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Association of Body Mass Index, Diabetes, Hypertension, and Blood Pressure Levels with Risk of Permanent Atrial Fibrillation

  • Original Research
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ABSTRACT

BACKGROUND

After an initial episode of atrial fibrillation (AF), AF may recur and become permanent. AF progression is associated with higher morbidity and mortality. Understanding the risk factors for permanent AF could help identify people who would benefit most from interventions.

OBJECTIVE

To determine whether body mass index (BMI), diabetes, hypertension, and blood pressure levels are associated with permanent AF among people whose initial AF episode terminated.

DESIGN

Population-based inception cohort study.

PARTICIPANTS

Enrollees in Group Health, an integrated health care system, aged 30–84 with newly diagnosed AF in 2001–2004, whose initial AF terminated within 6 months and who had at least 6 months of subsequent follow-up (N = 1,385).

MAIN MEASURES

Clinical characteristics were determined from medical records. Permanent AF was determined from medical records and ECG and administrative databases. Permanent AF was defined as AF present on two separate occasions 6–36 months apart, without any documented sinus rhythm between the two occasions. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs).

KEY RESULTS

Five-year cumulative incidence of permanent AF was 24 %. Compared with normal BMI (18.5–24.9 kg/m2), BMI levels of 25.0–29.9 (overweight), 30.0–34.9 (obese 1), 35.0–39.9 (obese 2), and ≥ 40.0 kg/m2 (obese 3) were associated with HRs of permanent AF of 1.26 (95 % CI: 0.92, 1.72); 1.35 (0.96, 1.91); 1.50 (0.97, 2.33); and 1.79 (1.13, 2.84), adjusted for age, sex, diabetes, hypertension, blood pressure, coronary heart disease, valvular heart disease, heart failure, and prior stroke. Diabetes, hypertension, and blood pressure were not associated with permanent AF.

CONCLUSIONS

For people whose initial AF episode terminates, benefits of having lower BMI may include a lower risk of permanent AF. Risk of permanent AF was similar for people with and without diabetes or hypertension and across blood pressure levels.

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Acknowledgements

We thank the study participants, Group Health Research Institute staff, and UW Cardiovascular Health Research Unit staff.

This research was supported by NHLBI grant R01 HL068986 (PI: Heckbert), NHLBI training grant T32 HL007902 (PI: Siscovick; Trainee: Thacker), and NIA grant K23 AG028954 (PI: Dublin).

A preliminary version of this research was presented at the American Heart Association 51st Cardiovascular Disease Epidemiology and Prevention Conference, Atlanta, GA, March 2011.

Conflict of Interest

Dr. Dublin has received a Merck/American Geriatrics Society New Investigator Award. Dr. Psaty is a member of the Data and Safety Monitoring Board (DSMB) for a trial of a device funded by the manufacturer and a member of the steering committee for the Yale Open Data Access Project funded by Medtronic. The other authors declare that they do not have any conflicts of interest.

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Authors and Affiliations

  1. Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA

    Evan L. Thacker PhD, Barbara McKnight PhD, Bruce M. Psaty MD, PhD, Paul N. Jensen MPH, Nicholas L. Smith PhD, David S. Siscovick MD & Susan R. Heckbert MD, PhD

  2. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Evan L. Thacker PhD, Bruce M. Psaty MD, PhD, W. T. Longstreth Jr. MD, MPH, Sascha Dublin MD, PhD, Paul N. Jensen MPH, Katherine M. Newton PhD, Nicholas L. Smith PhD, David S. Siscovick MD & Susan R. Heckbert MD, PhD

  3. Department of Biostatistics, University of Washington, Seattle, WA, USA

    Barbara McKnight PhD

  4. Department of Medicine, University of Washington, Seattle, WA, USA

    Bruce M. Psaty MD, PhD, W. T. Longstreth Jr. MD, MPH & David S. Siscovick MD

  5. Department of Health Services, University of Washington, Seattle, WA, USA

    Bruce M. Psaty MD, PhD

  6. Department of Neurology, University of Washington, Seattle, WA, USA

    W. T. Longstreth Jr. MD, MPH

  7. Group Health Research Institute, Seattle, WA, USA

    Bruce M. Psaty MD, PhD, Sascha Dublin MD, PhD, Katherine M. Newton PhD, Nicholas L. Smith PhD & Susan R. Heckbert MD, PhD

  8. Epidemiologic Research and Information Center, Veterans Affairs Office of Research and Development, Seattle, WA, USA

    Nicholas L. Smith PhD

  9. Department of Epidemiology, University of Alabama at Birmingham, RPHB 220, 1720 2nd Ave South, Birmingham, AL, 35294, USA

    Evan L. Thacker PhD

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  1. Evan L. Thacker PhD
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  2. Barbara McKnight PhD
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  3. Bruce M. Psaty MD, PhD
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  5. Sascha Dublin MD, PhD
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  7. Katherine M. Newton PhD
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  9. David S. Siscovick MD
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  10. Susan R. Heckbert MD, PhD
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Corresponding author

Correspondence to Evan L. Thacker PhD.

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Thacker, E.L., McKnight, B., Psaty, B.M. et al. Association of Body Mass Index, Diabetes, Hypertension, and Blood Pressure Levels with Risk of Permanent Atrial Fibrillation. J GEN INTERN MED 28, 247–253 (2013). https://doi.org/10.1007/s11606-012-2220-4

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  • DOI: https://doi.org/10.1007/s11606-012-2220-4

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