Clinical Obesity and New‐Onset Atrial Fibrillation: A Population‐Based Cohort Study From the Kailuan Cohort

BACKGROUND AND PURPOSE: Using the clinical obesity concept recently proposed by the Lancet Diabetes & Endocrinology Commission, this study evaluated the impact of clinical obesity on new-onset atrial fibrillation (AF) in the general population. METHODS: Individuals who underwent first health examinations from June 2006 to October 2007 in Kailuan were included. Based on body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and presence of obesity-related organ/tissue dysfunction, participants were divided into no obesity, preclinical obesity, and clinical obesity groups. RESULTS: A total of 98 730 participants free from AF at baseline were identified. Of these, 1343 developed new-onset AF over a median follow-up of 16.97 years. The AF incidence densities were 0.67, 0.68, and 1.25 per 1000 person-years in the no obesity, preclinical, and clinical obesity groups, respectively. Compared to the no obesity group, the clinical obesity (HR: 1.29, 95% CI: 1.12-1.47) group showed increased risks of new-onset AF. Clinical obesity remained associated with higher new-onset AF risk in participants aged < 45 years (HR: 2.34, 95% CI: 1.42-3.86) and 45- < 60 years (HR: 1.40, 95% CI: 1.14-1.71). In men, clinical obesity was associated with 35% higher risks of new-onset AF (HR: 1.34, 95% CI: 1.16-1.55). No significant association was observed between clinical obesity and new-onset AF in participants with a history of using anti-hypertensive agents (HR: 0.98, 95% CI: 0.73-1.30). CONCLUSIONS: Clinical obesity is an independent risk factor for new-onset AF, with age- and sex-specific associations, while metabolic-targeted therapies were associated with attenuated obesity-associated new-onset AF risk.