Anthropometric and lifestyle indicators of incident atrial fibrillation in a large, population-based Swedish population

Background and purpose Atrial fibrillation (AF) is the most common arrhythmia worldwide, with rising prevalence and a substantial burden of associated complications. Numerous risk factors including several lifestyle-related, contribute to the development of AF and an improved understanding of their impact is essential for optimizing early management and personalized prevention strategies. The purpose of this study was to analyse associations between anthropometric and lifestyle variables to AF incidence in a population-based contemporary prospective cohort. Methods In total, 30,154 middle-aged individuals (50-64 years of age) were randomly invited from the general population near six Swedish university cities and enrolled in the Swedish CArdioPulmonary bioImage Study (SCAPIS) between 2012 and 2018. Extensive baseline data was collected, including anthropometric measures (height, weight, waist-hip ratio (WHR), body mass index (BMI)), accelerometer-derived data for one week, questionnaire on physical activity, and substance use (smoking, snuff, and alcohol). Swedish national patient registers were used to identify incident AF, and Cox regression models adjusted for cardiovascular disease (CVD) comorbidities (age, sex, treatment for hypertension, hyperlipidemia or diabetes mellitus (DM), DM diagnosis, heart failure, ischemic heart disease and stroke) were applied to assess the associations between anthropometric and lifestyle variables and the risk of incident AF. Results After a mean follow-up of eight years and exclusion of 555 participants with AF at baseline or missing AF data, 621 study participants with incident AF and 28,978 participants without incident AF were identified. In total, 69% of participants with incident AF were male with a mean age of 59.5 years at inclusion. The presence of CVD comorbidities was higher in individuals with incident AF (Table). Several anthropometric measures were associated with an increased risk of incident AF in models adjusted for presence of CVD: height (HR 1.82, 95% CI 1.45-2.27), weight (HR 2.08, 95% CI 1.64-2.63), and weight at age 20 (HR 1.79, 95% CI 1.42-2.25), when comparing the 4th quartile (Q4) to the 1st (Q1). A higher proportion of time spent sedentary, as measured by an accelerometer, was associated with a higher risk of AF (HR 1.36, 95% CI 1.08-1.72), while a higher proportion of time in moderate-vigorous physical activity was protective of incident AF (HR 0.56, 95% CI 0.45-0.70) (Q4 versus Q1) (Figure). Current smoking was associated with incident AF (HR 1.42, 95% CI 1.12-1.78), while the relationship with snuff or reported alcohol consumption was not significant. Conclusions In this large, contemporary, population-based prospective and highly phenotyped cohort, several anthropometric and lifestyle indicators were associated with incident AF. Except for height, the findings underscore the importance of preventive measures in reducing the risk of AF in middle-aged individuals.TableFigure