scholarly journals Modifiable risk factors predict incident atrial fibrillation and heart failure

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001092
Author(s):  
Jorge A Wong ◽  
David Conen ◽  
Jeff S Healey ◽  
Linda S B Johnson
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Population Attributable Risk ◽  
Population Based ◽  
Modifiable Risk Factors ◽  
Current Cigarette Smoking ◽  
Cox Models ◽  
Risk Factor Modification ◽  
Obesity Hypertension

ObjectiveHeart failure (HF) frequently complicates atrial fibrillation (AF) and significantly increases mortality risk. Limited data exist on the modifiable risk factors associated with development of HF in AF patients.MethodsWe examined two large, prospective, population-based cohorts without prior AF or HF at baseline: Malmö Preventive Project (MPP, n=32 625) and Malmö Diet and Cancer Study (MDCS, n=27 695). Using Lunn-McNeil competing risks, multivariable Cox models were constructed to determine hazard ratios (HR) and 95% confidence intervals (CI) of risk factors for incident HF with AF, and AF alone.ResultsMean follow-up in MPP and MDCS was 27.6±8.4 and 17.7±5.3 years. In MPP, body mass index (HR 1.11, 95% CI 1.09 to 1.13 vs HR 1.05, 95% CI 1.04 to 1.06 per kg/m2), systolic blood pressure (HR 1.20, 95% CI 1.24 to 1.26 vs HR 1.08, 95% CI 1.06 to 1.10 per 10 mm Hg) and current cigarette smoking (HR 1.73, 95% CI 1.54 to 1.95 vs HR 1.23, 95% CI 1.15 to 1.32) had stronger associations with incident AF with HF compared with AF alone (all p for difference <0.0001). Similar results were observed in MDCS (all p for difference <0.009). These three risk factors and diabetes accounted for 51.8% and 54.1% of the population attributable risk (PAR) for AF with HF in MPP and MDCS, respectively, compared with 20.1% and 27.0% for AF alone.ConclusionsObesity, hypertension and active smoking preferentially associated with AF with HF, compared with AF alone, and accounted for >50% of the PAR. Randomised trials are needed to assess whether risk factor modification can reduce the incidence of AF with HF and reduce mortality.

scholarly journals Race- and Sex-Specific Population Attributable Fractions of Incident Heart Failure

2021 ◽  
Author(s):  
Arjun Sinha ◽  
Hongyan Ning ◽  
Mercedes R. Carnethon ◽  
Norrina B. Allen ◽  
John T. Wilkins ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Risk Factor ◽  
Black Women ◽  
Population Attributable Fraction ◽  
Population Based ◽  
Competing Risk ◽  
Modifiable Risk Factors ◽  
Risk Of Death ◽  
Obesity Hypertension

Background: Race- and sex-specific differences in heart failure (HF) risk may be related to differential burden and effect of risk factors. We estimated the population attributable fraction (PAF), which incorporates both prevalence and excess risk of HF associated with each risk factor (obesity, hypertension, diabetes, current smoking, and hyperlipidemia), in specific race-sex groups. Methods: A pooled cohort was created using harmonized data from 6 US longitudinal population-based cohorts. Baseline measurements of risk factors were used to determine prevalence. Relative risk of incident HF was assessed using a piecewise constant hazards model adjusted for age, education, other modifiable risk factors, and the competing risk of death from non-HF causes. Within each race-sex group, PAF of HF was estimated for each risk factor individually and for all risk factors simultaneously. Results: Of 38 028 participants, 55% were female and 22% Black. Hypertension had the highest PAF among Black men (28.3% [18.7–36.7]) and women (25.8% [16.3%–34.2%]). In contrast, PAF associated with obesity was the highest in White men (21.0% [14.6–27.0]) and women (17.9% [12.8–22.6]). Diabetes disproportionately contributed to HF in Black women (PAF, 16.4% [95% CI, 12.7%–19.9%]). The cumulative PAF of all 5 risk factors was the highest in Black women (51.9% [39.3–61.8]). Conclusions: The observed differences in contribution of risk factors across race-sex groups can inform tailored prevention strategies to mitigate disparities in HF burden. This novel competing risk analysis suggests that a sizeable proportion of HF risk may not be associated with modifiable risk factors.

scholarly journals Risk and predictors of heart failure in sarcoidosis in a population-based cohort study from Sweden

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319129
Author(s):  
Marios Rossides ◽  
Susanna Kullberg ◽  
Johan Grunewald ◽  
Anders Eklund ◽  
Daniela Di Giuseppe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
General Population ◽  
Strong Predictor ◽  
Strong Association ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Clinical Predictors ◽  
Cox Models ◽  
Classification Of Diseases

ObjectivesPrevious studies showed a strong association between sarcoidosis and heart failure (HF) but did not consider risk stratification or risk factors to identify useful aetiological insights. We estimated overall and stratified HRs and identified risk factors for HF in sarcoidosis.MethodsSarcoidosis cases were identified from the Swedish National Patient Register (NPR; ≥2 International Classification of Diseases-coded visits, 2003–2013) and matched to general population comparators. They were followed for HF in the NPR. Treated were cases who were dispensed ≥1 immunosuppressant ±3 months from the first sarcoidosis visit (2006–2013). Using Cox models, we estimated HRs adjusted for demographics and comorbidity and identified independent risk factors of HF together with their attributable fractions (AFs).ResultsDuring follow-up, 204 of 8574 sarcoidosis cases and 721 of 84 192 comparators were diagnosed with HF (rate 2.2 vs 0.7/1000 person-years, respectively). The HR associated with sarcoidosis was 2.43 (95% CI 2.06 to 2.86) and did not vary by age, sex or treatment status. It was higher during the first 2 years after diagnosis (HR 3.7 vs 1.9) and in individuals without a history of ischaemic heart disease (IHD; HR 2.7 vs 1.7). Diabetes, atrial fibrillation and other arrhythmias were the strongest independent clinical predictors of HF (HR 2.5 each, 2-year AF 20%, 16% and 12%, respectively).ConclusionsAlthough low, the HF rate was more than twofold increased in sarcoidosis compared with the general population, particularly right after diagnosis. IHD history cannot solely explain these risks, whereas ventricular arrhythmias indicating cardiac sarcoidosis appear to be a strong predictor of HF in sarcoidosis.

Prevention of atrial fibrillation – non-modifiable and modifiable risk factors for AF

2020 ◽  
Vol 2 (55) ◽  
pp. 14-19
Author(s):  
Agnieszka Wojdyła-Hordyńska ◽  
Grzegorz Hordyński
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Cardiovascular Diseases ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Combined Treatment ◽  
Lifestyle Changes ◽  
Modifiable Risk Factors

Atrial fibrillation is one of the most common arrhythmias, with a significant increase in incidence in recent years. AF is a major cause of stroke, heart failure, sudden cardiac death, and cardiovascular disease. Timely intervention and modification of risk factors increase chance to stop the disease. Aggressive, multilevel prevention tactics are a component of combined treatment, including – in addition to lifestyle changes, anticoagulant therapy, pharmacotherapy and invasive anti-arrhythmic treatment – prevention of cardiovascular diseases, hypertension, ischemia, valvular disease and heart failure.

scholarly journals Atrial fibrillation: A review of modifiable risk factors and preventive strategies

2019 ◽  
Vol 57 (2) ◽  
pp. 99-109 ◽  
Author(s):  
Alireza Sepehri Shamloo ◽  
Nikolaos Dagres ◽  
Arash Arya ◽  
Gerhard Hindricks
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Underlying Mechanism ◽  
Modifiable Risk Factors ◽  
Preventive Strategies ◽  
Mortality And Morbidity ◽  
Obstructive Sleep ◽  
Obesity Hypertension ◽  
Development And Management

Abstract Atrial fibrillation (AF), as the most common cardiac arrhythmia worldwide, is associated with increased mortality and morbidity. Successful therapeutic strategies have been introduced so far, but they are associated with significant costs. Therefore, identification of modifiable risk factors of AF and the development of appropriate preventive strategies may play a substantial role in promoting community health and reducing health care system costs. Modifiable cardiovascular risk factors including obesity, hypertension, diabetes mellitus, obstructive sleep apnea, alcohol consumption, smoking, and sedentary lifestyles have been proposed as possible contributors to the development and progression of AF. In this review, we discuss the role of modifiable risk factors in the development and management of AF and the evidence for the underlying mechanism for each of the potential risk factor.

Impact of stroke on heart function

ESC CardioMed ◽  
2018 ◽  
pp. 954-957
Author(s):  
Christoph Kleinschnitz
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Heart Disease ◽  
Neurological Disease ◽  
Heart Function ◽  
Population Based ◽  
Cardiac Diseases ◽  
Possible Cause

Much emphasis has been placed on the heart as a possible cause of neurological disease. Cardiac diseases, such as atrial fibrillation, valvular heart disease, or congestive heart failure are well-established, important risk factors for ischaemic stroke. Within population-based studies, about 30% of ischaemic strokes are caused by cardiac diseases.

scholarly journals Primary prevention of atrial fibrillation in patients with metabolic syndrome: correction of modifiable risk factors

2021 ◽  
Vol 6 (2) ◽  
pp. 103-115
Author(s):  
A. I. Olesin ◽  
I. V. Konstantinova
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Metabolic Syndrome ◽  
Primary Prevention ◽  
High Risk ◽  
Modifiable Risk Factors ◽  
Financial Costs ◽  
Increased Risk

Currently, around 34 million people worldwide suffer from atrial fibrillation (AF), with the number projected to double by 2060. Despite the treatment of AF has been significantly improved during the recent years, AF is still associated with an increased risk of severe complications such as systemic thromboembolism, progression of heart failure, stroke, and myocardial infarction. Due to a high risk of disability and mortality, AF represent a major socioeconomic problem for the healthcare in most countries, also because of related financial costs. Obesity, most often represented by metabolic syndrome, is widely recognized as an epidemic of the XXI century. Here we review the features of AF development in patients with metabolic syndrome, suggesting novel avenues for the primary prevention of AF. 

scholarly journals The Influence of Rheumatoid Arthritis Disease Characteristics on Heart Failure

2011 ◽  
Vol 38 (8) ◽  
pp. 1601-1606 ◽  
Author(s):  
ELENA MYASOEDOVA ◽  
CYNTHIA S. CROWSON ◽  
PAULO J. NICOLA ◽  
HILAL MARADIT-KREMERS ◽  
JOHN M. DAVIS ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Heart Failure ◽  
Population Based ◽  
Independent Effect ◽  
Cox Models ◽  
American College Of Rheumatology ◽  
Disease Characteristics ◽  
Rheumatoid Arthritis Disease ◽  
History Of

Objective.To examine the influence of rheumatoid arthritis (RA) characteristics and antirheumatic medications on the risk of heart failure (HF) in patients with RA.Methods.A population-based incidence cohort of RA patients aged ≥ 18 years (1987 American College of Rheumatology criteria first met between January 1, 1980, and January 1, 2008) with no history of HF was followed until onset of HF (defined by Framingham criteria), death, or January 1, 2008. We collected data on RA characteristics, antirheumatic medications, and cardiovascular (CV) risk factors. Cox models adjusting for age, sex, and calendar year were used to analyze the data.Results.The study included 795 RA patients [mean age 55.3 yrs, 69% women, 66% rheumatoid factor (RF)-positive]. During the mean followup of 9.7 years, 92 patients developed HF. The risk of HF was associated with RF positivity (HR 1.6, 95% CI 1.0, 2.5), erythrocyte sedimentation rate (ESR) at RA incidence (HR 1.6, 95% CI 1.2, 2.0), repeatedly high ESR (HR 2.1, 95% CI 1.2, 3.5), severe extraarticular manifestations (HR 3.1, 95% CI 1.9, 5.1), and corticosteroid use (HR 2.0, 95% CI 1.3, 3.2), adjusting for CV risk factors and coronary heart disease (CHD). Methotrexate users were half as likely to have HF as nonusers (HR 0.5, 95% CI 0.3, 0.9).Conclusion.Several RA characteristics and the use of corticosteroids were associated with HF, with adjustment for CV risk factors and CHD. Methotrexate use appeared to be protective against HF. These findings suggest an independent effect of RA on HF that may be further modified by antirheumatic treatment.

scholarly journals Risk factor modification reduced incidence of atrial fibrillation in an 18-year prospective cohort study: a time-updated analysis

2021 ◽  
Author(s):  
Mi Kyoung Son ◽  
Dae Sub Song ◽  
Kyoungho Lee ◽  
Hyun-Young Park
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Central Obesity ◽  
Hazard Ratio ◽  
Time Varying ◽  
Epidemiology Study ◽  
Cox Models ◽  
Risk Factor Modification ◽  
Changes In Risk

Abstract Background Although atrial fibrillation (AF) is an increasing health burden worldwide, strategies for AF prevention are lacking. This study aimed to identify modifiable risk factors (MRF) for and estimate their impact on AF risk in the midlife general population. Methods We assessed 9,049 participants who were free of prevalent AF at baseline from the Korean Genome and Epidemiology Study. Cox models with time-varying assessment of risk factors were used to identify significant MRF for incident AF. The MRF burden was defined as the proportion of times presented MRF during follow-up, based on the number of visits. Results Over a median follow-up of 13.1 years, 182 (2.01%) participants developed AF. In time-updated multivariable models accounting for changes in risk factors, three MRF including systolic blood pressure (SBP) more than 140 mmHg, obesity with central obesity, and an inactive lifestyle were significantly associated with incident AF. Compared to subjects with three MRF, those with one or no MRF had a decreased risk of AF (hazard ratio [95% CI] for one MRF, 0.483 [0.256–0.914]; and for no MRF, 0.291 [0.145–0.583]). A decreasing MRF burden was associated with reduced AF risk (hazard ratio [95% CI] per 10% decrease in SBP more than 140 mmHg, 0.937 [0.880–0.997]; in obesity with central obesity, 0.942 [0.907–0.978]; in inactivity, 0.926 [0.882–0.973]). Conclusions Maintenance or achievement of optimal MRF control was associated with decreased AF risk, suggesting that minimizing the burden of MRF might help prevent AF.

scholarly journals Comparison of Cardiovascular Risk Factors in European Population Cohorts for Predicting Atrial Fibrillation and Heart Failure, Their Subsequent Onset, and Death

2020 ◽  
Vol 9 (9) ◽  
Author(s):  
Benedikt Schrage ◽  
Bastiaan Geelhoed ◽  
Teemu J. Niiranen ◽  
Francesco Gianfagna ◽  
Julie K. K. Vishram‐Nielsen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Body Mass ◽  
High Sensitivity ◽  
Population Based ◽  
Male Sex ◽  
Subsequent Onset

Background Differences in risk factors for atrial fibrillation (AF) and heart failure (HF) are incompletely understood. Aim of this study was to understand whether risk factors and biomarkers show different associations with incident AF and HF and to investigate predictors of subsequent onset and mortality. Methods and Results In N=58 693 individuals free of AF/HF from 5 population‐based European cohorts, Cox regressions were used to find predictors for AF, HF, subsequent onset, and mortality. Differences between associations were estimated using bootstrapping. Median follow‐up time was 13.8 years, with a mortality of 15.7%. AF and HF occurred in 5.0% and 5.4% of the participants, respectively, with 1.8% showing subsequent onset. Age, male sex, myocardial infarction, body mass index, and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) showed similar associations with both diseases. Antihypertensive medication and smoking were stronger predictors of HF than AF. Cholesterol, diabetes mellitus, and hsCRP (high‐sensitivity C‐reactive protein) were associated with HF, but not with AF. No variable was exclusively associated with AF. Population‐attributable risks were higher for HF (75.6%) than for AF (30.9%). Age, male sex, body mass index, diabetes mellitus, and NT‐proBNP were associated with subsequent onset, which was associated with the highest all‐cause mortality risk. Conclusions Common risk factors and biomarkers showed different associations with AF and HF, and explained a higher proportion of HF than AF risk. As the subsequent onset of both diseases was strongly associated with mortality, prevention needs to be rigorously addressed and remains challenging, as conventional risk factors explained only 31% of AF risk.

scholarly journals Risk of cardiovascular disease among patients with sarcoidosis: a population-based retrospective cohort study, 1976–2013

2016 ◽  
Vol 49 (2) ◽  
pp. 1601290 ◽  
Author(s):  
Patompong Ungprasert ◽  
Cynthia S. Crowson ◽  
Eric L. Matteson
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Congestive Heart Failure ◽  
Cerebrovascular Accident ◽  
Index Date ◽  
Population Based ◽  
Artery Disease

A higher incidence of cardiovascular disease (CVD) has been observed in several chronic inflammatory diseases. However, data on sarcoidosis are limited.In this study, 345 patients with incident sarcoidosis in Olmsted County (Minnesota, USA) during 1976–2013 were identified based on comprehensive medical record review. 345 sex- and age-matched comparators were also identified from the same underlying population. Medical records were individually reviewed for CVD, including coronary artery disease, congestive heart failure, atrial fibrillation, cerebrovascular accident, transient ischaemic attack, peripheral arterial disease and abdominal aortic aneurysm. Cox proportional hazards models with adjustment for age, sex, calendar year and cardiovascular risk factors were used to compare the rate of development of CVD between cases and comparators.The prevalence of CVD before the index date was not significantly different between the two groups. Adjusting for age, sex and calendar year, the risk of incident CVD after the index date was significantly elevated among patients with sarcoidosis with an adjusted hazard ratio of 1.57 (95% CI 1.15–2.16). Adjustment for cardiovascular risk factors yielded an adjusted hazard ratio of 1.65 (95% CI 1.08–2.53). Significantly increased risk was also observed for several types of CVD, including coronary artery disease, congestive heart failure, atrial fibrillation and cerebrovascular accident.Increased incidence of CVD among patients with sarcoidosis was demonstrated in this population-based cohort, even after controlling for baseline traditional atherosclerotic risk factors.

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