Key result
Higher total fat mass was independently associated with an increased risk of new-onset atrial fibrillation (HR 1.17 per 1-standard deviation increase) after adjustment for lean mass.
Why the study?
Obesity is a well-established risk factor for atrial fibrillation, but whether body fat depots differentially associate with its development remains unknown.
Does increased accumulation of specific body fat depots increase the risk of new-onset atrial fibrillation in the general middle-aged and elderly population?
Cohort (n=3,468)
No
Does increased accumulation of specific body fat depots increase the risk of new-onset atrial fibrillation in the general middle-aged and elderly population?
Hazard Ratio: 1.17 (95% CI 1.04–1.32)
Total fat mass and gynoid fat mass are independently associated with new-onset atrial fibrillation after adjusting for body size, highlighting the predominant role of subcutaneous fat in AF development.
Higher fat mass may elevate AF risk beyond lean mass; hypothesis-generating for depot-specific prevention trials.
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.
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Lu et al. (2022) conducted a cohort in Atrial fibrillation (n=3,468). Body fat depots (total fat mass) vs. Lower levels of fat mass was evaluated on New-onset atrial fibrillation (HR 1.17, 95% CI 1.04-1.32). Higher total fat mass was independently associated with an increased risk of new-onset atrial fibrillation (HR 1.17 per 1-standard deviation increase) after adjustment for lean mass.
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