What is the clinical evidence from this study?

Study design: Observational. Population: Middle-aged adults (40-60 years) with cardiometabolic risk factors without type 2 diabetes and preserved left ventricular function (n=240). Primary outcome: New-onset and recurrent atrial fibrillation incidence and associated predictors.

March 7, 2026Open Access

Beyond body mass index: visceral adiposity and metabolic alterations as early markers of atrial dysfunction and atrial fibrillation in midlife

Q: What question did this study set out to answer?

This research aims to identify independent predictors of new-onset and recurrent atrial fibrillation in midlife individuals with cardiometabolic risk.

Key Result

Epicardial adipose tissue thickness independently predicted new-onset atrial fibrillation with OR 1.479 (p=0.006), and left atrial reservoir strain independently predicted recurrent atrial fibrillation with OR 0.845 (p<0.001) in middle-aged adults with cardiometabolic risk.

Key Points

This research aims to identify independent predictors of new-onset and recurrent atrial fibrillation in midlife individuals with cardiometabolic risk.
Cohort study with 240 outpatients aged 40-60 years.
Assessment of conventional anthropometric and biochemical parameters.
Comprehensive echocardiographic evaluation including left atrial reservoir strain and epicardial adipose tissue.
Binary logistic regression and ROC analyses utilized.
New-onset AF associated with fasting glucose, EAT thickness, electromechanical delay, uric acid, and lower LASr.
EAT showed the highest predictive ability for new-onset AF.
Recurrent AF linked to age, BMI, hsTnI levels, and lower LASr.

Study Design

Type

Observational (n=240)

Structured PICO

Population

240 middle-aged outpatients (40–60 years) with cardiometabolic risk factors (71 controls without AF, 77 with new-onset AF, 92 with recurrent AF), 49.6% male. Key exclusions: age >60 years, coronary artery disease, valvular or congenital heart disease, persistent arrhythmia, cardiomyopathy, LV systolic dysfunction (EF <50%), type 2 diabetes mellitus.

Outcome

Independent predictors of new-onset and recurrent atrial fibrillation

Visceral adiposity and metabolic alterations, particularly epicardial adipose tissue thickness and left atrial reservoir strain, are independent early markers of new-onset and recurrent atrial fibrillation in middle-aged individuals with cardiometabolic risk.

Limitations

Observational cohort design precludes causal inference.
Follow-up limited to single telephone contact at 5 years, limiting interim event detection.
Advanced metabolic markers like fasting insulin and HbA1c were not measured.
Renal function assessed solely by creatinine clearance, without albuminuria or cystatin C.
Lipid profiling was not systematically evaluated due to heterogeneity and medication use.
EAT measured by echocardiography rather than gold-standard CT or MRI imaging.
Body composition assessed by anthropometric indices rather than direct imaging quantification.
Modest sample size may limit statistical power and generalizability.
Population limited to middle-aged outpatients without diabetes or advanced comorbidities, restricting external applicability.

Abstract

Background Atrial fibrillation (AF) develops along the cardiometabolic continuum, where visceral adiposity and early atrial dysfunction may precede overt disease. We aimed to identify independent predictors of new- onset and recurrent AF in middle-aged individuals with cardiometabolic risk. Methods This observational cohort included 240 outpatients (40–60 years; 71 controls, 77 new-onset AF, 92 recurrent AF). Conventional anthropometric parameters (body mass index, body roundness index) and biochemical markers (fasting glucose, uric acid, creatinine clearance, inflammatory markers and high-sensitivity troponin I- hsTnI) were assessed. A comprehensive echocardiographic assessment including left atrial reservoir strain (LASr), electromechanical delay (EMD), and epicardial adipose tissue (EAT) were analyzed. Binary logistic regression and ROC analyses were performed. Results New-onset AF was independently associated with fasting glucose (OR 3.604; 95% CI 1.338–9.704; p=0.011), EAT thickness (OR 1.479; p=0.006), electromechanical delay (OR 1.043; p=0.001), uric acid (OR 1.006; p=0.026), and lower LASr (OR 0.944; p=0.045). Among the evaluated parameters, EAT demonstrated the highest discriminatory ability for new-onset AF (AUC 0.664; p0.001). Recurrent AF was independently associated with age (OR 1.122; p0.001), BMI (OR 1.209; p=0.028), hsTnI (OR 3.546; p0.001), and lower LASr (OR 0.845; p0.001). LASr showed good discriminatory performance for recurrent AF (AUC 0.781; p0.001). Conclusion These findings demonstrate that visceral adiposity and metabolic alterations are independently associated with atrial dysfunction and atrial fibrillation in middle-aged individuals with cardiometabolic risk.

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