Lifetime risk of atrial fibrillation according to optimal, borderline, or elevated levels of risk factors: cohort study based on longitudinal data from the Framingham Heart Study

Abstract

ObjectiveTo examine the association between risk factor burdens—categorized as optimal, borderline, or elevated—and the lifetime risk of atrial fibrillation.DesignCommunity based cohort study.SettingLongitudinal data from the Framingham Heart Study.ParticipantsIndividuals free of atrial fibrillation at index ages 55, 65, and 75 years were assessed. Smoking, alcohol consumption, body mass index, blood pressure, diabetes, and history of heart failure or myocardial infarction were assessed as being optimal (that is, all risk factors were optimal), borderline (presence of borderline risk factors and absence of any elevated risk factor), or elevated (presence of at least one elevated risk factor) at index age.Main outcome measureLifetime risk of atrial fibrillation at index age up to 95 years, accounting for the competing risk of death.ResultsAt index age 55 years, the study sample comprised 5338 participants (2531 (47.4%) men). In this group, 247 (4.6%) had an optimal risk profile, 1415 (26.5%) had a borderline risk profile, and 3676 (68.9%) an elevated risk profile. The prevalence of elevated risk factors increased gradually when the index ages rose. For index age of 55 years, the lifetime risk of atrial fibrillation was 37.0% (95% confidence interval 34.3% to 39.6%). The lifetime risk of atrial fibrillation was 23.4% (12.8% to 34.5%) with an optimal risk profile, 33.4% (27.9% to 38.9%) with a borderline risk profile, and 38.4% (35.5% to 41.4%) with an elevated risk profile. Overall, participants with at least one elevated risk factor were associated with at least 37.8% lifetime risk of atrial fibrillation. The gradient in lifetime risk across risk factor burden was similar at index ages 65 and 75 years.ConclusionsRegardless of index ages at 55, 65, or 75 years, an optimal risk factor profile was associated with a lifetime risk of atrial fibrillation of about one in five; this risk rose to more than one in three in individuals with at least one elevated risk factor.

Catheter ablation of atrial fibrillation—A key role in heart failure therapy?

“…Importantly, recent longitudinal data from the Framingham Heart Study highlighted the fact that the risk factor burden and the existence of multiple morbidities have a crucial role in the lifetime risk of atrial fibrillation. Participants with at least one elevated risk factor were confronted with a lifetime AF risk as high as 37.8% . Of note, diabetes mellitus seems to be a major factor for the development of AF.…”

“…Up to date, the mechanisms of sustained AF and the nature of arrhythmogenic substrates are still a matter of debate and inter-individual differences between patients most likely account for inconsistencies. 5 Importantly, recent longitudinal data from the Framingham Heart Study 6 highlighted the fact that the risk factor burden and the existence of multiple morbidities have a crucial role in the lifetime risk of atrial fibrillation. Participants with at least one elevated risk factor were confronted with a lifetime AF risk as high as 37.8%.…”

“…Participants with at least one elevated risk factor were confronted with a lifetime AF risk as high as 37.8%. 6 Of note, diabetes mellitus seems to be a major factor for the development of AF. Patients with diabetes mellitus were shown to have a lifetime risk of AF of approximately 40%.…”

Genetic risk and atrial fibrillation in patients with heart failure

“…Atrial fibrillation (AF) is the most common cardiac arrhythmia and is highly prevalent in patients with heart failure. [1][2][3] The co-existence of these conditions can be expected by virtue of their prevalence alone: the lifetime risk of developing AF is about one in three in individuals of European ancestry and one in five in individuals of African ancestry, [4][5][6] and after age 45 the lifetime risk of heart failure ranges between 20-45%. 7 Furthermore, both conditions have many shared risk factors which makes their co-existence more likely.…”

Categorising severity of disease is inevitable and essential in routine medical practice

“…For example, risk needs to be categorised in discussing anticoagulation for atrial fibrillation, statins for primary prevention, and adjuvant chemotherapy for breast cancer 234…”