Body mass index, abdominal fatness, fat mass and the risk of atrial fibrillation: a systematic review and dose-response meta-analysis of prospective studies

Waist circumference and body surface area and the risk of developing new-onset atrial fibrillation: A systematic review and meta-analysis of observational studies

BACKGROUND

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia with significant health consequences. Identifying modifiable risk factors, such as obesity, is crucial. While body mass index (BMI) is linked to increased AF risk, the association between new-onset AF (NOAF) and other anthropometric measures like waist circumference (WC) and body surface area (BSA) warrants further investigation.

OBJECTIVES

This systematic review and meta-analysis aimed to compare mean WC and BSA between individuals who developed NOAF and those who did not.

METHODS

We conducted a comprehensive search up to February 2024 for studies comparing mean WC and BSA in groups with and without incident NOAF. Participants had no prior AF history. We used a random-effects model to calculate standardized mean differences (SMDs) and 95 % confidence intervals (CIs). Subgroup analyses explored NOAF occurrence following coronary artery bypass graft (CABG) surgery, in the absence of any preceding procedure, and after other cardiac procedures.

RESULTS

Our analysis of 34 studies revealed that adults with NOAF had significantly higher WC (SMD = 0.20, 95 % CI 0.01; 0.39) and BSA (SMD = 0.06, 95 % CI 0.01; 0.11) compared to those without NOAF. Subgroup analysis showed a more pronounced association in individuals developing NOAF after CABG (SMD = 0.33, 95 % CI 0.17; 0.48) and in those without any prior procedure before NOAF diagnosis (SMD = 0.23, 95 % CI 0.08; 0.38) versus those without NOAF.

CONCLUSION

Higher WC and BSA appear to be significantly associated with an increased risk of NOAF, with the relations being more pronounced in specific subgroups.

Postoperative atrial fibrillation following cardiac surgery in severe obesity: the added value of waist circumference

INTRODUCTION

Obesity is an independent risk factor for postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) surgery. POAF in patients with severe obesity (body mass index [BMI] ≥ 35 kg/m2) is less studied. Whether waist circumference (WC) improves prediction of POAF independently of BMI among patients with severe obesity remains unknown.

AIM

To evaluate the risk of POAF, the role of WC in predicting POAF and postoperative complications after CABG surgery in severe obesity.

METHODS

Our cohort included 7995 patients undergoing CABG surgery (2006-19). POAF risk was compared across BMI and WC categories. In patients with severe obesity, the association of an increase in WC with POAF risk was assessed.

RESULTS

763 (9.5%) patients had a BMI ≥ 35 kg/m2. In this group, BMI was 38.5 ± 3.6 kg/m2 and WC was 123.4 ± 10.8 cm. More patients with severe obesity developed POAF compared to patients with a normal BMI (37 vs. 29%, aRR: 1.52[95%CI 1.36-1.72], p < 0.01). Within each BMI category, the risk of POAF was higher per increasing tertile of WC (p < 0.05). Among patients with a BMI ≥ 35 kg/m2, every 10 cm increment in WC was associated with an increased risk of POAF (aRR: 1.16[95%CI 1.08-1.24], p < 0.01). POAF in patients with severe obesity was associated with increased hospital length of stay.

CONCLUSIONS

Severe obesity increases the risk of POAF after CABG surgery. In this subgroup, elevated WC may provide additional prognostic value independently of BMI. Since POAF is associated with adverse long-term outcomes, abdominal obesity by measurement of WC should be assessed and targeted even in patient with severe obesity. Central Illustration Increasing waist circumference associated with increased atrial fibrillation risk post coronary artery bypass grafting. Bar graph of the unadjusted absolute risk and 95% confidence interval of postoperative atrial fibrillation for each tertile of waist circumference per body mass index category. Comparison of postoperative atrial fibrillation risk with chi-square test showing an increasing risk of postoperative atrial fibrillation related to increasing waist circumference within each body mass index category.

ABBREVIATIONS

BMI, body mass index; POAF, postoperative atrial fibrillation; WC, waist circumference.

Genetic analysis reveals the shared genetic architecture between breast cancer and atrial fibrillation

Background

Epidemiological studies have observed an association between atrial fibrillation (AF) and breast cancer (BC). However, the underlying mechanisms linking these two conditions remain unclear. This study aims to systematically explore the genetic association between AF and BC.

Methods

We utilized the largest available genome-wide association study (GWAS) datasets for European individuals, including summary data for AF (N = 1,030,836) and BC (N = 247,173). Multiple approaches were employed to systematically investigate the genetic relationship between AF and BC from the perspectives of pleiotropy and causality.

Results

Global genetic analysis using LDSC and HDL revealed a genetic correlation between AF and BC (rg = 0.0435, P = 0.039). Mixer predicted genetic overlap between non-MHC regions of the two conditions (n = 125, rg = 0.05). Local genetic analyses using LAVA and GWAS-PW identified 22 regions with potential genetic sharing. Cross-trait meta-analysis by CPASSOC identified one novel pleiotropic SNP and 14 pleiotropic SNPs, which were subsequently annotated. Eight of these SNPs passed Bayesian colocalization tests, including one novel pleiotropic SNP. Further fine-mapping analysis identified a set of causal SNPs for each significant SNP. TWAS analyses using JTI and FOCUS models jointly identified 10 pleiotropic genes. Phenome-wide association study (PheWAS) of novel pleiotropic SNPs identified two eQTLs (PELO, ITGA1). Gene-based PheWAS results showed strong associations with BMI, height, and educational attainment. PCGA methods combining GTEx V8 tissue data and single-cell RNA data identified 16 co-enriched tissue types (including cardiovascular, reproductive, and digestive systems) and 5 cell types (including macrophages and smooth muscle cells). Finally, univariable and multivariable bidirectional Mendelian randomization analyses excluded a causal relationship between AF and BC.

Conclusion

This study systematically investigated the shared genetic overlap between AF and BC. Several pleiotropic SNPs and genes were identified, and co-enriched tissue and cell types were revealed. The findings highlight common mechanisms from a genetic perspective rather than a causal relationship. This study provides new insights into the AF-BC association and suggests potential experimental targets and directions for future research. Additionally, the results underscore the importance of monitoring the potential risk of one disease in patients diagnosed with the other.

The Impact of Weight Categories on the Association Between Atrial Fibrillation/Flutter and Known Risk Factors: A Nationwide Inpatient Data Analysis

Background/Objectives: Atrial fibrillation and atrial flutter (Afib/Aflut) are the most common arrhythmias presenting to the emergency department. The goal of this study was to evaluate any predictor of Afib/flut with cardiovascular risk factors and demographics based on weight categories. Methods: Using ICD-10 codes from the large Nationwide Inpatient Sample (NIS) database in the years 2016-2020, we evaluate any association between the presence of Afib/Aflut with risk factors and demographics in different weight categories in adults over the age of 18. Results: A total of 23,037,013 afib/flut patients were found in the NIS database. Obesity and morbid obesity were independently associated with the presence of Afib/Aflut (for multivariate OR obesity: 1.28, CI 1.27-1.28, p < 0.001; for morbid obesity: OR 1.9, CI 1.89-1.91, p < 0.001). Regardless of weight categories such as cachexia, overweight, obese, or morbidly obese, traditional risk factors remained independently associated with Afib/Aflut. Furthermore, male gender and Caucasians were independently associated with the presence of Afib/Aflut regardless of any weight categories. (For example, in the overweight categories, the multivariate OR for females was 0.69, CI: 0.69-0.69, p < 0.001, and for African Americans, OR 0.62, CI 0.61-0.62, p < 0.001). Conclusions: Traditional risk factors were persistently associated with the occurrence of atrial fibrillation regardless of weight categories. Furthermore, the Caucasian race and male gender were also strong independent predictors of Afib/Aflut.

Association of healthy lifestyle and the incidence of atrial fibrillation in senior adults: a prospective cohort study

BACKGROUND

Limited evidence was available on the association of the integrated effect of multidimensional lifestyle factors with AF incidence among Chinese old adults. This cohort study was to examine the effect of combined lifestyle factors on AF risk among Chinese older adults.

METHODS

A total of 3,253 adults aged 60 years or more from the Guangzhou Heart Study were successfully followed up. The healthy lifestyle score (HLS) was established using a weighted approach from seven dimensions of lifestyles, including diet quality, leisure-time physical activity, sleep quality, alcohol drinking, smoking, mental status, and waist-to-hip ratio. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated using the Cox proportional hazard regression model.

RESULTS

During a median of 31.13 months of follow-up, 76 (2.34%) new-onset of AF were observed. After adjustment for confounders, HLS was associated with a 46% (HR: 0.54, 95% CI: 0.32-0.93) reduced AF risk when comparing the high with low tertiles of weight HLS, with an exposure-response trend. Every 0.1-unit increment of HLS was associated with 49% reduced AF risk. The protective effect of HLS on AF incidence was remarkable in the young-old (HR: 0.47, 95% CI: 0.29-0.79) but not in the old-old (HR: 0.85, 95% CI: 0.29-2.48), when comparing the high with low tertiles.

CONCLUSION

The results suggest that higher HLS was associated with lower AF incidence among Chinese old adults, and the findings highlight the need to consider multi-dimensional lifestyles when developing health promotion strategies to lower the risk of new-onset AF the risk of new-onset AF.

Elucidating the Linkage Between Obesity-Related Body Fat Indicators and Atrial Fibrillation: Supported by Evidence From Mendelian Randomization and Mediation Analyses

OBJECTIVES

To elucidating the linkage between obesity-associated body fat indicators and atrial fibrillation (AF) using Mendelian Randomization (MR) and mediation analysis.

METHODS

The study utilized three independent genome-wide association study (GWAS) datasets, with containing over 450 000 individuals each, to represent body fat indicators as the exposure variable. Additionally, two summary genetic datasets of AF were utilized as the clinical outcome. Single nucleotide polymorphisms (SNPs) with p-values less than 5 × 10-10 were identified as instrumental variables (IVs) for MR analysis. The primary analysis method employed was the inverse-variance weighting (IVW) model, supplemented by three additional models: MR-Egger regression, weighted median, and maximum likelihood. Sensitivity analysis was conducted, encompassing tests for heterogeneity and horizontal pleiotropy, utilizing Cochran's Q, MR-Egger intercept, and MR-PRESSO tests to validate the reliability of the findings. Furthermore, a mediation analysis was conducted to explore potential mediators involved in the pathogenesis of AF.

RESULTS

The IVW model demonstrated that per 1-SD increase in body fat indicators (body fat percentage, whole body fat mass, and trunk fat mass) is associated with an elevated risk of AF, with values of 63.1%, 55.0%, and 55.8% respectively. All three supplementary models arrived comparable conclusions with IVW model. The sensitivity analysis confirmed the absence of horizontal pleiotropy, thereby validating the reliability of the findings. Additionally, the mediation study indicates that hypertension and sleep apnea syndrome are identified as significant mediators during the pathogenesis of AF.

CONCLUSIONS

The study reveals that individuals with a higher body fat percentage tend to exhibit a heightened genetic predisposition for susceptibility to AF. Meanwhile, hypertension and sleep apnea syndrome have been identified as key mediators contributing to the pathogenesis of AF.

Trends in Global Burden and Socioeconomic Profiles of Atrial Fibrillation and Atrial Flutter: Insights from the Global Burden of Disease Study 2021

Background

Understanding trends in atrial fibrillation (AF) and atrial flutter (AFL) is crucial for effective prevention. This study quantifies the burden and identifies key risk factors for AF/AFL across 204 countries and territories from 1990 to 2021.

Methods

Using data from the Global Burden of Disease (GBD) study 2021, we employed average annual percentage change (AAPC) and Bayesian Age Period Cohort (BAPC) modelling to assess trends and future projections, with a focus on disparities across Socio-Demographic Index (SDI) levels.

Results

In 2021, AF/AFL remained the most common arrhythmia globally, with a prevalence of 52.55 million, 8.36 million disability-adjusted life years (DALYs), and 0.34 million deaths. For each 0.1 increase in SDI, age-standardized mortality rates increased by 4.94%, DALYs by 2.56%, and prevalence rates by 2.40%, highlighting the significant impact of socioeconomic development on AF/AFL burden. AAPC analysis indicated slight increases in deaths, prevalence, and DALYs, along with a decline in incidence, reflecting the impact of public health strategies. However, significant inequalities were observed across SDI levels, with a higher burden in high-SDI regions because of aging populations and improved detection, whereas lower SDI regions faced higher age-standardized mortality rates because of resource constraints.

Conclusions

By 2035, we project a 4.07% increase in incidence despite a 6.84% decrease in mortality. Nearly one-half of the AF/AFL burden is linked to modifiable risk factors, underscoring the importance of tailored prevention strategies and improved health care access, especially in lower SDI countries, to mitigate rising disease rates and reduce health care disparities.

2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2025 AHA Statistical Update is the product of a full year's worth of effort in 2024 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. This year's edition includes a continued focus on health equity across several key domains and enhanced global data that reflect improved methods and incorporation of ≈3000 new data sources since last year's Statistical Update.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Cryoballoon Pulmonary Vein Isolation in Obese Patients with Atrial Fibrillation Compared to Non-Obese Counterparts: A Meta-Analysis

Introduction: Obesity is an important risk factor for atrial fibrillation (AF) development. Data on cryoballoon ablation (CBA) outcomes in obese patients have so far been scarce. We reviewed the existing literature to compare the efficacy and safety of CBA in obese versus non-obese AF patients. Methods: A systematic literature search was conducted for studies comparing clinical outcomes (arrhythmia recurrence and/or procedural data and/or safety outcomes) between obese and non-obese patients undergoing CBA for AF. Statistical pooling was performed according to a random-effects model with generic inverse-variance weighting of relative risks (RRs) and standardised mean differences (SMDs) computing risk estimates with 95% confidence intervals (CIs). Results: Obese and non-obese patients had comparable arrhythmia recurrence rates (normal versus overweight, RR = 0.95, 95% CI: 0.82-1.11, p = 0.55, I2% = 91%; normal versus class I obesity, RR = 0.97, 95% CI: 0.82-1.13, p = 0.68, I2% = 87%; normal versus class II obesity, RR = 0.98, 95% CI: 0.91-1.07, p = 0.29, I2% = 65%). Procedure time was marginally increased in obese patients compared to non-obese counterparts (normal versus overweight, SMD = 0.05, 95% CI: -0.15-0.26, p = 0.62, I2% = 74%; normal versus class I obesity, SMD = 0.10, 95% CI: -0.00-0.19, p = 0.06, I2% = 2%; overweight versus class I obesity, SMD = 0.11, 95% CI: 0.01-0.21, p = 0.048, I2% = 25%). Regarding radiation exposure, fluoroscopy time was increased in patients with class I obesity compared to normal-weight or overweight patients and dose area product was also increased in obese patients compared to non-obese patients. Lastly, the risk of complications did not differ between obese and non-obese patients. Statistical heterogeneity and the small number of patients included are the main limitations of this study. Conclusion: CBA seems to be effective for obese patients suffering from AF, featuring also similar safety outcomes with non-obese individuals. Radiation exposure was increased in obese patients.

Serum Lipidomic Signatures Mediate the Association Between Coarse Grain Preference and Central Obesity in Adults With Normal Weight and High Wheat Intake

Little is known about the association between grain preference andabdominal fat accumulation, and mediating roles of circulating lipidomicsignatures. We quantified 1245 circulating lipids in 150 normal-weight centralobesity (NWCO) cases and 150 controls using targeted lipidomics. Grainpreference was determined by the highest intake frequency of grains (whiterice, wheat, or coarse grain). In our participants with high wheat intakefrequency, preferring coarse grain over rice was associated with a 60% lowerrisk of NWCO. Of the 585 lipids showing opposing associations with white riceand coarse grains, 46 were significantly linked to either (p < 0.05), predominantly alkylacyl phospholipids (PE-Os; n < 9) and alkenylacylphospholipids (PE-Ps; nx = 7). Network analysis identified a module primarilycomposed of PE-Os and PE-Ps, which was positively associated with coarse grain (p = 0.014). Another module, mainly consisting of triacylglycerols (TGs), was associatedwith white rice (p = 0.003) and mediated the association between white rice(mediation proportion: 20.30%; p = 0.027) or coarse grain preference (11.43%; p = 0.040) and NWCO. Specific lipids, such as TG(8:0_16:0_16:0) and TG(8:0_14:0_18:0), exhibited notable mediation effects. In normal-weight individuals with highwheat intake frequency, preferring coarse grain was inversely associated with NWCO, mediated by specific lipidomic signatures.

Segmental evaluation of predictive value of left atrial epicardial adipose tissue following catheter ablation for atrial fibrillation

BACKGROUND

Left atrial epicardial adipose tissue (LA-EAT) is associated with the recurrence of atrial tachyarrhythmias (AF/AT) after catheter ablation for atrial fibrillation (AF). However, no previous studies have assessed the predictive value of segment-specific LA-EAT volumes for AF/AT recurrence. This study aimed to assess the relationship between segmental LA-EAT volume and AF/AT recurrence.

METHODS

This study included 350 consecutive patients who underwent initial AF ablation (53.7 % paroxysmal AF (PAF)). Preoperative multidetector row computed tomography assessed LA-EAT, categorized into three segments: anterior-EAT, posterior-EAT, and interatrial septal adipose tissue (IAS-AT).

RESULTS

During a mean follow-up period of 351 ± 109 days, 56 patients (16.0 %) experienced AF/AT recurrence. The mean LA-EAT volume was 20.7 ± 11.1 ml and LA-EAT ≥26.8 ml was an independent risk factor for AF/AT recurrence (HR 2.21, 95 % confidence interval (CI): 1.24-3.93, P = 0.007). Receiver operating characteristic analyses revealed the area under the curve for IAS-AT was 0.669 (95 % CI: 0.596-0.743) with an optimal cut-off point of 1.3 ml (sensitivity 76.8 %; specificity 50.0 %), significantly outperforming the anterior- and posterior-EAT in predicting recurrent AF/AT. Multivariate analysis indicated IAS-AT was an independent predictor of AF/AT recurrence in patients with persistent AF (PeAF) (HR 3.52, 95 % CI: 1.52-8.13, P = 0.003), but not in patients with PAF.

CONCLUSIONS

LA-EAT predicts AF/AT recurrence after AF ablation, with IAS-AT proving significantly more effective than other LA-EAT segments in predicting recurrence. Notably, IAS-AT emerged as an independent predictor of AF/AT recurrence in patients with PeAF but not in those with PAF.

Impact of Body Mass Index on the Outcomes of Cryoballoon Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation

BACKGROUND

Atrial fibrillation (AF) is prevalent among obese patients, and cryoballoon ablation (CBA) is an effective strategy for the rhythm control of AF. The impact of body mass index (BMI) on the clinical outcomes of CBA for AF is not fully explored.

METHODS

85 consecutive patients with paroxysmal AF were enrolled and were categorized into three groups as per their BMI: normal weight (BMI 18.5-25 kg/m2), overweight (BMI 25-30 kg/m2), and obese patients (BMI > 30 kg/m2). The primary study endpoint was a late (12 month) recurrence of AF. Early recurrence of AF, symptom improvement, and procedural outcomes were some key secondary outcomes.

RESULTS

20 patients had normal weight, 35 were overweight, and 30 were obese. Obese patients featured a higher prevalence of diabetes mellitus, heavier exposure to smoking, and worse baseline symptoms (as assessed through EHRA class at admission and 12 months before CBA) compared to overweight and normal weight patients. Both late and early (<3 months) AF recurrence rates were comparable across the three groups. Of note, obese patients showed greater improvement in their symptoms post-CBA, defined as improvement by at least one EHRA class, compared to normal weight patients; this might be explained by improved diastolic function. Total procedure time and dose area product were significantly increased in obese patients. The multivariate logistic regression analysis indicated that early AF recurrence and the duration of hypertension are independent predictors of late AF recurrence.

CONCLUSION

CBA is effective in overweight and obese patients with paroxysmal AF. Procedure time and radiation exposure are increased in obese patients undergoing CBA.

Global burden of atrial fibrillation attributable to high body mass index from 1990 to 2021: findings from the Global Burden of Disease Study 2021

OBJECTIVES

To assess the global burden of atrial fibrillation (AF) attributable to high body mass index (BMI) from 1990 to 2021 and analyze its spatiotemporal distribution characteristics.

STUDY DESIGN

An observational study based on GBD 2021 data.

METHODS

Data on AF burden due to high BMI were obtained from the Global Burden of Disease Study (GBD) 2021. Estimated annual percentage change (EAPC) was calculated to evaluate temporal trends in age-standardized rates of deaths and disability-adjusted life years (DALYs) over 30 years.

RESULTS

In 2021, high BMI-related AF caused 27,000 deaths and 725,000 DALYs globally, a 376% increase since 1990. Females and the elderly (aged 70+) bore a higher burden. Upper-middle-income regions surpassed high-income regions in AF burden. Australasia had the highest age-standardized rates, while High-income Asia Pacific and South Asia had the lowest. South Asia showed rapid growth in age-standardized death rates.

CONCLUSION

The global burden of high BMI-related AF varies across regions and time, threatening global health, especially for females and the elderly. Targeted strategies are needed to reduce AF and obesity.

Comparison of body composition measures assessed by bioelectrical impedance analysis versus dual-energy X-ray absorptiometry in the United Kingdom Biobank

BACKGROUND

Bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA) serves as common modalities for body composition assessment. This study was aimed to evaluate the agreement between BIA and DXA measures in UK Biobank.

METHODS

UK Biobank participants with body fat mass (FM) and fat-free mass (FFM) estimates obtained through BIA (Tanita BC418MA) and DXA concurrently were included. Correlation between BIA and DXA-derived estimates were assessed with Lin's concordance correlation coefficients. Bland-Altman and Passing-Boblok analyses were performed to quantify the difference and agreement between BIA and DXA. Multivariable linear regression was used to identify predictors influencing the differences. Finally, prediction models were developed to calibrate BIA measures against DXA.

RESULTS

The analysis included 34437 participants (female 51.4%, mean age 64.1 years at imaging assessment). BIA and DXA measurements were highly correlated (Lin's concordance correlation coefficient 0.94 for FM and 0.94 for FFM). BIA (Tanita BC418MA) underestimates FM overall by 1.84 kg (23.77 vs. 25.61, p < 0.01), and overestimated FFM overall by 2.56 kg (52.49 vs. 49.93, p < 0.01). The BIA-DXA differences were associated with FM, FFM, BMI and waist circumference. The developed prediction models showed overall good performance in calibrating BIA data.

CONCLUSION

Our analysis exhibited strong correlation between BIA (Tanita BC418MA)- and DXA-derived body composition measures at a population level in UK Biobank. However, the BIA-DXA differences were observed at individual level and associated with individual anthropometric measures. Future studies may explore the use of prediction models to enhance the calibration of BIA measures for more accurate assessments in UK Biobank.

Joint and interactive associations of body mass index and genetic factors with cardiovascular disease: a prospective study in UK Biobank

BACKGROUND

Both body mass index (BMI) and genetic factors independently contribute to cardiovascular disease (CVD). However, it is unclear whether genetic risk modifies the association between BMI and the risk of incident CVD. This study aimed to investigate whether BMI categories and genetic risk jointly and interactively contribute to incident CVD events, including hypertension (HTN), atrial fibrillation (AF), coronary heart disease (CHD), stroke, and heart failure (HF).

METHODS

A total of 496,851 participants from the UK Biobank with one or more new-onset CVD events were included in the analyses. BMI was categorized as normal weight (< 25.0 kg/m2), overweight (25.0-29.9 kg/m2), and obesity (≥ 30.0 kg/m2). Genetic risk for each outcome was defined as low (lowest tertile), intermediate (second tertile), and high (highest tertile) using polygenic risk score. The joint associations of BMI categories and genetic risk with incident CVD were investigated using Cox proportional hazard models. Additionally, additive interactions were evaluated.

RESULTS

Among the 496,851 participants, 270,726 (54.5%) were female, with a mean (SD) age was 56.5 (8.1) years. Over a median follow-up (IQR) of 12.4 (11.5-13.1) years, 102,131 (22.9%) participants developed HTN, 26,301 (5.4%) developed AF, 32,222 (6.9%) developed CHD, 10,684 (2.2%) developed stroke, and 13,304 (2.7%) developed HF. Compared with the normal weight with low genetic risk, the obesity with high genetic risk had the highest risk of CVD: HTN (HR: 3.96; 95%CI: 3.84-4.09), AF (HR: 3.60; 95%CI: 3.38-3.83), CHD (HR: 2.76; 95%CI: 2.61-2.91), stroke (HR: 1.44; 95%CI: 1.31-1.57), and HF (HR: 2.47; 95%CI: 2.27-2.69). There were significant additive interactions between BMI categories and genetic risk for HTN, AF, and CHD, with relative excess risk of 0.53 (95%CI: 0.43-0.62), 0.67 (95%CI: 0.51-0.83), and 0.37 (95%CI: 0.25-0.49), respectively.

CONCLUSIONS

BMI and genetic factors jointly and interactively contribute to incident CVD, especially among participants with high genetic risk. These findings have public health implications for identifying populations more likely to have cardiovascular benefit from weight loss interventions.

Adulthood weight changes, body mass index in youth, genetic susceptibility and risk of atrial fibrillation: a population-based cohort study

BACKGROUND

Epidemiological evidence on weight change and atrial fibrillation (AF) remains limited and inconsistent. Previous studies on body mass index (BMI) in youth and AF rarely considered subsequent BMI. This study aimed to assess the associations of AF with weight change and BMI in youth, as well as modified effect by genetic susceptibility of AF.

METHODS

The study included 21,761 individuals (mean age 57.8 years) from the Malmö Diet and Cancer cohort. Weight information was obtained at three time points, including recalled weight at age 20 years, measured weight at baseline (middle adulthood), and reported weight at 5-year follow-up examination (late middle adulthood). A weighted genetic risk score of AF was created using 134 variants.

RESULTS

During a median follow-up of 23.2 years, a total of 4038 participants developed AF. The association between weight change from early to middle adulthood and AF risk was modified by sex (Pinteraction = 0.004); weight loss was associated with a lower AF risk in females, but not in males. Conversely, weight gain was positively associated with AF risk in a linear manner in females, whereas increased AF risk appeared only when weight gain exceeded a threshold in males. Participants with weight gain of > 5 kg from middle to late middle adulthood had a 19% higher risk of AF relative to those with stable weight, whereas weight loss showed a null association. Compared to individuals with a lower BMI at age 20 years, those with a BMI above 25 kg/m2 had an increased risk of AF (HR = 1.14; 95% CI: 1.02-1.28), after controlling for baseline BMI; this association was more pronounced in males or those with a lower genetic risk of AF.

CONCLUSIONS

Weight gain in middle adulthood was associated with higher AF risk. Weight loss from early to middle adulthood, but not from middle to late middle adulthood, was associated with a lower risk of AF only in females. Higher BMI in youth was associated with an increased risk of AF, particularly among males or those with a lower genetic risk of AF.

Reduction of cardiovascular complications during delivery hospitalization in patients undergoing bariatric procedures

BACKGROUND

The global surge in obesity presents a significant health challenge, leading to increased adoption of bariatric surgery as an intervention. However, the correlation between bariatric surgery and cardiovascular outcomes during subsequent pregnancies remains unclear. The aim of our study was to determine the prevalence of cardiovascular complications during delivery hospitalizations in patients with bariatric procedure.

METHODS

We performed a retrospective analysis utilizing the National Inpatient Sample database to examine data from delivery admissions of pregnant women with obesity and a history of bariatric surgery. These admissions were identified using International Classification of Diseases (ICD) codes from 2009 to 2019. In comparing pregnant individuals who had undergone bariatric surgery with those with obesity but had no such surgical history, we assessed the prevalence of cardiovascular complications.

RESULTS

Our study included 3,027,987 pregnancies in individuals with obesity and an additional 117,350 pregnancies following bariatric surgery. Compared to patients without bariatric surgery, post-surgery patients were older (32.84 years vs 29.02 years), primarily White (59.0%), and mostly treated in large urban hospitals. Cardiovascular outcomes showcased reduced odds of congestive heart failure [Adjusted odds ratios (AOR) 0.11, 95% confidence intervals (CI) 0.01-0.74], gestational hypertensive complications (AOR 0.55, 95% CI 0.53-0.59), and cardiac arrhythmia (AOR 0.76, 95% CI 0.64-0.89) in the post-surgery group, with no significant difference in peripartum cardiomyopathy rates (AOR 0.72, 95% CI 0.29-1.76) and no instances of stroke or acute MI. Perinatally, the surgery cohort had higher odds of preterm birth (AOR 1.30, 95% CI 1.24-1.38) and fetal growth restriction (AOR 2.47, 95% CI 2.32-2.63) but fewer incidents of being large for gestational-age (AOR 0.35, 95% CI 0.32-0.38). As bariatric surgery became increasingly recognized as a significant factor in certain complications, its prevalence among the study population increased from 2009 to 2019.

CONCLUSION

In summary, our research indicates that bariatric surgery is associated with a decreased risk of cardiovascular complications during delivery. This study highlights how insights from bariatric surgery outcomes could shape clinical guidelines for managing obesity in pregnant women.

Low-, moderate-, and high-risk obesity in association with cost drivers, costs over the lifecycle, and life expectancy

BACKGROUND

The prevalence of low-, moderate-, and high-risk obesity has been increasing globally. Our aim was to estimate the societal burden of these three obesity classes in the Austrian population by taking a societal-annual perspective and an individual-life-cycle perspective. Secondly, we sought to identify the respective cost drivers and the effects on life expectancy.

METHODS

We used population-weighted survey data on the distribution of body mass index (BMI) and data on relative risks regarding 83 diseases. Using fractional polynomial regressions, we estimated relative risks per BMI unit for about 30 cost-intensive diseases up to BMI values of 50. The approach for the cost analysis was based on the use of population-attributable fractions applied to direct medical and indirect cost data. Macro-disease-specific data regarding cost factors came from cost-of-illness statistics and administrative sources.

RESULTS

About 8.2% of deaths and 4.6% of health expenditure are attributable to obesity in Austria in 2019, causing 0.61% of GDP loss. A third of annual direct and indirect costs came from class 2 and class 3 obesity. From an individual perspective, life-cycle costs of class 2 and class 3 obesity were 1.9 and 3.6 times the costs of class 1 obesity, respectively. At the age of 45, people with high-risk obesity are about to lose approximately 4.9 life years and 9.7 quality-adjusted life years.

CONCLUSIONS

We have extended the method of population-attributable fractions, allowing us to estimate differences in the life-cycle direct medical and indirect costs between low-, moderate-, and high-risk obesity. We found that the lifetime costs of obesity are strikingly different between obesity classes, which has been veiled in the societal-annual perspective. Our findings provide a foundation for evaluating public health interventions aimed at combating obesity in order to mitigate the escalating individual and societal burden resulting from obesity prevalence and complications in the future.

Association between body mass index and results of cryoballoon ablation in Korean patients with atrial fibrillation: an analysis from the Korean Heart Rhythm Society Cryoablation registry

AIMS

Pulmonary vein isolation using cryoablation is effective and safe in patients with atrial fibrillation (AF). Although both obesity and underweight are associated with a higher risk for incident AF, there is limited data on the efficacy and safety following cryoablation according to body mass index (BMI) especially in Asians.

METHODS AND RESULTS

Using the Korean Heart Rhythm Society Cryoablation registry, a multicentre registry of 12 tertiary hospitals, we analysed AF recurrence and procedure-related complications after cryoablation by BMI (kg/m2) groups (BMI < 18.5, underweight, UW; 18.5-23, normal, NW; 23-25, overweight, OW; 25-30, obese Ⅰ, OⅠ; ≥30, obese Ⅱ, OⅡ). A total of 2648 patients were included (median age 62.0 years; 76.7% men; 55.6% non-paroxysmal AF). Patients were categorized by BMI groups: 0.9% UW, 18.7% NW, 24.8% OW, 46.1% OI, and 9.4% OII. Underweight patients were the oldest and had least percentage of non-paroxysmal AF (33.3%). During a median follow-up of 1.7 years, atrial arrhythmia recurred in 874 (33.0%) patients (incidence rate, 18.9 per 100 person-years). After multivariable adjustment, the risk of AF recurrence was higher in UW group compared with NW group (adjusted hazard ratio, 95% confidence interval; 2.55, 1.18-5.50, P = 0.02). Procedure-related complications occurred in 123 (4.7%) patients, and the risk was higher for UW patients (odds ratio, 95% confidence interval; 2.90, 0.94-8.99, P = 0.07), mainly due to transient phrenic nerve palsy.

CONCLUSION

Underweight patients showed a higher risk of AF recurrence after cryoablation compared with NW patients. Also, careful attention is needed on the occurrence of phrenic nerve palsy in UW patients.

Obesity effect on newly diagnosed and recurrent post-ablation atrial fibrillation: a systematic review and meta-analysis

BACKGROUND AND AIMS

The role of overweight and obesity in the development of atrial fibrillation (AF) is well established; however, the differential effect on the occurrence and recurrence of AF remains uncertain. The aim of this review is to compare the effect of underweight and varying degrees of obesity on onset of AF and in recurrent post-ablation AF, and, when possible, in relation to sex.

METHODS

A systematic literature search was conducted in PubMed, Embase, and Cochrane Library from inception to January 31, 2023. Studies reporting frequency of newly-diagnosed AF and of recurrent post-ablation AF in different BMI categories, were included. 3400 records were screened and 50 met the inclusion criteria. Standardized data search and abstraction were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement. Data were extracted from the manuscripts and were analyzed using a random effect model. The outcome was the occurrence of AF in population studies and in patients undergoing ablation.

RESULTS

Data from 50 studies were collected, of which 27 for newly-diagnosed AF and 23 for recurrent post-ablation AF, for a total of 15,134,939 patients, of which 15,115,181 in studies on newly-diagnosed AF and 19,758 in studies on recurrent post-ablation AF. Compared to normal weight, the increase in AF was significant (p < 0.01) for overweight, obese, and morbidly obese patients for newly-diagnosed AF, and for obese and morbidly obese patients for recurrent post-ablation AF. Newly-diagnosed AF was more frequent in obese female than obese male patients.

CONCLUSION

The effect of increased BMI was greater on the onset of AF, and obese women were more affected than men.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Exploring the Intricate Interplay Between Obesity and Atrial Fibrillation: Mechanisms, Management, and Clinical Implications

Atrial fibrillation (AF) stands as a prevalent and escalating cardiac arrhythmia in the United States, with obesity emerging as a prominent modifiable risk factor. This article explores the intricate relationship between obesity and AF, delving into the multifaceted pathophysiological mechanisms linking the 2 conditions. Various factors, such as autonomic dysfunction, left atrial stretch, inflammation, and hormonal imbalances, contribute to the initiation and perpetuation of AF in obese individuals. The Atrial Fibrillation Better Care pathway, emphasizing lifestyle modifications and weight loss strategies, emerges as a practical guideline for managing AF in obesity. This comprehensive review underscores the critical role of obesity as a significant modifiable risk factor for AF, urging a proactive approach to its management. Implementing the Atrial Fibrillation Better Care approach, focusing on encouraging physical activity, promoting healthy dietary habits, and raising awareness about the risks associated with obesity prove essential in preventing and mitigating the burden of AF in the obese population.

Genetically predicted waist circumference and risk of atrial fibrillation

INTRODUCTION

Observational studies have revealed an association between waist circumference (WC) and atrial fibrillation (AF). However, it is difficult to infer a causal relationship from observational studies because the observed associations could be confounded by unknown risk factors. Therefore, the causal role of WC in AF is unclear. This study was designed to investigate the causal association between WC and AF using a two-sample Mendelian randomization (MR) analysis.

METHODS

In our two-sample MR analysis, the genetic variation used as an instrumental variable for MR was acquired from a genome-wide association study (GWAS) of WC (42 single nucleotide polymorphisms with a genetic significance of P <5 × 10 -8 ). The data of WC (from the Genetic Investigation of ANthropometric Traits consortium, containing 232,101 participants) and the data of AF (from the European Bioinformatics Institute database, containing 55,114 AF cases and 482,295 controls) were used to assess the causal role of WC on AF. Three different approaches (inverse variance weighted [IVW], MR-Egger, and weighted median regression) were used to ensure that our results more reliable.

RESULTS

All three MR analyses provided evidence of a positive causal association between high WC and AF. High WC was suggested to increase the risk of AF based on the IVW method (odds ratio [OR] = 1.43, 95% confidence interval [CI], 1.30-1.58, P = 2.51 × 10 -13 ). The results of MR-Egger and weighted median regression exhibited similar trends (MR-Egger OR = 1.40 [95% CI, 1.08-1.81], P = 1.61 × 10 -2 ; weighted median OR = 1.39 [95% CI, 1.21-1.61], P = 1.62 × 10 -6 ). MR-Egger intercepts and funnel plots showed no directional pleiotropic effects between high WC and AF.

CONCLUSIONS

Our findings suggest that greater WC is associated with an increased risk of AF. Taking measures to reduce WC may help prevent the occurrence of AF.

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

AIM

The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation.

METHODS

A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate.

STRUCTURE

Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

AIM

The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation.

METHODS

A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate.

STRUCTURE

Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.

A Predictive Model of New-Onset Atrial Fibrillation After Percutaneous Coronary Intervention in Acute Myocardial Infarction Based on the Lymphocyte to C-Reactive Protein Ratio

Purpose

Lymphocyte to C-reactive protein ratio (LCR) is a recognized systemic inflammatory marker and novel prognostic indicator for several cancers. This study investigated the relationship between preoperative LCR and new-onset atrial fibrillation (NOAF) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).

Patients and Methods

Patients with AMI (n=662) with no history of atrial fibrillation (AF) were enrolled and classified into NOAF and non-NOAF groups based on the occurrence of postoperative NOAF during hospitalization. Logistic regression models were used to analyze NOAF risk factors and to assess the association between preoperative LCR and NOAF incidence. We constructed a new nomogram from the selected NOAF risk factors, and tested its predictive performance, degree of calibration, and clinical utility using receiver operating characteristic and calibration curves, decision curve analysis, and clinical impact curves.

Results

Overall, 84 (12.7%) patients developed NOAF during hospitalization. The LCR was significantly lower in the NOAF group. Preoperative LCR accurately predicted NOAF after AMI and was correlated with increased NOAF risk. Age, body mass index, diabetes, serum albumin levels, uric acid levels, left atrium (LA) diameter, left ventricular ejection fraction, left circumflex artery stenosis > 50%, and Killip class II status were independent predictors of NOAF after AMI. In addition, a new nomogram combined with LCR was constructed to stratify the risk of NOAF in patients with AMI. The performance of the new nomogram was satisfactory, as shown by the receiver operating characteristic curve, calibration curve, decision curve analysis and clinical impact curve.

Conclusion

Preoperative LCR was an independent predictor of NOAF in patients with AMI after PCI. The novel nomogram combined with LCR could rapidly and individually identify and treat patients at a high risk of NOAF.

Associations of Life's Essential 8 and fine particulate matter pollution with the incidence of atrial fibrillation

Both unhealthy lifestyle factors and ambient air pollution have been closely linked with the risk of atrial fibrillation (AF). We retrieved 250,898 participants without AF at baseline from UK Biobank. LE8 was determined by 8 metrics, and was characterized as low, moderate and high cardiovascular health (CVH). Exposure to PM2.5 was estimated at the geocoded residential address of each participant. During a median follow-up of 12.46 years, we identified 14,743 (5.9%) incident AF cases. Participants with moderate and high CVH showed a decreased risk of incident AF compared to those with low CVH. Of the LE8 metrics, ideal body mass index (BMI) and blood pressure (BP) were associated with a decrease of 11.57% and 11.46% AF cases. High PM2.5 exposure was associated with an 8% increased risk of AF as compared to low PM2.5 exposure. Compared with those who had low CVH and high PM2.5 exposure, participants with a high CVH and low PM2.5 exposure had the lower AF incidence. Our study found higher CVH is protective, while higher PM2.5 might be one risk factor of AF. Adherence to the LE8 guidelines may help reduce the incidence of AF, especially in those with lower PM2.5 exposure.

The Medical Burden of Obesity and Overweight in the US Military: Association of BMI with Clinically Diagnosed Medical Conditions in United States Military Service Members

BACKGROUND

A high BMI is associated with various medical conditions, notably type 2 diabetes, cardiovascular disease, and mental health disorders. In the US military, BMI increased linearly between 1975 and 2015.

OBJECTIVE

This cross-sectional study investigated the associations between BMI and a comprehensive range of clinically diagnosed medical conditions (CDMCs) in US military service members (SMs).

METHODS

A stratified random sample of SMs (n=26,177) completed an online questionnaire reporting their height, weight, and demographic/lifestyle characteristics. Medical conditions for 6 mo before questionnaire completion were obtained from a comprehensive military electronic medical surveillance system and grouped into 39 CDMCs covering both broad (largely systemic) and specific medical conditions. BMI was calculated as weight/height2 (kg/m2). The prevalence of CDMCs was compared among normal weight (<25.0 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30 kg/m2) SMs.

RESULTS

After multivariable adjustment for demographic/lifestyle characteristics, higher BMI was associated with higher odds of a diagnosed medical condition in 30 of 39 CDMCs, with all 30 displaying dose-response relationships. The 5 major CDMCs with the largest odds ratios comparing obese to normal weight were endocrine/nutritional/metabolic diseases (OR=2.67, 95%CI=2.24-3.15), nervous system diseases (odds ratio [OR]=2.59, 95%CI=2.32-2.90), circulatory system diseases (OR=2.56, 95%CI=2.15-3.06), musculoskeletal system diseases (OR=1.92, 95%CI=1.76-2.09), and mental/behavioral disorders (OR=1.69, 95%CI=1.51-1.90). Compared with normal weight SMs, overweight or obese SMs had a higher number of CDMCs (1.8±1.9 vs. 2.0±2.0 and 2.5±2.3, mean ± standard deviation, respectively, P<0.01).

CONCLUSIONS

In a young, physically active population, higher BMI was associated with a host of medical conditions, even after adjustment for demographic/lifestyle characteristics. The US Department of Defense should improve nutrition education and modify other factors that contribute to overweight and obesity. This study demonstrates that the medical burden of obesity is substantial in overweight and obese SMs.

Association between cardiovascular risk factors and atrial fibrillation

Background

The most prevalent sustained arrhythmia in medical practice, atrial fibrillation (AF) is closely associated with a high risk of cardiovascular disease. Nevertheless, the risk of AF associated with cardiovascular risk factors has not been well elucidated. We pooled all published studies to provide a better depiction of the relationship among cardiovascular risk factors with AF.

Methods

Studies were searched in the MEDLINE, Web of Science, and EMBASE databases since initiation until January 15, 2022. Prospective cohort studies assessing the relationship a minimum of single cardiovascular risk factors to AF incidence were included if they contained adequate data for obtaining relative risks (RR) and 95% confidence intervals (CI). Random-effects models were utilized to perform independent meta-analyses on each cardiovascular risk factor. PROSPERO registry number: CRD42022310882.

Results

A total of 17,098,955 individuals and 738,843 incident cases were reported for data from 101 studies included in the analysis. In all, the risk of AF was 1.39 (95% CI, 1.30-1.49) for obesity, 1.27 (95% CI, 1.22-1.32) per 5 kg/m2 for increase in body mass index, 1.19 (95% CI, 1.10-1.28) for former smokers, 1.23 (95% CI, 1.09-1.38) for current smokers, 1.31 (95% CI, 1.23-1.39) for diabetes mellitus, 1.68 (95% CI, 1.51-1.87) for hypertension, and 1.12 (95% CI, 0.95-1.32) for dyslipidemia.

Interpretation

Adverse cardiovascular risk factors correlate with an increased risk of AF, yet dyslipidemia does not increase the risk of AF in the general population, potentially providing new insights for AF screening strategies among patients with these risk factors.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, PROSPERO identifier (CRD42022310882).

Management and Anticoagulation Treatment of Non-Valvular Atrial Fibrillation in Elderly Patients: The Dali Study

Background

Non-valvular atrial fibrillation (NVAF) is associated with increased stroke in elderly populations, yet anticoagulant therapy is underutilized. We analyzed clinical characteristics and anticoagulation treatment rates of elderly NVAF patients hospitalized in Dali, China, to identify potential contributing factors.

Methods

We collected data for 155 elderly patients with NVAF aged ≥60 years, from July 01, 2020, to December 31, 2021. We analyzed the awareness rate, clinical characteristics, and anticoagulant treatment rate of atrial fibrillation (AF), and identified factors influencing treatment. Patients were followed up one year after discharge to assess vital status, cardiovascular events, and anticoagulation therapy status.

Results

Among 155 patients, 52.26% were female, and the average age was 75.77 years. The awareness rate of AF was 47.74% at admission, and only 21.94% received anticoagulant therapy. After discharge, the rate of anticoagulant therapy significantly increased to 70.97%, and 89.09% used new oral anticoagulants. Thromboembolic history and persistent AF predicted anticoagulant therapy at discharge, while male gender, previous bleeding history, and antiplatelet therapy predicted non-anticoagulant therapy. Out of 133 patients who completed a one-year follow-up, 23.31% died, 3.01% had strokes, and 3.01% experienced bleeding. Anticoagulant therapy decreased to 51.96% during the follow-up year.

Conclusion

Our findings highlight the low awareness rate and anticoagulant treatment rate, and high mortality among elderly NVAF patients in Dali. The development of comprehensive intervention strategies is critical to standardize AF management and improve prognosis.

An investigation of body mass distributional changes in Australia, 1995-2017/18

This study investigates changes in the distribution of body mass for adult Australians between 1995 and 2017/18. Using three nationally representative health surveys, we first apply the parametric generalised entropy (GE) class of inequality indices to measure the level of disparity in the body mass distribution. Results from the GE measure reveal that, while growth of body mass inequality is a population-wide experience, demographic and socio-economic factors explain only a modest portion of total inequality. We then apply the relative distributions (RD) method to garner richer insights on changes to the body mass distribution. The non-parametric RD method reveals growth in the proportion of adult Australians falling into the upper deciles of the body mass distribution since 1995. Then, hypothetically keeping the shape of the distribution unchanged, we discern that body mass increases across all deciles of the distribution (location effect) is an important contributor to the observed distributional change. After removing the location effect, however, we find a non-trivial role for distributional shape changes (growth of the proportion of adults at the upper and lower parts of the distribution as the proportion in the middle diminish). While our findings support current policy directions that target the population as a whole, factors driving shape changes to the body mass distribution also need consideration when designing anti-obesity campaigns, especially when aimed at women.

Effect of Obesity Duration and BMI Trajectories on Cardiovascular Disease: A Narrative Review

Obesity is an important risk factor for cardiovascular diseases (CVDs). It is crucial to understand the impact of its duration due to the more extended exposure period and the higher frequency of overweight/obesity at younger ages. In the last decade, various studies have discovered that the duration of obesity, in addition to its severity, might have an impact. Therefore, this study aimed to summarize the current literature to investigate the effect of body mass index (BMI) trajectories and overweight/obesity duration on cardiovascular outcomes. To retrieve related articles, we searched PubMed, EMBASE, Google Scholar, Web of Science, Scopus, and Cochrane electronic databases. The duration of overweight/obesity is significantly associated with CVDs, especially heart failure and atrial fibrillation. However, there are contradictory results regarding the association between coronary heart disease and stroke with the duration of obesity. Additionally, no association with peripheral vascular disease has yet to be reported. The absence of this association may be brought on by covariates or various follow-up times. Nevertheless, it seems that both stable overweight and remarkably stable obesity increase the risk of CVDs, as does both stable overweight and notably stable obesity. Metrics showing both the severity and the duration of overweight/obesity are more effective than each alone, and it is recommended to be used for assessing the risk of various CVDs. There are few studies in these areas, and studies with more extended follow-up periods, with a wide age range, while adjusting for some specific covariates, are needed.

Impact of proinflammatory epicardial adipose tissue and differentially enhanced autonomic remodeling on human atrial fibrillation

OBJECTIVES

The mechanisms underlying atrial fibrillation are yet to be elucidated. We sought to investigate the interactions among autonomic remodeling, epicardial adipose tissue, inflammation, and atrial fibrillation.

METHODS

Myocardium and adjacent epicardial adipose tissue of the left atrial appendage, right atrial appendage, and pulmonary vein muscle sleeves were obtained from 61 consecutive patients (35 with atrial fibrillation, 26 with no atrial fibrillation) during mitral valve surgeries. Patients were divided into the atrial fibrillation group and no atrial fibrillation group according to the history and Holter monitoring before surgery. Sympathetic and parasympathetic innervation were evaluated by tyrosine hydroxylase and choline acetyltransferase staining, respectively. Atrial fibrosis as well as cytokines/adipokines and related inflammatory proteins and signaling pathways in the epicardial adipose tissue were examined.

RESULTS

Immunohistochemical studies revealed significantly increased tyrosine hydroxylase (+) and choline acetyltransferase (+) neural elements in the left atrial appendage and pulmonary vein muscle sleeve myocardium, as well as adjacent epicardial adipose tissue in the atrial fibrillation group, particularly the pulmonary vein muscle sleeve sites. The receiver operating curve identified a threshold ratio (tyrosine hydroxylase/choline acetyltransferase) of 0.8986 in the epicardial adipose tissue (sensitivity = 82.86%; specificity = 80.77%; area under the curve = 0.85, 95% confidence interval = 0.76-0.95, P < .0001). More patients with a higher tyrosine hydroxylase/choline acetyltransferase ratio (≥0.8986) had atrial fibrillation. Expression levels of the genes and related proteins of the β1 adrenergic, mitogen-activated protein kinase, and nuclear factor kappa B signaling pathways were higher in patients with a higher tyrosine hydroxylase/choline acetyltransferase ratio. The tyrosine hydroxylase/choline acetyltransferase ratio also correlated with fibrosis.

CONCLUSIONS

Differentially enhanced autonomic remodeling and proinflammatory and profibrotic cytokines/adipokines in the epicardial adipose tissue adjacent to the pulmonary vein muscle sleeve site may work synergistically to promote atrial fibrillation.

Overfat cutoffs and the optimal combination of body fat indices for detecting cardiometabolic risk among school-aged children

OBJECTIVE

This study aimed to develop cutoffs and the optimal combination for body fat indices for screening cardiometabolic risk (CMR) among the pediatric population.

METHODS

This cross-sectional study consisted of 8710 (50.3% boys) Chinese children aged 6 to 18 years. Body fat indices, including fat mass index (FMI), body fat percentage, trunk to leg fat ratio (TLR), and android to gynoid fat ratio, were derived from dual-energy x-ray absorptiometry scans. The area under the receiver operating characteristic curve was used to determine the best combination and optimal cutoffs of body fat indices to identify CMR.

RESULTS

Compared with anthropometry-based obesity measures, i.e., BMI and waist circumference, the FMI + TLR combination presented statistically higher area under the receiver operating characteristic curve values for discriminating CMR and its clustering. The optimal overfat cutoffs of FMI and TLR were respectively determined at the 75th percentile in boys and at the 80th percentile of FMI and the 75th percentile of TLR in girls. Moreover, simplified thresholds derived from age-group-merged cutoffs showed similar performance as optimal cutoffs in detecting CMR.

CONCLUSIONS

Both the optimal and simplified overfat cutoffs were provided for the Chinese pediatric population. The use of FMI and TLR together allows for adequate screening of CMR and its clustering.

Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Effect of Prolonged and Substantial Weight Loss on Incident Atrial Fibrillation: A Systematic Review and Meta-Analysis

Background. Overweight and obesity are associated with atrial fibrillation (AF), and bariatric surgery (BS), able to induce sustained and prolonged weight loss, might represent the ideal treatment in the prevention of AF. Previous studies could not definitely establish a role for weight loss and BS in preventing incident AF so far. During the last few years, several studies on the effect of bariatric surgery on cardiovascular diseases have been published, and we performed a systematic review and meta-analysis to evaluate the role of weight loss through BS in the prevention of incident AF in obesity. Methods. This meta-analysis followed the PRISMA guideline. Eligible studies were controlled trials evaluating the appearance of atrial fibrillation in patients undergoing weight loss through BS as compared with patients receiving medical treatment. Quality of studies was assessed according to the Newcastle-Ottawa Quality Assessment Scale, and risk-of-bias was evaluated employing the Egger's test. All analyses were run by a random-effects model according to Hartung and Knapp and sensitivity analyses were performed. Heterogeneity was assessed through Q and I² statistics for each comparison, and potential publication bias was formally investigated. Results. Ten studies were included in the meta-analysis, and the overall result was statistically significant [OR = 0.665 (0.475-0.929), p = 0.017], with significant heterogeneity (Q = 48.98, p < 0.001; I² = 81.6%), but with no publication bias. In sensitivity analyses, the amount of weight loss, percentage of patients with diabetes and value of the Newcastle-Ottawa Quality Assessment Scale, were all associated with significance of effect. Since age was different in one study, a sensitivity analysis was performed by excluding this study; OR was similar [OR = 0.608 (0.454-0.814), p < 0.001]; heterogeneity was reduced but still significant (Q = 35.74, p < 0.001, I² = 77.6%) and again no publication bias was detected. Conclusions. Bariatric surgery as compared to medical treatment is associated with reduced appearance of incident AF.

Associations of high-normal blood pressure and impaired fasting glucose with atrial fibrillation

OBJECTIVE

To investigate the association of high-normal blood pressure (BP) and impaired fasting glucose (IFG) with the risk of atrial fibrillation (AF) in two cohorts.

METHODS

The Korean National Health Insurance Service-Health Screening (K-NHIS-HealS, 2002-2003, follow-up until 2013) Study and the UK Biobank (2007-2010, follow-up until 2021) were evaluated. We used Cox proportional hazards regression models to evaluate the associations of high-normal BP and IFG with incident AF.

RESULTS

In the K-NHIS-HealS and the UK Biobank, 2346 and 5314 incident AF events were recorded during the mean follow-up of 7.4 and 11.8 years. The adjusted HRs (95% CIs) for AF in the Korean and UK cohorts were 1.11 (1.02 to 1.21) and 1.07 (1.01 to 1.13) in individuals with high-normal BP; and 1.14 (1.04 to 1.25) and 1.10 (1.01 to 1.20) in individuals with IFG, respectively. The AF risk showed a dose-response relationship with BP and fasting blood glucose level. The risk of incident AF was increased by the combination of high-normal BP and IFG.

CONCLUSIONS

In healthy individuals, high-normal BP and IFG were important risk factors for AF. When high-normal BP and IFG were combined, the risk of new-onset AF was significantly increased. These findings may suggest that lifestyle interventions for high-normal BP and IFG should be considered to reduce the risk of AF.

Blood pressure, hypertension and the risk of atrial fibrillation: a systematic review and meta-analysis of cohort studies

Elevated blood pressure and hypertension have been associated with increased risk of atrial fibrillation in a number of epidemiological studies, however, the strength of the association has differed between studies. We conducted a systematic review and meta-analysis of the association between blood pressure and hypertension and atrial fibrillation. PubMed and Embase databases were searched for studies of hypertension and blood pressure and atrial fibrillation up to June 6th 2022. Cohort studies reporting adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) of atrial fibrillation associated with hypertension or blood pressure were included. A random effects model was used to estimate summary RRs. Sixty eight cohort studies were included in the meta-analysis. The summary RR was 1.50 (95% CI: 1.42-1.58, I2 = 98.1%, n = 56 studies) for people with hypertension compared to those without hypertension (1,080,611 cases, 30,539,230 participants), 1.18 (95% CI: 1.16-1.21, I2 = 65.9%, n = 37 studies) per 20 mmHg increase in systolic blood pressure (346,471 cases, 14,569,396 participants), and 1.07 (95% CI: 1.03-1.11, I2 = 91.5%, n = 22 studies) per 10 mmHg increase in diastolic blood pressure (332,867 cases, 14,354,980 participants). There was evidence of a nonlinear association between diastolic blood pressure and atrial fibrillation with a steeper increase in risk at lower levels of diastolic blood pressure, but for systolic blood pressure the association appeared to be linear. For both systolic and diastolic blood pressure, the risk increased even within the normal range of blood pressure and persons at the high end of systolic and diastolic blood pressure around 180/110 mmHg had a 1.8-2.3 fold higher risk of atrial fibrillation compared to those with a blood pressure of 90/60 mmHg. These results suggest that elevated blood pressure and hypertension increases the risk of atrial fibrillation and there is some increase in risk even within the normal range of systolic and diastolic blood pressure.

Clinical relevance of incomplete device endothelialization after left atrial appendage closure

PURPOSE

This study aimed to assess the incidence, potential risk factors and clinical impact of incomplete device endothelialization(IDE) after left atrial appendage closure (LAAC).

METHODS

A total of 101 consecutive patients with nonvalvular atrial fibrillation (AF) who underwent successful LAAC and received antithrombotic treatment using a standard regimen were prospectively followed up to 6 months after the procedure. The status of device endothelialization and device-related thrombus (DRT) were evaluated using cardiac computed tomography (CT). Major adverse cardio-cerebral events (MACCE) including all-cause death, heart failure(HF) hospitalization, acute ischemic stroke, transient ischemic attack(TIA), peripheral vascular embolism, and major bleeding were recorded.

RESULTS

IDE was detected in 65 (64.4%) patients. Patients with IDE or complete device endothelialization (CDE) did not significantly differ with respect to baseline clinical characteristics and interventional procedure features. Multivariate analysis model revealed that persistent AF, left atrial appendage ostial diameter and left atrial size were independent risk factors for IDE. During 6-month follow-up, the incidence of DRT was 4.6% in patients with IDE and 2.8% in those with CDE, respectively (p > 0.05), and the overall rate of MACCE was non-significantly higher in the IDE group (7.7% vs. 2.8%, p = 0.32).

CONCLUSION

IDE is common after LAAC, especially in patients with persistent AF, higher left atrial appendage ostial diameter and left atrial size. IDE confers an increased risk for DRT, but may be not necessarily associated with thromboembolic events and poor clinical outcome, providing careful monitoring and continued antithrombotic therapy are given.

The interplay among body weight, blood pressure, and cardiorespiratory fitness in predicting atrial fibrillation

BACKGROUND

Hypertension, obesity, and low cardiorespiratory fitness (CRF) are known risk predictors for the development of atrial fibrillation (AF) that often interrelate with each other. We examined the interplay of these 3 risk indicators with the occurrence of AF in patients without known cardiovascular disease.

METHODS

A retrospective analysis of 13,042 patients underwent exercise stress testing (EST). The occurrence of AF during the median follow-up period of 6.8 years was investigated in relation to the presence of obesity (body mass index ≥30 kg/m²), hypertension (blood pressure ≥140/90 mmHg or history of hypertension), or low CRF (exercise capacity <8 metabolic equivalents). Cox proportional hazards models were used to evaluate the individual and combined association between the 3 risk indicators and AF.

RESULTS

The mean age of the study population was 58 ± 9 years; 49% were women. AF occurred in 499 patients (3.8%). Obesity [hazard ratio (95% confidence interval)], 1.36 (1.12-1.65), hypertension, 1.47 (1.19-1.82), and low CRF, 1.32 (1.06-1.64), were independent risk predictors for AF after multivariable adjustment, including after adjusting for each other and also when the risk predictors were analyzed as continuous variables. In a combined model, a gradual increase in the risk of AF was observed, reaching an adjusted hazard ratio of 2.53 (1.77-3.62) in those with all 3 compared with neither risk indicators. P-for-interaction between hypertension and obesity, or hypertension and low CRF was nonsignificant.

CONCLUSIONS

Obesity, low CRF, and hypertension are independently associated with an excess risk of developing AF in patients without known cardiovascular disease, both individually and more so when coexisting together.

Impact of anthropometric factors on outcomes in atrial fibrillation patients: analysis on 10 220 patients from the European Society of Cardiology (ESC)-European Heart Rhythm Association (EHRA) EurObservational Research Programme on Atrial Fibrillation (EORP-AF) general long-term registry

AIM

To investigate the association of anthropometric parameters [height, weight, body mass index (BMI), body surface area (BSA), and lean body mass (LBM)] with outcomes in atrial fibrillation (AF).

METHODS AND RESULTS

Ten-thousand two-hundred twenty patients were enrolled [40.3% females, median age 70 (62-77) years, followed for 728 (interquartile range 653-745) days]. Sex-specific tertiles were considered for the five anthropometric variables. At the end of follow-up, survival free from all-cause death was worse in the lowest tertiles for all the anthropometric variables analyzed. On multivariable Cox regression analysis, an independent association with all-cause death was found for the lowest vs. middle tertile when body weight (hazard ratio [HR] 1.66, 95%CI 1.23-2.23), BMI (HR 1.65, 95%CI 1.23-2.21), and BSA (HR 1.49, 95%CI 1.11-2.01) were analysed in female sex, as well as for body weight in male patients (HR 1.61, 95%CI 1.25-2.07). Conversely, the risk of MACE was lower for the highest tertile (vs. middle tertile) of BSA and LBM in males and for the highest tertile of weight and BSA in female patients. A higher occurrence of haemorrhagic events was found for female patients in the lowest tertile of height [odds ratio (OR) 1.90, 95%CI 1.23-2.94] and LBM (OR 2.13, 95%CI 1.40-3.26).

CONCLUSIONS

In AF patients height, weight, BMI, BSA, and LBM were associated with clinical outcomes, with all-cause death being higher for patients presenting lower values of these variables, i.e. in the lowest tertiles of distribution. The anthropometric variables independently associated with other outcomes were also different between male and female subjects.

Sex Differences in Atrial Fibrillation Risk: The VITAL Rhythm Study

Importance

Women have a lower incidence of atrial fibrillation (AF) compared with men in several studies, but it is unclear whether this sex difference is independent of sex differences in prevalent cardiovascular disease (CVD), body size, and other risk factors.

Objective

To examine sex differences in AF incidence and whether AF risk factors differ by sex in a contemporary cohort of men and women without prevalent CVD.

Design, Setting, and Participants

This was a prospective cohort analysis within the Vitamin D and Omega-3 Trial (VITAL) Rhythm Study, a randomized trial that examined the effect of vitamin D and ω-3 fatty acid supplementation on incident AF among men 50 years or older and women 55 years or older without a prior history of prevalent AF, CVD, or cancer at baseline. Data were analyzed from September 29, 2020, to June 29, 2021.

Exposures

Sex, height, weight, body mass index (BMI), body surface area (BSA), and other AF risk factors at study enrollment.

Main Outcomes and Measures

Incident AF confirmed by medical record review.

Results

A total of 25 119 individuals (mean [SD] age, 67.0 [7.1] years; 12 757 women [51%]) were included in this study. Over a median (IQR) follow-up of 5.3 (5.1-5.7) years, 900 confirmed incident AF events occurred among 12 362 men (495 events, 4.0%) and 12 757 women (405 events, 3.2%). After adjustment for age and treatment assignment, women were at lower risk for incident AF than men (hazard ratio [HR], 0.68; 95% CI, 0.59-0.77; P < .001). The inverse association between female sex and AF persisted after adjustment for race and ethnicity, smoking, alcohol intake, hypertension, diabetes (type 1, type 2, gestational), thyroid disease, exercise, and BMI (HR, 0.73; 95% CI, 0.63-0.85; P <.001). However, female sex was positively associated with AF when height (HR, 1.39; 95% CI, 1.14-1.72; P = .001), height and weight (HR 1.49, 95% CI, 1.21-1.82; P <.001), or BSA (HR, 1.25; 95% CI, 1.06-1.49; P = .009) were substituted for BMI in the multivariate model. In stratified models, risk factor associations with incident AF were similar for women and men.

Conclusions and Relevance

In this cohort study, findings suggest that after controlling for height and/or body size, women without CVD at baseline were at higher risk for AF than men, suggesting that sex differences in body size account for much of the protective association between female sex and AF. These data underscore the importance of AF prevention in women.

Imaging-based body fat depots and new-onset atrial fibrillation in general population: a prospective cohort study

BACKGROUND

Obesity is a well-established risk factor for atrial fibrillation (AF). Whether body fat depots differentially associate with AF development remains unknown.

METHODS

In the prospective population-based Rotterdam Study, body composition was assessed using dual-energy X-ray absorptiometry (DXA) and liver and epicardial fat using computed tomography (CT). A body composition score was constructed by adding tertile scores of each fat depot. Principal component analysis was conducted to identify potential body fat distribution patterns. Cox proportional hazards regression was used to calculate hazard ratios and 95% confidence intervals (HR; 95% CI) per 1-standard deviation increase in corresponding fat depots to enable comparisons.

RESULTS

Over a median follow-up of 9.6 and 8.6 years, 395 (11.4%) and 172 (8.0%) AF cases were ascertained in the DXA and the CT analyses, respectively. After adjustments for cardiovascular risk factors, absolute fat mass (HR; 95% CI 1.33; 1.05-1.68), gynoid fat mass (HR; 95% CI 1.36; 1.12-1.65), epicardial fat mass (HR; 95% CI 1.27; 1.09-1.48), and android-to-gynoid fat ratio (HR; 95% CI 0.81; 0.70-0.94) were independently associated with new-onset AF. After further adjustment for lean mass, associations between fat mass (HR; 95% CI 1.17; 1.04-1.32), gynoid fat mass (HR; 95% CI 1.21; 1.08-1.37), and android-to-gynoid fat ratio (HR; 95% CI 0.84; 0.72-0.97) remained statistically significant. Larger body fat score was associated with a higher AF risk (HR; 95% CI 1.10; 1.02-1.20). Borderline significant association was found between a subcutaneous fat predominant pattern with AF onset (HR; 95% CI 1.21; 0.98-1.49).

CONCLUSIONS

Various body fat depots were associated with new-onset AF. Total fat mass and gynoid fat mass were independently associated with AF after adjustment for body size. The inverse association between android-to-gynoid fat ratio with AF presents a novel finding. A significant dose-response relationship between body fat accumulation and AF was observed. Our results underscore the predominant role of subcutaneous fat on AF development among a middle-aged and elderly population. Associations betw2een body fat depots, fat distribution and new-onset atrial fibrillation.

ABBREVIATIONS

AF, atrial fibrillation.

Atrial fibrillation patterns and their cardiovascular risk profiles in the general population: the Rotterdam study

BACKGROUND

Clinical guidelines categorize atrial fibrillation (AF) based on the temporality of AF events. Due to its dependence on event duration, this classification is not applicable to population-based cohort settings. We aimed to develop a simple and standardized method to classify AF patterns at population level. Additionally, we compared the longitudinal trajectories of cardiovascular risk factors preceding the AF patterns, and between men and women.

METHODS

Between 1990 and 2014, participants from the population-based Rotterdam study were followed for AF status, and categorized into 'single-documented AF episode', 'multiple-documented AF episodes', or 'long-standing persistent AF'. Using repeated measurements we created linear mixed-effects models to assess the longitudinal evolution of risk factors prior to AF diagnosis.

RESULTS

We included 14,061 participants (59.1% women, mean age 65.4 ± 10.2 years). After a median follow-up of 9.4 years (interquartile range 8.27), 1,137 (8.1%) participants were categorized as 'single-documented AF episode', 208 (1.5%) as 'multiple-documented AF episodes', and 57 (0.4%) as 'long-standing persistent AF'. In men, we found poorer trajectories of weight and waist circumference preceding 'long-standing persistent AF' as compared to the other patterns. In women, we found worse trajectories of all risk factors between 'long-standing persistent AF' and the other patterns.

CONCLUSION

We developed a standardized method to classify AF patterns in the general population. Participants categorized as 'long-standing persistent AF' showed poorer trajectories of cardiovascular risk factors prior to AF diagnosis, as compared to the other patterns. Our findings highlight sex differences in AF pathophysiology and provide insight into possible risk factors of AF patterns.

Association between noise exposure and atrial fibrillation: a meta-analysis of cohort studies

Noise has become an important environmental risk factor. Some studies have shown that exposure to noise can cause coronary artery disease, high blood pressure, and stroke. At present, the relationship between noise exposure and the risk of atrial fibrillation (AF) is inconsistent. Based on previous studies, we proposed the hypothesis that noise exposure is associated with a higher risk of AF. Eight databases, such as PubMed, Embase, Cochrane Library, and Web of Science, were searched from inception until January 5, 2022. The pooled relative risk (RR) with its 95% confidence interval (CI) was used to estimate the association between AF and highest noise level and per 10 dB (A) increment of noise. According to the size of heterogeneity, the random or fixed effects model was adopted as the pooling method. A total of 5 articles comprising 3,866,986 participants were identified, providing 7 estimates of highest noise level and 6 estimates of per 10 dB (A) increment of noise exposure. For the highest noise level, there was a statistically significant association between noise exposure and the risk of AF (RR = 1.05; 95% CI: 1.02-1.09; I² = 44.1%). In addition, we found the risk of AF for per 10 dB (A) increment of noise exposure was 1.01 (95% CI: 1.00-1.02; I² = 81.3%). In summary, our study found that noise exposure was associated with a higher risk of AF. More high-quality studies are needed in the future to confirm these conclusions given the limitations of study.

Associations between obesity parameters and the risk of incident atrial fibrillation and ischaemic stroke in the different age groups

Objective

Obesity and aging are important predisposing factors to atrial fibrillation (AF) and ischaemic stroke (IS). However, limited data comprehensively evaluated the relationships between obesity measurements and AF and IS in different ages.

Methods

A total of 9,432,332 adults from the Korean National Health Insurance Service Database were included. The study population was categorized into the six age subgroups by an increase every decade from the twenties. We evaluated AF and IS risk according to body mass index (BMI) and waist circumference (WC) in the different age groups.

Results

During a mean follow-up of 8.2 ± 1.0 years, BMI-AF presented a J-shaped association across ages. The highest hazard ratio (HR) of the BMI ≥ 30 kg/m² group was observed in subjects aged 30–39 years [HR 1.80, 95% CI 1.63–1.98, p < 0.001]. Underweight adults over 60 years also presented an increased AF risk. Incident IS risk increased in those with BMI over the normal range in early and midlife, but the association became obscured in adults aged > 60 years. Among the BMI ≥ 30 kg/m² groups, subjects aged 20–29 years presented the highest risk of IS [HR 3.00, 95% CI (2.34–3.84), p < 0.001]. Overall, WC-AF and WC-IS showed positive linear correlations, but the WC-IS association was weak in subjects aged ≥ 40 years.

Conclusion

The higher risks of AF and IS according to an increment of BMI and WC were most apparent among the young ages. The association between obesity measurements and IS was not significantly above the midlife. Weight management in the young and integrated risk factor management in the elderly are warranted.

Elevated levels of body mass index and waist circumference, but not high variability, are associated with an increased risk of atrial fibrillation

BACKGROUND

Although obesity has been associated with risk of atrial fibrillation (AF), the associations of variability of obesity measures with AF risk are uncertain, and longitudinal studies among Chinese population are still lacking. We aimed to evaluate the impacts of obesity and variability of body mass index (BMI) and waist circumference (WC) on the risk of atrial fibrillation (AF) in a large Chinese cohort study.

METHODS

A total of 44,135 participants of the Kailuan Study who were free of cancer and cardiovascular disease and underwent three consecutive surveys from 2006 to 2010 were followed for incident AF until 2020. Average BMI and WC over time and variability were calculated. Cox proportional hazards regression models were used to assess hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations of obesity and variability in BMI and WC with AF risk.

RESULTS

During a mean follow-up of 9.68 years, there were 410 cases of incident AF. In multivariable-adjusted models, compared with normal BMI/WC, individuals with general obesity and abdominal obesity had increased risk of AF, with corresponding HRs of 1.73 (95% CI: 1.31-2.30) and 1.38 (95% CI: 1.11-1.60), respectively. The short-term elevation in AF risk persisted for the obese even after adjustment for updated biologic intermediaries and weight. Variability in BMI and WC were not associated with the risk of AF. The restricted cubic spline models indicated significant linear relationships between levels of WC and BMI and risk of AF.

CONCLUSIONS

Elevated levels of BMI and WC were associated with an increased risk of AF, whereas variability in BMI and WC were not. Therefore, achieving optimal levels of BMI and WC could be valuable in AF prevention.