What is the clinical evidence from this study?

Study design: Review. Population: Atrial Fibrillation. Intervention: Risk factor modification.

December 30, 2021Open Access

The effect of obesity, hypertension, diabetes mellitus, alcohol, and sleep apnea on the risk of atrial fibrillation

Key Result

Obesity, hypertension, diabetes mellitus, obstructive sleep apnea, and alcohol consumption significantly increase the risk of atrial fibrillation, while risk factor modification can reduce AF recurrence.

Structured PICO

Does modification of risk factors such as obesity, hypertension, diabetes, alcohol, and sleep apnea reduce the risk and recurrence of atrial fibrillation?

Population

Individuals at risk for atrial fibrillation and patients with existing atrial fibrillation

Intervention

Risk factor modification including weight reduction, blood pressure control, and alcohol abstinence

Outcome

Incidence of atrial fibrillation and recurrence of atrial fibrillation

This review highlights that metabolic and lifestyle factors—specifically obesity, hypertension, diabetes, sleep apnea, and alcohol—are major drivers of atrial fibrillation, and their targeted modification can significantly reduce AF incidence and recurrence.

Limitations

Quality of data in some observational studies is limited and not adjusted for confounding risk factors such as obesity and hypertension.

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia associated with a two-fold increase in mortality caused by a higher risk of stroke and heart failure. Currently, AF is present in ~ 2 % of the general population, and its incidence and prevalence are increasing. Obesity, hypertension, diabetes mellitus, obstructive sleep apnea, and alcohol consumption increase the risk of AF. Each unit of increase in BMI increases the risk of AF by 3 %, and intensive weight loss is also associated with reduced AF recurrence. Hypertension increases the risk of AF by 50 % in men and by 40 % in women, and explains ~ 20 % of new AF cases. Patients with obstructive sleep apnea are at four times higher risk of developing AF than subjects without sleep apnea. Higher concentrations of pro-inflammatory cytokines, higher amounts of epicardial adipose tissue, and a higher degree of ventricular diffuse myocardial fibrosis are present in AF patients and patients with the aforementioned metabolic disorders. Several prospective cohort studies and randomized trials have been initiated to show whether weight loss and treatment of other risk factors will be associated with a reduction in AF recurrences.

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