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