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. 2020 Oct 27:31:100663.
doi: 10.1016/j.ijcha.2020.100663. eCollection 2020 Dec.

Association between cardiorespiratory fitness, obesity, and incidence of atrial fibrillation

Shirit Kamil-Rosenberg  1 , Peter Kokkinos  2 , Christina Grune de Souza E Silva  1 , Win Leth Shwe Yee  1 , Joshua Abella  1 , Khin Chan  1 , Jonathan Myers  1
Affiliations

Association between cardiorespiratory fitness, obesity, and incidence of atrial fibrillation

Shirit Kamil-Rosenberg et al. Int J Cardiol Heart Vasc. .

Abstract

Background: The interaction between cardiorespiratory fitness (CRF) and incidence of atrial fibrillation (AF) and the interaction between obesity and incidence of AF have been explored separately. Therefore, we evaluated the association between CRF, body mass index (BMI), and risk of developing AF in a cohort of middle-aged and older US Veterans.

Methods: Symptom limited exercise tests (ETT) were conducted among 16,397 Veterans (97% male) from January 9,1987 to December 31,2017. No history of AF was evident at the time of the ETTs. CRF was expressed as quartiles of peak metabolic equivalents (METs) achieved within each age decile. Weight status was classified as normal (BMI < 25 kg/m2), overweight (BMI 25-30 kg/m2), obese (BMI 30-35 kg/m2), or severely obese (BMI > 35 kg/m2). Multivariable Cox proportional hazards regression models were used to compare the association between BMI, CRF categories, and incidence of AF.

Results: Over a median follow-up of 10.7 years, 2,155 (13.1%) developed AF. Obese and severely obese subjects had 13% and 32% higher risks for incidence of AF, respectively, vs. normal weight subjects. Overweight and obese subjects in the most fit quartile had 50% decline in AF risk compared to the least-fit subjects. Severely obese subjects had marked increases in AF risk (~50-60%) regardless of fitness level. Risk of developing AF increases with higher BMI and lower CRF.

Conclusion: Improving CRF should be advocated when assessing those at risk for developing AF.

Keywords: AF, Atrial fibrillation; Arrhythmias; BMI; BMI, Body mass index; CPRS, Computerized patient record system; CRF, Cardiorespiratory fitness; CVD, Cardiovascular disease; Cardiopulmonary fitness; DM, Diabetes mellitus; ETT, Exercise tolerance test; HR, Hazard ratio; HTN, Hypertension; MET, Metabolic equivalent; PA, Physical activity; Risk factors; VA, Veterans affairs.

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Figures

Fig. 1
Fig. 1
Flow chart describing patient population. *Patients not able to perform an ETT because they were unstable or required emergent intervention or were unable to complete the test for orthopedic, neurologic, or other reasons; patients not treated with beta-blockers, but unable to achieve at least 85% of predicted maximal heart rate during the test; and those with an implanted pacemaker, lost to follow-up or subjects with any missing data relevant to the outcome. ETT = Exercise Tolerance Test.
Fig. 2
Fig. 2
Hazard ratios for incidence of atrial Fibrillation by obesity status with 95% confidence intervals. Normal BMI is the reference group. BMI: Body Mass Index; Normal : 18.5–24. 9 kg/m2; Overweight: 25–29.9 kg/m2; Obese: 30–34.5 kg/m2; Severe Obese: ≥35 kg/m2.
Fig. 3
Fig. 3
Risk of atrial fibrillation (HR and 95% CI) within each BMI category according to quartiles of cardiorespiratory fitness, with the least fit group as the referent.P < 0.001 for each CRF category within all BMI categories. Numbers within each bar indicate 95% confidence intervals.
Fig. 4
Fig. 4
Risk of atrial fibrillation (hazard ratio and 95% confidence intervals) for fit and unfit subjects within each BMI category using normal weight (kg/m2).Fit and normal BMI subjects as the referent group. P < 0.001.
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