Epidemiology and Modifiable Risk Factors for Atrial Fibrillation

Overview

Journal Nat Rev Cardiol

Specialty Cardiology & Vascular Diseases

Date 2023 Jan 4

PMID 36600003

Authors

Adrian D Elliott

Melissa E Middeldorp

Isabelle C Van Gelder

Christine M Albert

Prashanthan Sanders

Affiliations

Soon will be listed here.

Abstract

The global prevalence of atrial fibrillation (AF) has increased substantially over the past three decades and is currently approximately 60 million cases. Incident AF and its clinical consequences are largely the result of risk factors that can be modified by lifestyle changes. In this Review, we provide evidence that the lifetime risk of AF is modified not only by sex and race but also through the clinical risk factor and comorbidity burden of individual patients. We begin by summarizing the epidemiology of AF, focusing on non-modifiable and modifiable risk factors, as well as targets and strategies for the primary prevention of AF. Furthermore, we evaluate the role of modifiable risk factors in the secondary prevention of AF as well as the potential effects of risk factor interventions on the frequency and severity of subsequent AF episodes. We end the Review by proposing strategies that require evaluation as well as global policy changes that are needed for the prevention of incident AF and the management of recurrent episodes in patients already affected by AF.

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References

Roth G, Mensah G, Johnson C, Addolorato G, Ammirati E, Baddour L . Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020; 76(25):2982-3021. PMC: 7755038. DOI: 10.1016/j.jacc.2020.11.010. View

Odutayo A, Wong C, Hsiao A, Hopewell S, Altman D, Emdin C . Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis. BMJ. 2016; 354:i4482. DOI: 10.1136/bmj.i4482. View

Chugh S, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin E . Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2013; 129(8):837-47. PMC: 4151302. DOI: 10.1161/CIRCULATIONAHA.113.005119. View

Schnabel R, Yin X, Gona P, Larson M, Beiser A, McManus D . 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet. 2015; 386(9989):154-62. PMC: 4553037. DOI: 10.1016/S0140-6736(14)61774-8. View

Lloyd-Jones D, Wang T, Leip E, Larson M, Levy D, Vasan R . Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation. 2004; 110(9):1042-6. DOI: 10.1161/01.CIR.0000140263.20897.42. View

Heeringa J, van der Kuip D, Hofman A, Kors J, van Herpen G, Stricker B . Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J. 2006; 27(8):949-53. DOI: 10.1093/eurheartj/ehi825. View

Rodriguez C, Soliman E, Alonso A, Swett K, Okin P, Goff Jr D . Atrial fibrillation incidence and risk factors in relation to race-ethnicity and the population attributable fraction of atrial fibrillation risk factors: the Multi-Ethnic Study of Atherosclerosis. Ann Epidemiol. 2014; 25(2):71-6, 76.e1. PMC: 4559265. DOI: 10.1016/j.annepidem.2014.11.024. View

Alonso A, Agarwal S, Soliman E, Ambrose M, Chamberlain A, Prineas R . Incidence of atrial fibrillation in whites and African-Americans: the Atherosclerosis Risk in Communities (ARIC) study. Am Heart J. 2009; 158(1):111-7. PMC: 2720573. DOI: 10.1016/j.ahj.2009.05.010. View

Ugowe F, Jackson 2nd L, Thomas K . Racial and ethnic differences in the prevalence, management, and outcomes in patients with atrial fibrillation: A systematic review. Heart Rhythm. 2018; 15(9):1337-1345. DOI: 10.1016/j.hrthm.2018.05.019. View

10.

Martinez C, Katholing A, Wallenhorst C, Granziera S, Cohen A, Freedman S . Increasing incidence of non-valvular atrial fibrillation in the UK from 2001 to 2013. Heart. 2015; 101(21):1748-54. DOI: 10.1136/heartjnl-2015-307808. View

11.

Guo Y, Tian Y, Wang H, Si Q, Wang Y, Lip G . Prevalence, incidence, and lifetime risk of atrial fibrillation in China: new insights into the global burden of atrial fibrillation. Chest. 2014; 147(1):109-119. DOI: 10.1378/chest.14-0321. View

12.

Mou L, Norby F, Chen L, ONeal W, Lewis T, Loehr L . Lifetime Risk of Atrial Fibrillation by Race and Socioeconomic Status: ARIC Study (Atherosclerosis Risk in Communities). Circ Arrhythm Electrophysiol. 2018; 11(7):e006350. PMC: 6053683. DOI: 10.1161/CIRCEP.118.006350. View

13.

Staerk L, Wang B, Preis S, Larson M, Lubitz S, Ellinor P . Lifetime risk of atrial fibrillation according to optimal, borderline, or elevated levels of risk factors: cohort study based on longitudinal data from the Framingham Heart Study. BMJ. 2018; 361:k1453. PMC: 5917175. DOI: 10.1136/bmj.k1453. View

14.

Magnussen C, Niiranen T, Ojeda F, Gianfagna F, Blankenberg S, Njolstad I . Sex Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors, and Mortality in Community Cohorts: Results From the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe). Circulation. 2017; 136(17):1588-1597. PMC: 5657474. DOI: 10.1161/CIRCULATIONAHA.117.028981. View

15.

Alonso A, Krijthe B, Aspelund T, Stepas K, Pencina M, Moser C . Simple risk model predicts incidence of atrial fibrillation in a racially and geographically diverse population: the CHARGE-AF consortium. J Am Heart Assoc. 2013; 2(2):e000102. PMC: 3647274. DOI: 10.1161/JAHA.112.000102. View

16.

Huxley R, Lopez F, Folsom A, Agarwal S, Loehr L, Soliman E . Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the Atherosclerosis Risk in Communities (ARIC) study. Circulation. 2011; 123(14):1501-8. PMC: 3181498. DOI: 10.1161/CIRCULATIONAHA.110.009035. View

17.

Chamberlain A, Agarwal S, Ambrose M, Folsom A, Soliman E, Alonso A . Metabolic syndrome and incidence of atrial fibrillation among blacks and whites in the Atherosclerosis Risk in Communities (ARIC) Study. Am Heart J. 2010; 159(5):850-6. PMC: 2864775. DOI: 10.1016/j.ahj.2010.02.005. View

18.

Weng L, Preis S, Hulme O, Larson M, Choi S, Wang B . Genetic Predisposition, Clinical Risk Factor Burden, and Lifetime Risk of Atrial Fibrillation. Circulation. 2017; 137(10):1027-1038. PMC: 5840011. DOI: 10.1161/CIRCULATIONAHA.117.031431. View

19.

Di Benedetto L, Michels G, Luben R, Khaw K, Pfister R . Individual and combined impact of lifestyle factors on atrial fibrillation in apparently healthy men and women: The EPIC-Norfolk prospective population study. Eur J Prev Cardiol. 2018; 25(13):1374-1383. DOI: 10.1177/2047487318782379. View

20.

Larsson S, Drca N, Jensen-Urstad M, Wolk A . Combined impact of healthy lifestyle factors on risk of atrial fibrillation: Prospective study in men and women. Int J Cardiol. 2015; 203:46-9. DOI: 10.1016/j.ijcard.2015.10.106. View