Body Mass Index in Adolescence and Long‐Term Risk of Early Incident Atrial Fibrillation and Subsequent Mortality, Heart Failure, and Ischemic Stroke

Abstract

Background We sought to determine the role of obesity in adolescent men on development of atrial fibrillation (AF) and subsequent associated clinical outcomes in subjects diagnosed with AF. Methods and Results We conducted a nationwide, register‐based, cohort study of 1 704 467 men (mean age, 18.3±0.75 years) enrolled in compulsory military service in Sweden from 1969 through 2005. Height and weight, blood pressure, fitness, muscle strength, intelligence quotient, and medical disorders were recorded at baseline. Records obtained from the National Inpatient Registry and the Cause of Death Register were used to determine incidence and clinical outcomes of AF. During a median follow‐up of 32 years (interquartile range, 24–41 years), 36 693 cases (mean age at diagnosis, 52.4±10.6 years) of AF were recorded. The multivariable‐adjusted hazard ratio (HR) for AF increased from 1.06 (95% CI, 1.03–1.10) in individuals with body mass index (BMI) of 20.0 to <22.5 kg/m 2 to 3.72 (95% CI, 2.44–5.66) among men with BMI of 40.0 to 50.0 kg/m 2 , compared with those with BMI of 18.5 to <20.0 kg/m 2 . During a median follow‐up of ≈6 years in patients diagnosed with AF, we identified 3767 deaths, 3251 cases of incident heart failure, and 921 cases of ischemic stroke. The multivariable‐adjusted HRs for all‐cause mortality, incident heart failure, and ischemic stroke in AF‐diagnosed men with baseline BMI >30 kg/m 2 compared with those with BMI <20 kg/m 2 were 2.86 (95% CI, 2.30–3.56), 3.42 (95% CI, 2.50–4.68), and 2.34 (95% CI, 1.52–3.61), respectively. Conclusions Increasing BMI in adolescent men is strongly associated with early AF, and with subsequent worse clinical outcomes in those diagnosed with AF with respect to all‐cause mortality, incident heart failure, and ischemic stroke.

Interacting and joint effects of triglyceride-glucose index (TyG) and body mass index on stroke risk and the mediating role of TyG in middle-aged and older Chinese adults: a nationwide prospective cohort study

“…Our study reiterates the well-established association between elevated BMI and increased stroke risk, corroborating previous research findings [ 3 , 4 ]. Obesity, as indicated by BMI, is recognized as a significant and modifiable risk factor for stroke [ 3 , 4 ].…”

“…Our study reiterates the well-established association between elevated BMI and increased stroke risk, corroborating previous research findings [ 3 , 4 ]. Obesity, as indicated by BMI, is recognized as a significant and modifiable risk factor for stroke [ 3 , 4 ]. Particularly abdominal or visceral obesity, is associated with a host of metabolic abnormalities, including insulin resistance, dyslipidemia, and inflammation [ 27 – 29 ].…”

“…In contrast to our initial hypothesis, our findings suggest that there is no significant synergy or interaction between these two factors in their impact on stroke risk. In essence, while both BMI and the TyG independently contribute to stroke risk [ 3 , 4 , 14 , 15 ], their combined effect does not appear to exceed the sum of their individual effects. This observation introduces complexity into our understanding of how BMI and the TyG jointly influence stroke risk.…”

“…Stroke remains a leading cause of mortality and long-term disability worldwide, necessitating a deeper understanding of its risk factors for effective prevention and management [ 1 , 2 ]. Traditionally, body mass index (BMI) has been employed as a principal metric for assessing obesity, which is a well-established risk factor for stroke [ 3 , 4 ]. However, BMI, a measure based solely on height and weight, has limitations in capturing the complexity of metabolic health.…”

Obesity-Related Atrial Fibrillation: Cardiac Manifestation of a Systemic Disease

“…There are multiple lines of evidence linking obesity and AF. Numerous epidemiological studies have shown that obesity is associated with new-onset AF even after adjustment for other comorbidities associated with obesity [ 24 , 25 , 26 ]. A meta-analysis of 51 studies with over 600,000 individuals by Wong et al showed a 29% greater risk of overall incident AF and a 10% greater risk of postoperative AF for each 5-unit increase in BMI [ 19 , 27 ].…”