Changes in exercise frequency and cardiovascular outcomes in older adults

Abstract Aims Little is known about the association of changes in moderate to vigorous physical activity (MVPA) level with cardiovascular disease (CVD), especially in older adults whose ability to engage in frequent MVPA naturally wanes as they age. We aimed to examine the association of changes in MVPA and CVD in older adults. Methods and results In a nationwide cohort study of older adults aged 60 years or older, we identified more than 1.1 million subjects without previous history of CVD at baseline who underwent two consecutive national health screening from 2009 to 2012. We prospectively assessed the risk of CVD occurred between 2013 and 2016 according to changes in frequency of MVPA by initial MVPA status. Compared to those who were continuously physically inactive, those who increased their frequency of MVPA from physically inactive to 1–2 times per week [0.7/1000 person-years (PY) decrease in incidence rate (IR); adjusted hazard ratio (aHR) 0.95; 95% confidence interval (CI) 0.92–0.99], 3–4 times per week (1.5/1000 PY decrease in IR; aHR 0.89; 95% CI 0.84–0.94), ≥5 times per week (0.4/1000 PY decrease in IR; aHR 0.91; 95% CI 0.85–0.97) had a significantly reduced risk for total CVD (P for trend <0.001). Older adults who became physically inactive from engaging in more than 1–2 times of MVPA per week had a higher CVD risk compared to those who maintained their frequency of MVPA. Conclusion Among older adults, engaging in higher frequency of MVPA or maintaining MVPA level was associated with reduced risk of CVD.

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Association of daily composition of physical activity and sedentary behaviour with incidence of cardiovascular disease in older adults

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-021-01157-0 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Manasa S. Yerramalla ◽

Duncan E. McGregor ◽

Vincent T. van Hees ◽

Aurore Fayosse ◽

Aline Dugravot ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Sedentary Behaviour ◽

Cox Regression ◽

Vigorous Physical Activity ◽

Movement Behaviour ◽

Cvd Risk ◽

Daily Movement ◽

Intensity Physical Activity ◽

Current Duration

Abstract Background Moderate-to-vigorous physical activity (MVPA) is proposed as key for cardiovascular diseases (CVD) prevention. At older ages, the role of sedentary behaviour (SB) and light intensity physical activity (LIPA) remains unclear. Evidence so far is based on studies examining movement behaviours as independent entities ignoring their co-dependency. This study examines the association between daily composition of objectively-assessed movement behaviours (MVPA, LIPA, SB) and incident CVD in older adults. Methods Whitehall II accelerometer sub-study participants free of CVD at baseline (N = 3319, 26.7% women, mean age = 68.9 years in 2012–2013) wore a wrist-accelerometer from which times in SB, LIPA, and MVPA during waking period were extracted over 7 days. Compositional Cox regression was used to estimate the hazard ratio (HR) for incident CVD for daily compositions of movement behaviours characterized by 10 (20 or 30) minutes greater duration in one movement behaviour accompanied by decrease in another behaviour, while keeping the third behaviour constant, compared to reference composition. Analyses were adjusted for sociodemographic, lifestyle, cardiometabolic risk factors and multimorbidity index. Results Of the 3319 participants, 299 had an incident CVD over a mean (SD) follow-up of 6.2 (1.3) years. Compared to daily movement behaviour composition with MVPA at recommended 21 min per day (150 min/week), composition with additional 10 min of MVPA and 10 min less SB was associated with smaller risk reduction – 8% (HR, 0.92; 95% CI, 0.87–0.99) – than the 14% increase in risk associated with a composition of similarly reduced time in MVPA and more time in SB (HR, 1.14; 95% CI, 1.02–1.27). For a given MVPA duration, the CVD risk did not differ as a function of LIPA and SB durations. Conclusions Among older adults, an increase in MVPA duration at the expense of time in either SB or LIPA was found associated with lower incidence of CVD. This study lends support to public health guidelines encouraging increase in MVPA or at least maintain MVPA at current duration.

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Can we walk away from cardiovascular disease risk or do we have to ‘huff and puff’? A cross-sectional compositional accelerometer data analysis among adults and older adults in the Copenhagen City Heart Study

10.21203/rs.2.20193/v3 ◽

2020 ◽

Author(s):

Melker Staffan Johansson ◽

Karen Søgaard ◽

Eva Prescott ◽

Jacob Louis Marott ◽

Peter Schnohr ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Older Adults ◽

Data Analysis ◽

Sedentary Behaviour ◽

Accelerometer Data ◽

Cvd Risk ◽

Cross Sectional ◽

Heart Study ◽

Copenhagen City Heart Study

Abstract Background: It is unclear whether walking can decrease cardiovascular disease (CVD) risk or if high intensity physical activity (HIPA) is needed, and whether the association is modified by age. We investigated how sedentary behaviour, walking, and HIPA, were associated with systolic blood pressure (SBP), waist circumference (WC), and low-density lipoprotein cholesterol (LDL-C) among adults and older adults in a general population sample using compositional data analysis. Specifically, the measure of association was quantified by reallocating time between sedentary behaviour and 1) walking, and 2) HIPA. Methods: Cross-sectional data from the fifth examination of the Copenhagen City Heart Study was used. Using the software Acti4, we estimated daily time spent in physical behaviours from accelerometer data worn 24 h/day for 7 days (i.e., right frontal thigh and iliac crest; median wear time: 6 days, 23.8 h/day). SBP, WC, and LDL-C were measured during a physical examination. Inclusion criteria were ≥5 days with ≥16 h of accelerometer recordings per day, and no use of antihypertensives, diuretics or cholesterol lowering medicine. The 24-hour physical behaviour composition consisted of sedentary behaviour, standing, moving, walking, HIPA (i.e., sum of climbing stairs, running, cycling and rowing), and time in bed. We used fitted values from linear regression models to predict the difference in outcome given the investigated time reallocations relative to the group-specific mean composition. Results: Among 1053 eligible participants, we found an interaction between the physical behaviour composition and age. Age-stratified analyses (i.e., </≥65 years; 773 adults, 280 older adults) indicated that less sedentary behaviour and more walking was associated with lower SBP among older adults only. For less sedentary behaviour and more HIPA, the results i) indicated an association with lower SBP irrespective of age, ii) showed an association with a smaller WC among adults, and iii) showed an association with a lower LDL-C in both age groups. Conclusions: Less sedentary behaviour and more walking seems to be associated with lower CVD risk among older adults, while HIPA types are associated with lower risk among adults. Therefore, to reduce CVD risk, the modifying effect of age should be considered in future physical activity-promoting initiatives.

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Abstract 047: Sedentary Behavior Increases Risk for Cardiovascular Disease in Older Women: The Objective Physical Activity and Cardiovascular Health (OPACH) Study

Circulation ◽

10.1161/circ.137.suppl_1.047 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

John Bellettiere ◽

Michael J LaMonte ◽

Eileen Rillamas-Sun ◽

Jacqueline Kerr ◽

Kelly R Evenson ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Sedentary Behavior ◽

Older Women ◽

Cardiovascular Health ◽

Sedentary Time ◽

Vigorous Physical Activity ◽

Cvd Risk ◽

Bout Duration ◽

Increased Risk

Background: Evidence on sedentary behavior and cardiovascular disease (CVD) is largely based on self-reported sedentary time. Furthermore, how sedentary time is accumulated (in longer vs. shorter bouts) may be related to CVD risk but has not been tested. Methods: Women (n=5638, mean age=79±7) with no history of myocardial infarction or stroke wore accelerometers for 4-7 days and were followed for up to 4 years for incident CVD. Hazard ratios (HR) and 95% confidence intervals (CIs) for CVD and coronary heart disease (CHD) events were estimated across quartiles of sedentary time and mean sedentary bout duration using Cox proportional hazard models adjusting for covariates. Separate models evaluated associations after adding moderate-to-vigorous physical activity (MVPA) and possible mediators: body mass index, diabetes, hypertension, systolic blood pressure, fasting glucose, HDL-cholesterol, and triglycerides. We then tested whether mean bout duration was associated with increased risk for CVD and CHD among women with above median sedentary time (≥10hr/day). Results: Covariate-adjusted HRs for CVD and CHD increased across quartiles of both sedentary time and mean bout duration (Table). All CHD associations remained significant but attenuated after adjustment for possible mediators. After adjustment for MVPA, highest vs. lowest quartile HRs (CI) for CHD were 1.6 (0.7-3.4; p-trend = .08) for sedentary time and 1.8 (0.9-3.5; p-trend = .047) for mean bout duration. Among women with high sedentary time, the HRs (CI) comparing the 75 th vs. 25 th percentile of mean bout duration were 1.05 (0.95-1.15) for CVD and 1.16 (1.01-1.34) for CHD. Conclusions: Both sedentary time and mean bout duration showed independent, dose-response associations with increased risk of CVD and CHD events in older women. Among women with high sedentary time, longer mean bout duration was associated with higher CHD risk. Taken together, this provides evidence that both total sedentary time and the way it is accumulated are predictive of incident CHD.

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Abstract P376: Associations Between Moderate To Vigorous Physical Activity And Sedentary Time On Cognitive Function In Older Adults With Cardiovascular Disease

Circulation ◽

10.1161/circ.141.suppl_1.p376 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Nicole M Hoffmann ◽

Megan E Petrov

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Cognitive Function ◽

Sedentary Time ◽

Reference Group ◽

Vigorous Physical Activity ◽

Cognitive Testing ◽

Digit Symbol Substitution Test ◽

Increased Risk ◽

History Of

Cardiovascular disease (CVD) is associated with increased risk for cognitive decline. Lifestyle behaviors such as moderate to vigorous physical activity (MVPA) and reduced sedentary time (ST) may mitigate this decline, but limited research exists. The aim of the study was to examine the joint association of MVPA and ST on cognitive function by CVD status. Adults (n=2844, ≥60yrs) from the 2011-2014 National Health and Nutrition Examination Survey underwent cognitive testing (Digit Symbol Substitution Test [DSST]; Animal Fluency [AF]). Participants reported minutes of MVPA per week (categorized by U.S. PA Guidelines: ≥ 150min MPA and/or ≥ 75min VPA PA vs <150min MPA and <75min VPA), and typical ST per day (≤7hrs vs >7hrs ) , and reported physician-diagnosed CVD (i.e., myocardial infarction, stroke, coronary heart disease, or heart failure). Weighted linear regression analyses assessed the joint association of MVPA and ST on cognitive function, and tested the modifying effect of CVD status (alpha level for interaction terms set at 0.1) after adjustment for demographics, hypertension, diabetes, body mass index, and depression symptomatology. See Table. There were significant main effects for combined MVPA-ST groups on DSST (Wald F (3,30)=4.92, p =.007) and AF (Wald F (3,30)=5.01, p =.006). Individuals who did not engage in MVPA regardless of ST had significantly worse scores on DSST compared to the reference group. There was a significant main effect for CVD on DSST (Wald F (1,32)=8.82, p =.006). There was a significant interaction between MVPA-ST groups and CVD status on DSST (Wald F (3,30)=3.691, p =.023). Stratified analyses indicated among individuals with CVD, the buffering effect of MVPA was maintained, but the interaction was not significant for those without CVD. In a sample of adults with a history of CVD, meeting recommendations for MVPA appeared to preserve executive functioning regardless of ST. This research highlights the added importance for people with a history of CVD to participate in the recommended amount of MVPA.

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Physical Activity and Cardiovascular Disease Among Older Adults: The Case of Race and Ethnicity

Journal of Aging and Physical Activity ◽

10.1123/japa.2016-0012 ◽

2017 ◽

Vol 25 (4) ◽

pp. 505-509 ◽

Cited By ~ 2

Author(s):

Kerstin Gerst Emerson ◽

Jennifer Gay

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Older Adults ◽

Light Intensity ◽

Race And Ethnicity ◽

Mexican Americans ◽

Ordinary Least Squares ◽

Moderate Intensity ◽

Least Squares Regression ◽

Cvd Risk

The goals of this study were (1) to test the relative contribution of light intensity and moderate-to-vigorous intensity physical activity (MVPA) to cardiovascular disease (CVD) risk in older adults, and (2) to examine the influence of ethnicity. We used pooled data from the 2003–2004 and 2005–2006 waves of the National Health and Nutritional Examination Survey (NHANES). The sample consisted of 1,171 non-Hispanic White, non-Hispanic Black, and Mexican American adults aged 65 and older. Using ordinary least squares regression, we showed no statistically significant relationship between lower CVD risk with light intensity activity. However, greater minutes of MVPA was associated with lower CVD risk. Mexican Americans had statistically significantly higher risk for CVD compared to non-Hispanic Whites after controlling for physical activity. Mexican Americans remain an at-risk group for CVD. Regardless of race or ethnicity, physical activity recommendations among elders should be for at least moderate intensity activity for a more favorable CVD outcome.

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A model of lifetime health outcomes in cardiovascular disease based on clinical trials and large cohorts

European Heart Journal ◽

10.1093/eurheartj/ehab724.3149 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

R Wu ◽

C Williams ◽

I Schlackow ◽

J Zhou ◽

J Emberson ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Life Expectancy ◽

Remaining Life ◽

Uk Biobank ◽

Cvd Risk ◽

Micro Simulation ◽

History Of ◽

Remaining Life Expectancy ◽

The Uk

Abstract Background and purpose Cardiovascular disease (CVD) risk of individuals depends on their socio-demographic characteristics, clinical risk factors, and treatments, and strongly influences their quality of life and survival. Individual-based long-term disease models, which aim to more accurately calculate the lifetime consequences, can help to target treatments, develop disease management programmes, and assess the value of new therapies. We present a new micro-simulation CVD model. Methods This micro-simulation model was developed using individual participant data from the Cholesterol Treatment Trialists' collaboration (CTT: 118,000 participants; 15 trials) and calibrated (with added socioeconomic deprivation, ethnicity, physical activity, mental illness, cancer and incident diabetes) in the UK Biobank cohort (UKB: 502,000 participants). Parametric survival models estimated risks of key endpoints (myocardial infarction (MI), stroke, coronary revascularisation (CRV), diabetes, cancer and vascular (VD) and nonvascular death (NVD) using participants' age, sex, ethnicity, physical activity, socioeconomic deprivation, smoking history, lipids, blood pressure, creatinine, previous cardiovascular diseases, diabetes, mental illness and cancer at entry and non-fatal incidents of the key endpoints during follow-up. The model integrates the risk equations and enables annual projection of endpoints and survival over individuals' lifetimes. The model was used to project remaining life expectancy across UK Biobank participants. Results Nonfatal cardiovascular events and age were the major determinants of CVD risk and, together with incident diabetes and cancer, of individuals' survival. The cumulative incidence of the key endpoints predicted by the CTT-UKB model corresponded well to their observed incidence in the UK Biobank cohort, overall (Figure 1) and in categories of participants by age, sex, prior CVD and CVD risk. Predicted remaining life expectancy across UK Biobank participants without history of CVD ranged between 22 and 43 years in men and between 24 and 46 years in women, depending on their age and CVD risk (Figure 2). Among UK Biobank participants with history of CVD, depending on their age, predicted remaining life expectancy ranged from 20 to 32 years in men and from 26 to 38 years in women. Conclusion This new lifetime CVD model accurately predicts morbidity and mortality in a large UK population cohort. It will be made available to provide individualised projections of expected lifetime health outcomes and benefits of treatments. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme, UK Medical Research Council (MRC), British Heart Foundation Figure 1. Predicted (in black) versus observed (95% CI; in red) incidence of major clinical outcomes in the UK Biobank. Figure 2. Predicted remaining life expectancy of participants in UK Biobank cohort, by age and CVD risk or previous CVD at entry. QRISK, a 10-year CVD risk scoring algorithm for people without previous CVD, recommended for use in the UK National Health Service.

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Abstract 13: Economic Impact of Moderate-vigorous Physical Activity Among Those with and without Established Cardiovascular Disease: 2012 Medical Expenditure Panel Survey

Circulation ◽

10.1161/circ.133.suppl_1.13 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Javier Valero-Elizondo ◽

Joseph A Salami ◽

Chukwuemeka U Osondu ◽

Adnan Younus ◽

Alejandro Arrieta ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Medical Expenditure Panel Survey ◽

Vigorous Physical Activity ◽

Medical Expenditure ◽

Panel Survey ◽

Cvd Risk ◽

Vigorous Exercise ◽

Physically Active ◽

Artery Disease

Background: Physical activity (PA) is an established factor for favorable cardiovascular disease (CVD) outcomes and quality of life. However, to date little is available on PA’s independent impact on healthcare cost. In this study, we aimed to estimate this effect on medical expenditure from a nationally representative cohort with and without CVD. Methods: The 2012 Medical Expenditure Panel Survey data was analyzed. Our study population was limited to non-institutionalized adults ≥ 40 years of age. Variables of interest were CVD (coronary artery disease, stroke, heart failure, dysrhythmias or peripheral artery disease), modifiable risk factors (MRF; hypertension, diabetes mellitus, hypercholesterolemia, smoking, and/or obesity), and PA (dichotomous variable: defined as moderate-vigorous exercise of ≥ 30 minutes, 5 times/week). Two-part econometric models were utilized to study cost data; a generalized linear model with gamma distribution and link log was used to assess expenditures per capita, taking into consideration the survey’s complex design. Results: Our final study sample consisted of 15,651 surveyed individuals (mean age: 58.5 ± 12 years, 46% male). Overall, 46% engaged in at least moderate exercise, translating to 21 million physically active adults in the U.S. Of those with CVD, 34% reported PA, vs. 47% without CVD. In those without CVD, a higher prevalence of PA was noted with lower MRF burden (≥ 3: 35%, 2: 44%, 0-1: 53%). Generally, participants reporting moderate-vigorous PA incurred significantly lower healthcare costs, seen both in those with and without CVD. Among those without CVD, those engaged in moderate-vigorous PA with 0-1 & ≥ 3 MRF had $1,038 & $1,785 less healthcare expenditure, respectively, than their less physically active counterparts. Conclusion: In addition to tremendously improving CVD risk, moderate-vigorous PA is also associated with significantly less healthcare spending. Our findings further reinforce the importance of physical activity in health promotion and CVD prevention.

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The Associations Between Cardiovascular Risk Factors, Physical Activity, and Arterial Stiffness in Youth

Journal of Physical Activity and Health ◽

10.1123/jpah.10.2.198 ◽

2013 ◽

Vol 10 (2) ◽

pp. 198-204 ◽

Cited By ~ 11

Author(s):

Darolyn J. Walker ◽

Andrea MacIntosh ◽

Anita Kozyrskyj ◽

Allan Becker ◽

Jon McGavock

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Cardiovascular Disease ◽

Body Mass Index ◽

Risk Factor ◽

Arterial Stiffness ◽

Cardiometabolic Risk ◽

Vigorous Physical Activity ◽

Cardiometabolic Risk Factor ◽

Cvd Risk

Background:The primary aim of this population-based study was to determine if arterial stiffness is associated with cardiovascular disease (CVD) risk factor clustering and physical activity in youth 12−14 years old. We hypothesized that arterial stiffness would be positively associated with CVD risk factor clustering and negatively associated with physical activity in a dose-response manner in this cohort of youth.Methods:This was a cross sectional study of 485 youth recruited from the 1995 Manitoba birth cohort. The primary outcome, arterial stiffness, was assessed noninvasively using conventional pulse wave analysis and velocity. The primary exposure variables included 1) a measure of cardiometabolic risk, defined as a composite of novel and traditional risk factors for cardiovascular disease and type 2 diabetes and 2) self-reported physical activity.Results:Neither cardiometabolic risk factor clustering, nor physical activity were associated with either measure of arterial stiffness in this cohort of youth 12−14 years. Cardiometabolic risk decreased with increasing levels of vigorous physical activity, (P < .05) and increased with increasing body mass index.Conclusions:Cardiometabolic risk factor clustering and physical activity are not associated with arterial stiffness in youth 12−14 years of age. Increased vigorous physical activity is associated with reduced cardiometabolic risk in youth independent of body mass index.

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Abstract P268: Assessing Physical Inactivity Using Accelerometers in Comparison to International Physical Activity Questionnaire

Circulation ◽

10.1161/circ.131.suppl_1.p268 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Rodrigo P Silva ◽

Rodolfo L Arantes ◽

Agatha C Matheus ◽

Alan C Barbosa ◽

Evandro F Sperandio ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Family History ◽

Physical Inactivity ◽

International Physical Activity Questionnaire ◽

Combined Method ◽

Physical Activity Questionnaire ◽

History Of ◽

Activity Questionnaire ◽

Physically Inactive

Introduction: Among the instruments to assess the level of physical activity in daily life (LPADL), questionnaires are cost advantageous and accelerometers are more accurate. Recent studies have shown poor agreement between these methods. Hypothesis: We tested the hypothesis that the combination of the questionnaire and the accelerometer is the best strategy to assess the prevalence of physical inactivity in adults. Objective: To evaluate and compare the prevalence of physical inactivity in adults, identified by the International Physical Activity Questionnaire (IPAQ), by triaxial accelerometry and by the combination of both. Methods: Two hundred and fifty-one participants older than 18 years were enrolled. After obtaining clinical, demographic and anthropometric data, participants underwent the following assessments: spirometry, cardiopulmonary exercise testing, body composition (bioimpedance), isokinetic muscle function, balance (force platform), and six-minute walk test. Participants who obtained the total score < 600 MET-min/wk were considered physically inactive using IPAQ. Those that performed < 150 min/wk of moderate to vigorous physical activity were considered physically inactive in the accelerometer-based method. In the combined method we considered physically inactive those who presented the IPAQ and/or the accelerometer-based criteria. Additionally, for participants who reported practicing aquatic, martial arts or cycling, only the IPAQ total score was considered. We compared the prevalence of physical inactivity and agreement between the methods. Three multivariate logistic regression models for each one of the methods were developed and predictors were mutualy compared. Results: The prevalence of physical inactivity was significantly different between the methods (IPAQ = 10%; accelerometry = 20%, and combined method = 25%). The agreement between IPAQ and accelerometry was poor (kappa = 0.152, p = 0.01). The main predictors using the IPAQ were age, fat mass, family history of cardiovascular disease, dyslipidemia, and obesity. The determinants using accelerometry were age, sex, lean body mass (LBM), family history of cardiovascular disease and smoking. The combined method selected age, sex, LBM, family history of cardiovascular disease, dyslipidemia, obesity, smoking, peak V’O2 and balance. With the exception of dyslipidemia and family history of cardiovascular disease, the combined method showed better odds ratio values. Conclusion: The combination of the IPAQ and accelerometry to determine physical inactivity was more valid when compared to the aforementioned instruments separately. The prevalence of physical inactivity and its predictors were more consistent in the combined approach in the present study. Our results suggest that the most popular methods for assessing LPADL in epidemiological studies are complementary.

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Lifestyle is associated with atrial fibrillation development in patients with type 2 diabetes mellitus

Scientific Reports ◽

10.1038/s41598-021-84307-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Chan Soon Park ◽

Kyung-Do Han ◽

Eue-Keun Choi ◽

Da Hye Kim ◽

Hyun-Jung Lee ◽

...

Keyword(s):

Physical Activity ◽

Alcohol Consumption ◽

Vigorous Physical Activity ◽

Previous History ◽

Lifestyle Behaviors ◽

Increased Risk ◽

History Of ◽

Never Smokers ◽

New Onset

AbstractWe evaluated the impacts of lifestyle behaviors, namely smoking, alcohol consumption, and physical activity, on the development of new-onset AF in patients with DM. Using the Korean Nationwide database, we identified subjects diagnosed with type 2 DM and without previous history of AF between 2009 and 2012. Self-reported lifestyle behaviors were analyzed. Among 2,551,036 included subjects, AF was newly diagnosed in 73,988 patients (median follow-up 7.1 years). Both ex-smokers (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.02–1.07) and current smokers (HR 1.06, 95% CI 1.03–1.08) demonstrated a higher risk of AF than never smokers. Patients with moderate (15–29 g/day) (HR 1.12, 95% CI 1.09–1.15) and heavy (≥ 30 g/day) (HR 1.24, 95% CI 1.21–1.28) alcohol consumption exhibited an increased risk of AF, while subjects with mild alcohol consumption (< 15 g/day) (HR 1.01, 95% CI 0.99–1.03) had an AF risk similar to that of non-drinkers. Patients who engaged in moderate-to-vigorous physical activity showed a lower risk of AF (HR 0.93, 95% CI 0.91–0.94) than those who did not. This study suggests that smoking, alcohol consumption, and physical activity are associated with new-onset AF in patients with DM, and lifestyle management might reduce the risk of AF in this population.

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