Risk Factor Management for Atrial Fibrillation

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population. Many cardiovascular diseases and concomitant conditions increase the risk of the development of AF, recurrent AF, and AF-associated complications. Knowledge of these factors and their management is hence important for the optimal management of patients with AF. Recent studies have suggested that lowering the blood pressure threshold can improve the patients' outcome. Moreover, adverse events associated with a longer duration of hypertension can be prevented through strict blood pressure control. Pre-hypertension, impaired fasting glucose, abdominal obesity, weight fluctuation, and exposure to air pollution are related to the development of AF. Finally, female sex is not a risk factor of stroke, and the age threshold for stroke prevention should be lowered in Asian populations. The management of diseases related to AF should be provided continuously, whereas lifestyle factors should be monitored in an integrated manner.

Keywords: Atrial fibrillation; Hypertension; Obesity; Risk factors.

Figure 1. Risk of adverse outcomes according to blood pressure.

CI = confidence interval; HR = hazard ratio.

Figure 2. Benefit-to-harm ratios of optimal (120–129/<80 mmHg) versus suboptimal blood pressure control (130–139/80–89 mmHg) according to 10-year predicted cardiovascular risk subgroups.

AF = atrial fibrillation; CVD = cardiovascular disease. ^*If a p value is less than 0.05, it is flagged with one star.

Figure 3. Duration of hypertension and risk of ischemic stroke in patients with AF according to different age categories. (A) Age <55 years. (B) Age 55–64 years. (C) Age 65–74 years. (D) Age ≥75 years. Patients with hypertension duration under 1 year are used as reference.

AF = atrial fibrillation; CI = confidence interval; HR = hazard ratio.

Figure 4. Risk of ischemic stroke according to the duration of hypertension in patients with AF. (A) Baseline SBP <120 mmHg. (B) Baseline SBP 120–139 mmHg.

AF = atrial fibrillation; CI = confidence interval; HR = hazard ratio; HTN = hypertension; SBP = systolic blood pressure.

Figure 5. Incidence and risk of AF based on the combination of risk factors.

AF = atrial fibrillation; BMI = body mass index; HR = hazard ratio; HTN = hypertension; LCL = lower confidence limit; IFG = impaired fasting glucose; UCL = upper confidence limit.

Figure 6. Spline curves between BMI and WC, and the HR of new-onset AF. Although there was a non-linear J-shaped association between continuous BMI variables and AF risk (A), the AF risk increased positively as WC increased (B).

AF = atrial fibrillation; BMI = body mass index; HR = hazard ratio; WC = waist circumference.

Figure 7. Incidence rate according to BMI variability. New-onset AF (A), MI (B), ischemic stroke (C), and cardiovascular death (D). Q1: ASV<0.5; Q2: 0.5≤ASV<1.0; Q3: 1.0≤ASV<1.5; Q4: ASV≥1.5.

AF = atrial fibrillation; ASV = average successive variability; BMI = body mass index; MI = myocardial infarction. ^*Asterisks indicate that there is a significant difference between overall Q1 and Q4 (p<0.05).

Figure 8. AF and MI. (A) Cumulative incidence of MI related to AF in the propensity scored-matched cohort. (B) Age-adjusted incidence rate and incidence rate ratios of MI.

AF = atrial fibrillation; MI = myocardial infarction. ^*If a p value is less than 0.05, it is flagged with one star.

Figure 9. Concentration-response relationships between incident AF and long-term exposures to air pollution. (A) PM_2.5. (B) PM₁₀.

AF = atrial fibrillation; HR = hazard ratio; PM_2.5 = particulate matter <2.5 μm; PM₁₀ = particulate matter <10 μm.

Figure 10. ROC curves of delta CHA₂DS₂-VASc scores in predicting ischemic stroke.

AUC = area under the curve; CI = confidence interval; ROC = receiver operating characteristic; SE = standard error.