Cardiorespiratory Fitness and Risk of Incident Atrial Fibrillation

Abstract

A trial fibrillation (AF) is the most common sustained cardiac arrhythmia, currently affecting >2 million people in the United States. 1 With an aging population, its prevalence is projected to double over the next 30 years. 2,3 The total health expenditures incurred by patients with AF are almost 5 times those of patients without AF, ranging between $6 and $26 billion.4 AF is also associated with considerable morbidity and mortality. 5 Although the management of AF has received much attention, literature furthering our understanding of AF prevention remains limited. Editorial see p 1821 Clinical Perspective on p 1834Several studies have suggested an association between lifetime physical activity and the development of AF. 6,7 However, these studies used self-reported physical activity as a measure of physical function, which is not a direct measure of underlying physiology. The impact of cardiorespiratory fitness (CRF) on risk of AF has not been examined previously in large, multiracial cohort. In addition, it is not known if this relationship is influenced by incident coronary artery disease or incident left ventricular dysfunction, and the interactions between modifiable risk factors of AF (including obesity, hypertension, diabetes mellitus, smoking, and hyperlipidemia) and CRF and incident AF are also not well established.Background-Poor cardiorespiratory fitness (CRF) is an independent risk factor for cardiovascular morbidity and mortality.However, the relationship between CRF and atrial fibrillation (AF) is less clear. The aim of this analysis was to investigate the association between CRF and incident AF in a large, multiracial cohort that underwent graded exercise treadmill testing. Methods and Results-From 1991 to 2009, a total of 64 561 adults (mean age, 54.5±12.7 years; 46% female; 64% white) without AF underwent exercise treadmill testing at a tertiary care center. Baseline demographic and clinical variables were collected. Incident AF was ascertained by use of International Classification of Diseases, Ninth Revision code 427.31 and confirmed by linkage to medical claim files. Nested, multivariable Cox proportional hazards models were used to estimate the independent association of CRF with incident AF. During a median follow-up of 5.4 years (interquartile range, 3-9 years), 4616 new cases of AF were diagnosed. After adjustment for potential confounders, 1 higher metabolic equivalent achieved during treadmill testing was associated with a 7% lower risk of incident AF (hazard ratio, 0.93; 95% confidence interval, 0.92-0.94; P<0.001). This relationship remained significant after adjustment for incident coronary artery disease (hazard ratio, 0.92; 95% confidence interval, 0.91-0.93; P<0.001). The magnitude of the inverse association between CRF and incident AF was greater among obese compared with nonobese individuals (P for interaction=0.02). Conclusions Methods Study Population and SettingsThe methods of the Henry Ford Exercise Testing (FIT) Project have been published previously. 8 In short, the FIT...

Aerobic Interval Training Reduces the Burden of Atrial Fibrillation in the Short Term

“…Light to moderate amounts of exercise seem to reduce AF risk, 13,15,16 and better cardiorespiratory fitness is shown to have a graded, inverse relationship to AF risk up to a certain point. 28,29 Our study results extend these previous findings by also showing a reduced burden of AF in individuals with manifest disease. This concept of AF treatment has not previously been reported, but other studies have shown that modification of risk factors reduces AF burden, 30,31 risk of new-onset AF, 32 and recurrence after ablation 33,34 and cardioversion.…”

Association Between Midlife Cardiorespiratory Fitness and Risk of Stroke

“…[2][3][4][5][6] However, the mechanism by which higher levels of CRF might lower stroke risk have not been well established, and it remains uncertain to what extent there may be a direct effect of CRF on stroke risk, independent of established stroke risk factors such as hypertension, diabetes mellitus (DM), and atrial fibrillation (AF). [7][8][9][10] Although previous studies evaluating the relationship between CRF/physical activity and risk of stroke adjust for the baseline risk factors, [3][4][5][6][7]11 they do not allow for the adjustment for subsequent, downstream risk factors acquired after CRF/physical activity measurement. Against this background, we linked the Cooper Center Longitudinal Study (CCLS) with individual claims data from the Center for Medicare and Medicaid Services (CMS) to better characterize the association between midlife CRF and stroke risk at a later age.…”

Evaluation of Patients with Lower Extremity Peripheral Artery Disease by Walking Tests: A Pilot Study

“…Selvin shows in the National Health and Nutrition Survey (NHANES) that arterial hypertension is strongly correlated with PAD (Selvin and Erlinger, 2004). Rhythm disorders decrease the patient's biologic balance and affect the quality of life (Feringa et al, 2006;Qureshi et al, 2015).…”