Modifiable Risk Factors for Atrial Fibrillation

Miller JD, Aronis KN, Chrispin J, et al.
Obesity, Exercise, Obstructive Sleep Apnea, and Modifiable Atherosclerotic Cardiovascular Disease Risk Factors in Atrial Fibrillation. J Am Coll Cardiol 2015;66:2899-2906.

The following are key points to remember from this review of the role of weight loss, exercise, and cardiac risk factor modification in the prevention and management of atrial fibrillation (AF):

  1. A meta-analysis of 51 studies that included >600,000 patients indicated that the relative risk of new-onset or postoperative AF increases by 10-29% for every 5 kg/m2 increase in body mass index.
  2. Possible reasons for the link between obesity and AF include left atrial enlargement, increased pericardial and epicardial fat, and chronic systemic inflammation.
  3. Randomized and nonrandomized studies have demonstrated that weight loss in overweight patients with AF reduces the AF burden and reduces the risk of recurrent AF after catheter ablation.
  4. The bulk of evidence suggests that endurance athletes have a heightened risk of AF, but that light to moderate exercise and an improvement in fitness level can reduce the risk of AF.
  5. Hypertension and diabetes are established risk factors for AF, but there is no convincing evidence that the treatment of hypertension or diabetes reduces the risk of AF.
  6. The data on the relationship between lipid levels or statins/fish oil and AF are mixed and the current recommendation for use of lipid-lowering agents for AF prevention is limited to cardiac surgery patients.
  7. There is strong evidence that obstructive sleep apnea (OSA) increases the risk of AF and that treatment of OSA reduces the risk of recurrent AF, including after cardioversion and catheter ablation.
  8. There is no evidence that smoking cessation or reduction in light to moderate alcohol intake reduces the risk of recurrent AF.

Clinical Topics: Arrhythmias and Clinical EP, Dyslipidemia, Prevention, Sports and Exercise Cardiology, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Lipid Metabolism, Nonstatins, Hypertension, Sleep Apnea

Keywords: Arrhythmias, Cardiac, Athletes, Atrial Fibrillation, Body Mass Index, Catheter Ablation, Diabetes Mellitus, Electric Countershock, Fish Oils, Hypertension, Obesity, Overweight, Primary Prevention, Risk Factors, Sleep Apnea, Obstructive, Smoking Cessation, Weight Loss

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