scholarly journals Age-specific atrial fibrillation incidence, attributable risk factors and risk of stroke and mortality: results from the MORGAM Consortium

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001624
Author(s):  
Bente Morseth ◽  
Bastiaan Geelhoed ◽  
Allan Linneberg ◽  
Lars Johansson ◽  
Kari Kuulasmaa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Alcohol Consumption ◽  
Age Groups ◽  
High Alcohol ◽  
Cox Models ◽  
High Alcohol Consumption ◽  
Increased Risk ◽  
History Of ◽  
New Onset

BackgroundThe main aim was to examine age-specific risk factor associations with incident atrial fibrillation (AF) and their attributable fraction in a large European cohort. Additionally, we aimed to examine risk of stroke and mortality in relation to new-onset AF across age.MethodsWe used individual-level data (n=66 951, 49.1% men, age range 40–98 years at baseline) from five European cohorts of the MOnica Risk, Genetics, Archiving and Monograph Consortium. The participants were followed for incident AF for up to 10 years and the association with modifiable risk factors from the baseline examinations (body mass index (BMI), hypertension, diabetes, daily smoking, alcohol consumption and history of stroke and myocardial infarction (MI)) was examined. Additionally, the participants were followed up for incident stroke and all-cause mortality after new-onset AF.ResultsAF incidence increased from 0.9 per 1000 person-years at baseline age 40–49 years, to 17.7 at baseline age ≥70 years. Multivariable-adjusted Cox models showed that higher BMI, hypertension, high alcohol consumption and a history of stroke or MI were associated with increased risk of AF across age groups (p<0.05). Between 30% and 40% of the AF risk could be attributed to BMI, hypertension and a history of stroke or MI. New-onset AF was associated with a twofold increase in risk of stroke and death at ages≥70 years (p≤0.001).ConclusionIn this large European cohort aged 40 years and above, risk of AF was largely attributed to BMI, high alcohol consumption and a history MI or stroke from middle age. Thus, preventive measures for AF should target risk factors such as obesity and hypertension from early age and continue throughout life.

scholarly journals Atrial fibrillation risk factor burden and disease onset across age decades

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Morseth ◽  
B Geelhoed ◽  
A Linneberg ◽  
S Soderberg ◽  
L Johansson ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Alcohol Consumption ◽  
Daily Smoking ◽  
Modifiable Risk Factors ◽  
Risk Of Death ◽  
Increased Risk ◽  
History Of ◽  
New Onset

Abstract Background Although a number of risk factors have been associated with the progression of atrial fibrillation (AF), there is limited knowledge of their relevance for AF in relation to age. Purpose We examined whether the association between modifiable risk factors and AF differed between age decades. Methods Data were derived from five European cohorts from Denmark, Finland, Italy, Sweden, and Norway. In total, 66 951 individuals (49.1% men) aged ≥40 years (mean baseline age 53.5 years) and without prevalent AF were followed for incident AF, with the follow-up truncated at 10 years. Data on risk factors (body mass index [BMI], hypertension [systolic blood pressure ≥140 mmHg and/or use of antihypertensive medication], diabetes mellitus, myocardial infarction [MI] event before baseline examinations, daily smoking, and alcohol consumption) were available from the baseline examinations. Stratification into age decades was based on age at baseline examination. Furthermore, the participants were followed for events of stroke or mortality after AF diagnosis. Mortality, stroke, and AF outcomes were derived from national registers and hospital discharge registers. All analyses were adjusted for AF risk factors. Results The incidence of AF increased from 0.9 per 1000 person-years at the age of 40 to &lt;50, to 17.7 at the age of ≥70 years. Multivariable-adjusted Cox models showed that BMI, hypertension, alcohol consumption, and history of MI were associated with increased risk of AF across age decades (p&lt;0.05). Of these, the risk of AF associated with BMI and an MI event before baseline examinations differed across age decades. For each 5 units increase in BMI, risk of AF increased with 40% (95% confidence interval 17–68%) at the age of 40 to &lt;50, falling to 17% (6–29%) at the age of ≥70 years (p=0.08 for difference between age decades 40 to &lt;50 and ≥70). Participants with a history of MI showed decreased risk of AF with ageing, from a hazard ratio (HR) of 5.53 (2.85–10.73) in the 40 to &lt;50 age group to a HR of 1.41 (1.11–1.79) at the age of ≥70 (p&lt;0.001). Daily smoking and prevalent diabetes mellitus were in general not associated with AF. The multivariable-adjusted associations between new-onset AF and the succeeding risk of stroke and mortality increased with age, showing a 1.6 to 2.6-fold increase in risk of death at ages ≥60 years and two-fold increased risk of stroke in participants aged ≥70 years (p≤0.001). Conclusion The relative importance of modifiable risk factors on incident AF do not vary across age decades, with a few exceptions; BMI and a history of MI were stronger risk factors for AF at younger ages. Thus, preventive measures should target risk factors rigorously, in particular obesity. New-onset AF was associated with increased risk of stroke and mortality only at older ages, emphasizing the importance of adequate patient management in the older and oldest old. Funding Acknowledgement Type of funding source: None

Non-genetic risk factors for atrial fibrillation are equally important in both young and old age: A nationwide population-based study

2020 ◽  
pp. 204748732091566
Author(s):  
Yun Gi Kim ◽  
Kyung-Do Han ◽  
Jong-Il Choi ◽  
Yun Young Choi ◽  
Ha Young Choi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Alcohol Consumption ◽  
Genetic Risk ◽  
Age Groups ◽  
Genetic Risk Factors ◽  
Population Based ◽  
The Impact ◽  
Onset Atrial Fibrillation ◽  
New Onset

Aims There are several non-genetic risk factors for new-onset atrial fibrillation, including age, sex, obesity, hypertension, diabetes, and alcohol consumption. However, whether these non-genetic risk factors have equal significance among different age groups is not known. We performed a nationwide population-based analysis to compare the clinical significance of non-genetic risk factors for new-onset atrial fibrillation in various age groups. Methods and results A total of 9,797,409 people without a prior diagnosis of atrial fibrillation who underwent a national health check-up in 2009 were included. During 80,130,090 person-years of follow-up, a total of 196,136 people were diagnosed with new-onset atrial fibrillation. The impact of non-genetic risk factors on new-onset atrial fibrillation was examined in different age groups. Obesity, male sex, heavy alcohol consumption, smoking, hypertension, diabetes and chronic kidney disease were associated with an increased risk of new-onset atrial fibrillation. With minor variations, these risk factors were consistently associated with the risk of new-onset atrial fibrillation among various age groups. Using these risk factors, we created a scoring system to predict future risk of new-onset atrial fibrillation in different age groups. In receiver operating characteristic curve analysis, the predictive value of these risk factors ranged between 0.556 and 0.603, and no significant trends were observed. Conclusions Non-genetic risk factors for new-onset atrial fibrillation may have a similar impact on different age groups. Except for sex, these non-genetic risk factors can be modifiable. Therefore, efforts to control non-genetic risk factors might have relevance for both the young and old.

scholarly journals Comparison of risk profiles for new-onset atrial fibrillation between patients aged <60 and ≥60 years

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0258770
Author(s):  
In-Soo Kim ◽  
Yeon-Jik Choi ◽  
Eui-Young Choi ◽  
Pil-Ki Min ◽  
Young Won Yoon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cox Regression ◽  
Age Groups ◽  
Chronic Obstructive ◽  
Modifiable Risk Factors ◽  
Age Group ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
New Onset

Background Atrial fibrillation (AF) has a heterogeneous pathophysiology according to individual patient characteristics. This study aimed to identify the effects of widely known risk factors on AF incidence according to age and to elucidate the clinical implications of these effects. Methods and results We analyzed data from 501,668 subjects (≥18years old) without AF and valvular heart disease from the Korean National Health Insurance Service-National Sample Cohort. The total population was divided into two groups according to age, <60years and ≥60years. AF occurred in 0.7% of the overall population (3,416 of 501,668) during the follow-up period (mean 47.6 months). In Cox regression analysis, age, male sex, previous ischemic stroke, heart failure, and hypertension were related to increased risk of new-onset AF in both age groups. Especially in the <60years age group, risk of new-onset AF was increased by relatively modifiable risk factors: obesity (body mass index ≥25kg/m2; hazard ratio[HR] 1.37 [1.22–1.55], p<0.001, interaction p<0.001), and hypertension (HR 1.93[1.69–2.22], p<0.001, interaction p<0.001). Although interactions were not significant, chronic obstructive pulmonary disease (HR 1.41[1.24–1.60], p<0.001) and chronic kidney disease (HR 1.28[1.15–1.41], p<0.001) showed increased trends of the risk of new-onset AF in the ≥60years age group. Conclusion The risk profile for new-onset AF was somewhat different between the <60years and the ≥60years age groups. Compared to the ≥60years group, relatively modifiable risk factors (such as obesity and hypertension) had a greater impact on AF incidence in the <60years age group. Different management strategies to prevent AF development according to age may be needed.

scholarly journals Determinants of new onset cardiometabolic risk among normal weight children

2019 ◽  
Vol 44 (4) ◽  
pp. 781-789
Author(s):  
Andraea Van Hulst ◽  
Marina Ybarra ◽  
Marie-Eve Mathieu ◽  
Andrea Benedetti ◽  
Gilles Paradis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Screen Time ◽  
Cardiometabolic Risk ◽  
Normal Weight ◽  
Healthy Children ◽  
Parental History ◽  
Increased Risk ◽  
History Of ◽  
Metabolically Healthy ◽  
New Onset

Abstract Objective To identify determinants for the development of “normal weight metabolically unhealthy” (NWMU) profiles among previously metabolically healthy normal weight children. Methods The QUALITY cohort comprises youth 8–10 years of age with a parental history of obesity (n = 630). Of these, normal weight children with no metabolic risk factors were identified and followed up 2 years later (n = 193). Children were classified as NWMU if they remained normal weight but developed at least one cardiometabolic risk factor. They were classified as normal weight metabolically healthy otherwise. Multivariable logistic regression models were used to identify whether adiposity (anthropometrics and DXA), lifestyle habits (physical activity, screen time, vegetables, and fruit- and sugar-sweetened beverages intake), fitness, and family history of cardiometabolic disease were associated with new onset NWMU. Results Of the 193 normal weight and metabolically healthy children at baseline, 45 (23%) became NWMU 2 years later (i.e., 48% had elevated HDL cholesterol, 13% had elevated triglycerides, and 4% had impaired fasting glucose). Changes in adiposity between baseline and follow-up were associated with an increased risk of NWMU for all adiposity measures examined (e.g., for ∆zBMI OR = 3.95; 95% CI: 1.76, 8.83). Similarly, a 2-year change in screen time was associated with incident NWMU status (OR = 1.24; 95% CI 1.04, 1.49). Conclusions Children who increase their adiposity levels as they enter puberty, despite remaining normal weight, are at risk of developing cardiometabolic risk factors. Studies examining long-term consequences of NWMU profiles in pediatrics are needed to determine whether changes in screening practice are warranted.

Chinese spirits consumption is an independent risk factor of left atrial appendage thrombosis in non-valvular atrial fibrillation patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Yang ◽  
Y Tian
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Catheter Ablation ◽  
Alcohol Consumption ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Increased Risk ◽  
The Relationship

Abstract Background Alcohol consumption is often associated with an increased risk of atrial fibrillation; however, its association with left atrial appendage (LAA) thrombosis in patients with non-valvular atrial fibrillation (NVAF) remains undefined. Purpose To investigate the relationship between Chinese spirits consumption and LAA thrombosis in NVAF patients. Methods 504 consecutive adult patients with NVAF undergoing first radiofrequency catheter ablation who were enrolled retrospectively from January 2016 to April 2019. LAA thrombosis was identified by transesophageal echocardiography before catheter ablation. Risk factors for LAA thrombosis were determined by uni-/multivariate analysis of data derived from a questionnaire on alcohol consumption and other risk factors for AF, and biochemical and imaging information. Results Of the 504 patients studied, 86 (17.1%) had a drinking habit, and 59 patients (11.7%) had LAA thrombosis. The proportion of alcohol drinking patients was 47.5% (28/59) in the thrombosis group and 12.7% (58/455) in the non-thrombosis group (P&lt;0.001). In multivariate analysis, Chinese spirits consumption (≥12g daily; OR 15.025, 95% CI 6.123–36.815, P&lt;0.001), non-paroxysmal AF (OR 8.301, 95% CI 3.946–17.460, P&lt;0.001), AF duration (OR 1.019, 95% CI 1.010–1.027, P&lt;0.001), CHA2DS2-VASc score (OR 2.078, 95% CI 1.625–2.658, P&lt;0.001), and effective anticoagulation (OR 0.348, 95% CI 0.132–0.921, P=0.033) were independently associated with LAA thrombosis. Conclusions Chinese spirits consumption was independently associated with LAA thrombosis in NVAF patients. Whether avoiding alcohol consumption might reduce the occurrence of LAA thrombosis and thromboembolism in NVAF patients requires further study. Funding Acknowledgement Type of funding source: None

Longitudinal changes in anthropometric measures and new-onset atrial fibrillation among men and women from general population

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Z Lu ◽  
S Geurts ◽  
M.J Tilly ◽  
M.A Ikram ◽  
B Arshi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
General Population ◽  
Community Dwelling ◽  
Anthropometric Measures ◽  
Men And Women ◽  
Longitudinal Changes ◽  
Increased Risk ◽  
Over Time ◽  
New Onset

Abstract Background Atrial fibrillation (AF) is the most common cardiac arrhythmia of clinical significance. Recent evidence suggests differences in epidemiology and risk factors of AF between women and men. Obesity and body size are established risk factors for AF. However, anthropometric measures tend to change over time. Few studies have investigated the impact of longitudinal changes in anthropometric measures on incident AF among men and women. Purpose To assess the association between longitudinal changes in different anthropometric measures and new-onset AF among community-dwelling men and women. Methods Among 12,848 participants free of AF at baseline were included in this large prospective population-based cohort study, each anthropometric measure was measured at least once and up to five times. Anthropometric measures included weight, height, waist circumference (WC), hip circumference (HC), waist to hip ratio (WHR), and body mass index (BMI). Anthropometric measures were standardized for direct comparisons. Joint models were used to assess the association of each anthropometric factor and their longitudinal changes with incident AF. Models were adjusted for age and traditional cardiovascular risk factors. Results A total of 5,266 men and 7,218 women (mean age 63.87 years for men and 64.94 years for women) were followed up for a median of 10.5 years. AF occurred in 630 (12.0%) men and 692 (8.7%) women. Longitudinal increases in weight, height, WC, HC and BMI increased the risk for new-onset AF in a linear manner. The age-adjusted hazard ratios (HRs) and 95% confidence interval (95% CI) were 1.38 (1.26–1.51) for weight, 1.41 (1.26–1.59) for height, 1.26 (1.13–1.41) for WC, 1.36 (1.19–1.55) for HC and 1.22 (1.11–1.35) for BMI among men. Among women, the age-adjusted HRs (95% CI) were 1.41 (1.30–1.52) for weight, 1.21 (1.07–1.38) for height, 1.39 (1.27–1.52) for WC, 1.29 (1.19–1.40) for HC and 1.28 (1.19–1.37) for BMI. Further, longitudinal increase in WHR was significantly associated with increased risk of AF in women [HR (95% CI): 1.42 (1.21–1.66)] but not in men [HR (95% CI): 1.11 (0.96–1.30)]. Conclusions Longitudinal changes in anthropometric measures were associated with the increased risk for new-onset AF among men and women in the general population. An increase in measures of central obesity over time showed a stronger association with incident AF among women, compared to men. Our findings underscore the importance of a sex-specific approach for screening and monitoring of anthropometric measures for AF prevention. Main results among men and women Funding Acknowledgement Type of funding source: None

scholarly journals Venous-Thromboembolism in Elderly Patients with Acute Myeloid Leukemia

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4679-4679 ◽  
Author(s):  
Radhika Gangaraju ◽  
Smita Bhatia ◽  
Kelly Kenzik
Keyword(s):  
Risk Factors ◽  
Cumulative Incidence ◽  
Myeloid Leukemia ◽  
Peripheral Vascular ◽  
Increased Risk ◽  
Elderly Aml ◽  
History Of ◽  
Race Ethnicity ◽  
Morbid Conditions ◽  
New Onset

BACKGROUND: Venous-thromboembolism (VTE) is a debilitating condition and is associated with excess mortality. Small, single institution studies suggest that the risk of VTE in acute myeloid leukemia (AML) patients is elevated and is similar to that seen in solid tumor patients. However, population-based studies describing VTE risk and predictors of VTE in elderly AML patients are lacking. We used Medicare-linked SEER (Surveillance, Epidemiology, and End Results) data to address this knowledge gap. METHODS: We identified 4,166 Medicare beneficiaries diagnosed with AML at age ≥67y between 2007 and 2013. We ascertained baseline sociodemographics and pre-existing comorbidities for 2y prior to AML diagnosis. Patients were followed from AML diagnosis until development of post-AML VTE, or, in the absence of VTE diagnosis, for 2y (if alive), or until death, blood or marrow transplant, or end of study (12/31/2014), whichever came first. VTE diagnosis was based on ICD 9 codes using validated claims algorithms, and included deep vein thrombosis (DVT), pulmonary embolism (PE) and thrombophlebitis. Statistical Analysis: Cumulative incidence functions were used to assess post-AML VTE risk (overall, new-onset). Cox regression models examined the following risk factors associated with VTE: age at AML diagnosis, sex, race/ethnicity, socioeconomic status, history of pre-AML VTE, and pre-existing co-morbid conditions (hypertension, dyslipidemia, diabetes, stroke, rheumatoid arthritis, ischemic heart disease, chronic obstructive pulmonary disease, chronic kidney disease, congestive heart failure, atrial fibrillation, anemia and peripheral vascular disease). RESULTS: Median age at AML diagnosis was 79y (range: 67-105y); 52% were male, 83% non-Hispanic white and 20% resided in an area where >20% of the population lived below poverty level; 50% of the cohort received chemotherapy. Prior to AML diagnosis, 15% were receiving anticoagulants; 2% were on anticoagulation for pre-AML VTE. Cumulative Incidence of VTE: Overall, 167 (4.0%) patients were diagnosed with post-AML VTE (DVT [63%], PE [32%], thrombophlebitis [5%]); 38% had >1 VTE. Of the 167 patients with post-AML VTE, only 25 (15%) had new-onset VTE; the remaining 142 carried a history of pre-AML VTE. The 2y cumulative incidence of any post-AML VTE was 4.3% (95%CI: 3.6%-5.1%) (Fig 1). Fifty-six percent of VTE episodes occurred within 3 months of AML diagnosis. The incidence was 0.6% (95% CI: 0.5%-0.8%) for new-onset VTE and was 1.9% (95%CI 1.3-2.6) for multiple VTEs. The 2y cumulative incidence of post-AML VTE among those with a history of pre-AML VTE was 17.1% (95% CI: 13.3-21.9%). Risk factors for VTE: Adjusting for age at diagnosis, race/ethnicity, census-tract poverty, and co-morbid conditions, AML patients who had pre-AML VTE, were at 7.6-fold increased risk of post-AML VTE (95%CI: 4.8-12.0, p<0.001). No other risk factors were associated with post-AML VTE risk, with the exception of a marginal association between a prior history of peripheral vascular disease and new-onset VTE (HR=3.5, 95%CI: 0.9-14.8, p=0.08) (Table 1). Risk factors for VTE among patients receiving chemotherapy: Adjusting for age at diagnosis, race/ethnicity, census-tract poverty and co-morbid conditions, AML patients with pre-AML VTE were at 8.1-fold increased risk of any post-AML VTE (95%CI: 4.4-14.7, p<0.001). Mortality associated with VTE: The 2y cumulative incidence of mortality for those with no pre-AML VTE was 91%, compared to 95% for those with a pre-AML VTE (HR 1.23, p=0.017). New-onset VTE after the diagnosis of AML was not associated with an increased risk in mortality (HR 1.04, p=0.705). CONCLUSION: History of VTE prior to diagnosis of AML significantly increases the risk of post-AML VTE and overall mortality. These findings can be used to inform appropriate thromboprophylaxis in elderly AML patients who carry a pre-AML diagnosis of VTE. Disclosures No relevant conflicts of interest to declare.

scholarly journals Development of atrial fibrillation following trauma increases short term risk of cardiovascular events

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Sean P. Nassoiy ◽  
Robert H. Blackwell ◽  
McKenzie Brown ◽  
Anai N. Kothari ◽  
Timothy P. Plackett ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Cardiovascular Events ◽  
Prior History ◽  
Trauma Patients ◽  
Index Hospitalization ◽  
Inpatient Mortality ◽  
Increased Risk ◽  
History Of ◽  
New Onset

Abstract Context New onset atrial fibrillation (AF) is associated with poor outcomes in several different patient populations. Objectives To assess the effect of developing AF on cardiovascular events such as myocardial infarction (MI) and cerebrovascular accident (CVA) during the acute index hospitalization for trauma patients. Methods The Healthcare Cost and Utilization Project State Inpatient Databases for California and Florida were used to identify adult trauma patients (18 years of age or older) who were admitted between 2007 and 2010. After excluding patients with a history of AF and prior history of cardiovascular events, patients were evaluated for MI, CVA, and death during the index hospitalization. A secondary analysis was performed using matched propensity scoring based on age, race, and preexisting comorbidities. Results During the study period, 1,224,828 trauma patients were admitted. A total of 195,715 patients were excluded for a prior history of AF, MI, or CVA. Of the remaining patients, 15,424 (1.5%) met inclusion criteria and had new onset AF after trauma. There was an associated increase in incidence of MI (2.9 vs. 0.7%; p<0.001), CVA (2.6 vs. 0.4%; p<0.001), and inpatient mortality (8.5 vs. 2.1%; p<0.001) during the index hospitalization in patients who developed new onset AF compared with those who did not. Cox proportional hazards regression demonstrated an increased risk of MI (odds ratio [OR], 2.35 [2.13–2.60]), CVA (OR, 3.90 [3.49–4.35]), and inpatient mortality (OR, 2.83 [2.66–3.00]) for patients with new onset AF after controlling for all other potential risk factors. Conclusions New onset AF in trauma patients was associated with increased incidence of myocardial infarction (MI), cerebral vascular accident (CVA), and mortality during index hospitalization in this study.

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

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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