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

Abstract

Background: The 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.

Methods: We 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.

Results: AF 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).

Conclusion: In 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.

Keywords: atrial fibrillation; epidemiology; risk factors; stroke.

Figure 1

Risk of AF by age groups, presented as HR with 95% CI. HRs were presented on a log scale with base 2, adjusted for sex, BMI, SBP, total serum cholesterol, daily smoking, history of diabetes, antihypertensive drugs, daily alcohol consumption, and study site. AF, atrial fibrillation; BMI, body mass index; SBP, systolic blood pressure.

Figure 2

Risk of stroke and mortality according to new-onset AF versus no AF, presented as HR with 95% CI. HRs were adjusted for age, sex, BMI, SBP, total serum cholesterol, daily smoking, history of diabetes, antihypertensive drugs, daily alcohol consumption, and study site. AF, atrial fibrillation; BMI, body mass index; SBP, systolic blood pressure.