Physical Activity and the Risk of Incident Atrial Fibrillation in Women

Everett, Brendan M.; Conen, David; Buring, Julie E.; Moorthy, M. Vinayaga; Lee, I-Min; Chen, Albert

doi:10.1161/circoutcomes.110.951442

Cited by 102 publications

(97 citation statements)

References 44 publications

(52 reference statements)

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“…19 Similarly, women enrolled in the Women's Health Initiative (WHI) Study who achieved at least 7.5 MET·h/wk were found to be at a modestly lower risk of AF (HR, 0.86; 95% CI, 0.75-0.98; P=0.03). 20 However, this association did not remain significant after adjustment for BMI (a measure of obesity). The authors commented that BMI plays an important role in determining the relationship between physical activity and AF.…”

Section: Discussionmentioning

confidence: 95%

Cardiorespiratory Fitness and Risk of Incident Atrial Fibrillation

Qureshi

Alirhayim

Blaha³

et al. 2015

Circulation

178

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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...

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Section: Discussionmentioning

confidence: 95%

Cardiorespiratory Fitness and Risk of Incident Atrial Fibrillation

Qureshi

Alirhayim

Blaha³

et al. 2015

Circulation

178

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“…[78][79][80] Conversely, excessive or vigorous sports practices (eg, endurance or high-performance athletes) are linked to a higher AF prevalence. A cumulative lifetime practice >1500 hours is associated with a ≈3-fold risk of developing AF (HR, 2.87) and greater AF recurrence rates after catheter ablation (multivariate HR, 1.81).…”

Section: Physical Activity/exercisementioning

confidence: 99%

The Clinical Profile and Pathophysiology of Atrial Fibrillation

Andrade

Khairy

Dobrev

et al. 2014

Circulation Research

943

364

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Atrial fibrillation (AF) is the most common arrhythmia (estimated lifetime risk, 22%–26%). The aim of this article is to review the clinical epidemiological features of AF and to relate them to underlying mechanisms. Long-established risk factors for AF include aging, male sex, hypertension, valve disease, left ventricular dysfunction, obesity, and alcohol consumption. Emerging risk factors include prehypertension, increased pulse pressure, obstructive sleep apnea, high-level physical training, diastolic dysfunction, predisposing gene variants, hypertrophic cardiomyopathy, and congenital heart disease. Potential risk factors are coronary artery disease, kidney disease, systemic inflammation, pericardial fat, and tobacco use. AF has substantial population health consequences, including impaired quality of life, increased hospitalization rates, stroke occurrence, and increased medical costs. The pathophysiology of AF centers around 4 general types of disturbances that promote ectopic firing and reentrant mechanisms, and include the following: (1) ion channel dysfunction, (2) Ca 2+ -handling abnormalities, (3) structural remodeling, and (4) autonomic neural dysregulation. Aging, hypertension, valve disease, heart failure, myocardial infarction, obesity, smoking, diabetes mellitus, thyroid dysfunction, and endurance exercise training all cause structural remodeling. Heart failure and prior atrial infarction also cause Ca 2+ -handling abnormalities that lead to focal ectopic firing via delayed afterdepolarizations/triggered activity. Neural dysregulation is central to atrial arrhythmogenesis associated with endurance exercise training and occlusive coronary artery disease. Monogenic causes of AF typically promote the arrhythmia via ion channel dysfunction, but the mechanisms of the more common polygenic risk factors are still poorly understood and under intense investigation. Better recognition of the clinical epidemiology of AF, as well as an improved appreciation of the underlying mechanisms, is needed to develop improved methods for AF prevention and management.

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“…All of the studies used for the meta-analysis, 12-15 divided subjects into 4 or 5 groups on the basis of cumulative PA per week, 13 amount and intensity of work-related PA, 14 leisure-type PA, 15 or amount of exercise per week. 12 For all of the studies included, the extreme groups (ie, maximum versus minimal amount of PA) were used for the current analyses.…”

Section: Exposure Assessmentmentioning

confidence: 99%

“…Aizer et al 12 divided the patients into several groups on the basis of frequency of sweat-breaking exercise per week. The study of Everett et al 13 used metabolic equivalent task for each PA performed and divided the patient into several groups on the basis of metabolic equivalent task range. The study of Frost et al 14 evaluated the amount of PA performed at work and divided the patients into several groups.…”

Section: Exposure Assessmentmentioning

confidence: 99%

“…At the same time, only limited and inconsistent data are available on a potential association between regular physical activity (PA) and the risk of AF in the general population. Although some studies (both traditional case-control 6,10 and prospective cohort 12 ) reported an increased risk of AF with regular PA, others studies found no association 13,14 or nonstatistically significant lower risk of AF. 15 To test the hypothesis that regular PA does not increase the risk of AF, we conducted a systematic review and meta-analysis.…”

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confidence: 99%

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Regular Physical Activity and Risk of Atrial Fibrillation

Ofman

Khawaja

Rahilly‐Tierney

et al. 2013

Circ: Arrhythmia and Electrophysiology

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Background-Although previous studies have suggested that competitive athletes have a higher risk of atrial fibrillation than the general population, limited and inconsistent data are available on the association between regular physical activity and the risk of atrial fibrillation. Methods and Results-A systematic, comprehensive literature search was performed using MEDLINE, EMBASE, and COCHRANE until 2011. Extracted data from the eligible studies were meta-analyzed using fixed effects model. Four studies, which included 95 526 subjects, were eligible for meta-analysis. For all of the studies included, the extreme groups (ie, maximum versus minimal amount of physical activity) were used for the current analyses. The total number of participants belonging to the extreme groups was 43 672. The pooled odds ratio (95% confidence interval) for atrial fibrillation among regular exercisers was 1.08 (0.97-1.21). Conclusions-Our data do not support a statistically significant association between regular physical activity and increased incidence of atrial fibrillation. (Circ Arrhythm Electrophysiol. 2013;6:252-256.)

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Physical Activity and the Risk of Incident Atrial Fibrillation in Women

Cited by 102 publications

References 44 publications

Cardiorespiratory Fitness and Risk of Incident Atrial Fibrillation

Cardiorespiratory Fitness and Risk of Incident Atrial Fibrillation

The Clinical Profile and Pathophysiology of Atrial Fibrillation

Regular Physical Activity and Risk of Atrial Fibrillation

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