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Journal of the American Heart Association

Clinical Articles, Lead Article

Early weight and glucose control may ward off AF

Efforts aimed at weight reduction or glycaemic control may affect the proportion of the population with sustained atrial fibrillation (AF), according to a study published recently in the Journal of the American Heart Association.1

The authors prospectively examined differential associations between traditional, lifestyle, and biomarker AF risk factors and development of paroxysmal versus nonparoxysmal AF (persistent/permanent) among 34,720 women enrolled in the Women’s Health Study who were free of cardiovascular disease and AF at baseline. AF patterns were defined based on current guidelines and classified according to the most sustained form of AF within 2 years of diagnosis.

During a median follow‐up of 16.4 years, 690 women developed paroxysmal AF and 349 women developed nonparoxysmal AF. In multivariable time‐varying competing risk models, increasing age (hazard ratio [HR] 1.11, 95% CI 1.10 to 1.13, versus HR 1.08, 1.07 to 1.09, per year), body mass index (HR 1.07, 1.05 to 1.09, versus HR 1.03, 1.02 to 1.05, per kg/m2), and weight (HR 1.30, 1.22 to 1.39, versus HR 1.14, 1.08 to 1.20, per 10 kg) were more strongly associated with the development of nonparoxysmal AF compared with paroxysmal AF.

Dr Roopinder K Sandhu (University of Alberta, Canada)

Dr Roopinder K Sandhu (University of Alberta, Canada)

Haemoglobin A1c levels at baseline were directly related to the development of nonparoxysmal AF but inversely associated with paroxysmal AF in multivariable competing risk models (P for nonequal association=0.01).

Speaking to BJC Arrhythmia Watch, co-author Dr Roopinder K Sandhu (University of Alberta, Canada) said: “This study prospectively examines the association between AF risk factors and the development of paroxysmal versus non-paroxysmal AF among 34,720 women enrolled in the Women’s Health Study without prior cardiovascular disease or AF. Traditional and lifestyle AF risk factors were assessed and updated before development of AF and biomarkers were measured at study entry.”

“In multivariable time-varying competing risk models, we found increasing age and adiposity (weight, BMI, categories of BMI) were more strongly associated with non-paroxysmal AF compared with paroxysmal AF. Haemoglobin A1c levels at baseline were directly related to development of non-paroxysmal AF but inversely associated with paroxysmal AF in a multivariable competing risk model,” she added.

“These data raise the possibility that early efforts aimed at weight reduction or glycaemic control in the general population, before the development of AF, may have a significant impact on the proportion of individuals who develop non-paroxysmal AF but warrants further study. This study included relatively healthy, middle-aged ,female health professional and results may not be generalisable to other populations,” Dr Sandhu concluded.

References

1. Sandhu RK, Conen D, Tedrow UB, et al. Predisposing factors associated with development of persistent compared with paroxysmal atrial fibrillation. J Am Heart Assoc 2014;3:e000916. http://dx.doi.org/10.1161/​JAHA.114.000916

Published on: August 5, 2014

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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