Association Between Modifiable Risk Factors and Heart Failure in Women With Atrial Fibrillation

Heart failure (HF) is the most common non-fatal event experienced in women with new-onset atrial fibrillation (AFib), and directly modifiable risk factors, such as obesity, hypertension, smoking and diabetes account for the majority of the population risk of HF, according to research published in JACC: Heart Failure.

Study authors Neal A. Chatterjee, MD, MSc, FIT, et al., assessed 34,736 women participating in the Women's Health Study, ages 45 and older, who were free of prevalent cardiovascular disease upon study entry. Data analysis showed that new-onset AF was associated with an increased risk of HF, and once women with AFib developed HF, all-cause and cardiovascular mortality increased. The combination of systolic blood pressure (SBP) >120 mm Hg, obesity, tobacco use and diabetes mellitus accounted for an estimated 62 percent of population-attributable risk of HF. When compared with women with three to four of these modifiable risk factors, those who achieved or maintained optimal risk factor control benefitted from a progressive decrease in HF risk.

"The onset of AFib has been consistently associated with increased mortality in diverse populations, including those with low cardiovascular disease burden… Despite major advances, improvement in overall survival for patients with AFib has been modest," write Chatterjee, et al. "Our data provide support for the concept that targeting modifiable risk factors, including obesity, smoking, elevated SBP, and diabetes mellitus, in patients with new-onset AF[ib] has the potential to significantly reduce the individual risk and population burden of HF." Given its prevalence in patients with AFib, strategies for HF prevention are lacking. Study authors suggest that prospective assessment of risk factor modification at the time of AFib diagnosis may warrant future investigation.

In an editorial comment, Darae Ko, MD, FIT, writes, "There is now convincing evidence that HF prevention is an important management priority for patients with AF[ib]. Efforts to reduce HF incidence are critical to reduce the public health burden of AF[ib]. Several large, prospective observational studies have identified potential therapeutic targets of intervention. Pragmatic randomized controlled trials are needed to generate effective evidence-based strategies."

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Chronic Heart Failure, Hypertension, Smoking

Keywords: Risk Factors, Atrial Fibrillation, Blood Pressure, Smoking, Public Health, Diabetes Mellitus, Hypertension, Heart Failure, Systolic, Obesity

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