Risk for New AF Climbs With Cardiometabolic Comorbidity Burden

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The study covered in this summary was published in SSRN.com as a preprint and has not yet been peer reviewed.

Key Takeaway

Patients with a greater number of cardiometabolic comorbidities — including obesity, diabetes, hypertension, coronary heart disease, heart failure, or stroke — have a significantly higher lifetime risk of new atrial fibrillation (AF), the effect more pronounced in women.

Why This Matters

Understanding the relationship between burden of cardiometabolic disorders in men and women with AF is key to developing strategies for lowering the risk for new AF and diagnosing and managing it.

Study Design

The population-based cohort study used data from the Rotterdam Study, which is investigating the prevalence and progression of risk factors for chronic diseases in individuals aged 45 and over.
Data on cardiometabolic disorders were collected from participants via questionnaires at baseline and from interviews and clinical and laboratory assessments.
Sex-specific Cox proportional-hazards regression models were used to assess the association between burden of cardiometabolic comorbidities and risk for new-onset AF.
The 5432 women and 4113 men were categorized by number of cardiometabolic comorbidities: 0, 1, 2, 3, and 4 or more.
Estimated lifetime risks for atrial fibrillation were calculated for participants at index ages of 55, 65, and 75 years.

Key Results

The rates of new-onset AF during the median follow-up of 7.8 years were 7.4% for women and 9.9% for men.
In unadjusted Model 1, a greater burden of cardiometabolic disorders corresponded to a higher risk for incident AF.
Each additional cardiometabolic disorder added a 41% greater risk for AF overall; the corresponding risk increase was 52% for women and 28% for men.
In Model 3 (adjusted for sex, baseline age, Rotterdam Study subcohort, total cholesterol, HDL cholesterol, smoking, use of lipid-modifying agents, and cardiac therapies received), there was a stronger association for women, compared with men, between the cardiometabolic comorbidity burden and AF.
Among those with ≥ 4 cardiometabolic disorders:
- Men had almost a twofold increased risk for AF, hazard ratio (HR) 1.81 (95% CI, 1.06 – 3.10) compared with having no cardiometabolic disorder.
- Women had a more-than fivefold increased corresponding risk, HR 5.24 (95% CI, 2.57 – 10.7).
In the overall population, the lifetime risk for AF at different index ages tended to increase with the number of cardiometabolic disorders. This trend was also seen among women and men separately.
The highest lifetime risk for AF was in men age 55 with ≥ 4 cardiometabolic disorders; their estimated incidence was 34.1%
For women of the same age in the same cardiometabolic burden category, the estimated lifetime risk was 33.3%.
At the index age of 75 years, women — but not men — showed a significant association between burden of cardiometabolic disorders and lifetime risk for AF (P < .01 for women and P = .76 for men).

Limitations

The cohort included mostly older adults of European ancestry, so the results may not be generalizable to other populations.
Residual confounding is likely due to the study’s observational design.
Atrial fibrillation can be asymptomatic and/or paroxysmal and therefore hard to detect, so the cohort’s prevalence of new AF may be underestimated.

Disclosures

The authors declared no conflicts of interest.
This study was supported by Erasmus Medical Center and Erasmus University, Rotterdam, the Netherlands; the Netherlands Organization for Scientific Research; the Netherlands Organization for Health Research and Development; the Research Institute for Diseases in the Elderly; the Netherlands Genomics Initiative; the Ministry of Education, Culture and Science; the Ministry of Health, Welfare and Sport; the Dutch Heart Foundation; and the European Commission (DG XII); and the Municipality of Rotterdam.

This is a summary of a preprint research study, “Burden of cardiometabolic disorders and lifetime risk of new-onset atrial fibrillation among men and women: a perspective cohort study,” written by Zuolin Lu, MSc, Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands, and colleagues on SSRN, provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on SSRN.com.

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