen JC, et al. The spectrum of thyroid disease and risk of new onset atrial fibrillation: a large population cohort study. Brit Med J. 2012;345.
Acknowledgments
The 1994/95 Busselton health survey was supported by a grant from the Health Promotion Foundation of Western Australia. This analysis was supported by a grant from the National Health and Medical Research Council of Australia (Project number 1020373). We would like to acknowledge the Data Linkage Branch (Department of Health WA) for extraction and provision of the linked hospital admission and death data, the Busselton Population Medical Research Institute for permission to access the survey data, and the residents of Busselton for their long-standing support of the Busselton health surveys.
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Knuiman, M., Briffa, T., Divitini, M. et al. A cohort study examination of established and emerging risk factors for atrial fibrillation: the Busselton Health Study. Eur J Epidemiol 29, 181–190 (2014). https://doi.org/10.1007/s10654-013-9875-y
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DOI: https://doi.org/10.1007/s10654-013-9875-y