Early life and adulthood risk factors for middle age P -wave prolongation and left atrial enlargement

AIMS: P-wave prolongation and left atrial (LA) enlargement are markers of atrial cardiomyopathy and increase the risk for atrial fibrillation, stroke, and mortality. We investigated whether the cumulative burden of cardiovascular risk factors in early life is associated with P-wave duration and LA size in middle age. METHODS AND RESULTS: The Cardiovascular Risk in Young Finns Study is a prospective, ongoing, multicentre cohort initiated in 1980. Traditional cardiovascular risk factors were assessed repeatedly between 1980 and 2001 (ages 6-24 years), and transthoracic echocardiography and electrocardiography were performed in 2011. Associations between cumulative early life risk factors and P-wave duration, LA diameter, and LA volume were analysed using logistic regression. Body mass index (BMI) was the main modifiable determinant of P-wave prolongation and LA enlargement. Each standard deviation (SD) increase in early life BMI burden was associated with longer P-wave duration (0.120 SD; 1.85 ms), larger LA diameter (0.264 SD; 0.11 cm), and greater LA volume (0.235 SD; 3.31 mL). Male sex associated with all studied P-wave and LA parameters and older age associated with larger LA diameter. Higher physical activity in middle age was associated with 0.116 SD increased LA volume (1.64 mL). Participants with persistent or adult-onset high BMI were more likely to have larger LA. CONCLUSION: Excess BMI from childhood through adulthood is a key determinant of atrial remodelling in middle age. These findings highlight the long-term impact of early life adiposity and underscore the importance of lifelong weight management in preventing atrial cardiomyopathy and its clinical sequelae.