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Published on: February 26, 2013
Modifiable Risk Factors for Incident Heart Failure in Atrial Fibrillation
Neal A Chatterjee1, Claudia U Chae2, Eunjung Kim3
1Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Insights
In women with new-onset atrial fibrillation (AF), modifiable risk factors like obesity, hypertension, smoking, and diabetes significantly increase heart failure (HF) risk. Controlling these factors can substantially lower HF incidence.
Area of Science:
- Cardiology
- Epidemiology
- Preventive Medicine
Background:
- Atrial fibrillation (AF) is associated with a high risk of incident heart failure (HF), the most common nonfatal complication.
- Effective strategies for HF prevention in AF patients are currently lacking.
Purpose of the Study:
- To identify modifiable risk factors for heart failure (HF) in women with new-onset atrial fibrillation (AF).
- To estimate the impact of modifying these risk factors on HF risk.
Main Methods:
- Analysis of 34,736 women from the Women's Health Study, free of cardiovascular disease at baseline.
- Use of Cox models with time-varying risk factor assessment post-AF diagnosis to identify significant predictors of HF.
- Multivariable analyses accounting for changes in risk factors after AF diagnosis.
Main Results:
- New-onset AF significantly increased HF risk (HR: 9.03).
- Systolic blood pressure >120 mmHg, BMI ≥30 kg/m², current smoking, and diabetes were independently associated with incident HF.
- These four modifiable risk factors accounted for an estimated 62% of the population-attributable risk of HF.
- Optimal control of these risk factors progressively decreased HF risk.
Conclusions:
- Modifiable risk factors such as obesity, hypertension, smoking, and diabetes are major contributors to HF risk in women with new-onset AF.
- Achieving optimal levels of these risk factors is associated with a reduced risk of developing HF.
- Further research into prospective risk factor modification strategies at the time of AF diagnosis is warranted.
Objectives:
This study sought to identify modifiable risk factors and estimate the impact of risk factor modification on heart failure (HF) risk in women with new-onset atrial fibrillation (AF).
Background:
Incident HF is the most common nonfatal event in patients with AF, although strategies for HF prevention are lacking.
Methods:
We assessed 34,736 participants in the Women's Health Study who were free of prevalent cardiovascular disease at baseline. Cox models with time-varying assessment of risk factors after AF diagnosis were used to identify significant modifiable risk factors for incident HF.
Results:
Over a median follow-up of 20.6 years, 1,495 women developed AF without prevalent HF. In multivariable models, new-onset AF was associated with an increased risk of HF (hazard ratio [HR]: 9.03; 95% confidence interval [CI]: 7.52 to 10.85). Once women with AF developed HF, all-cause (HR: 1.83; 95% CI: 1.37 to 2.45) and cardiovascular mortality (HR: 2.87; 95% CI: 1.70 to 4.85) increased. In time-updated, multivariable models accounting for changes in risk factors after AF diagnosis, systolic blood pressure >120 mm Hg, body mass index ≥30 kg/m2, current tobacco use, and diabetes mellitus were each associated with incident HF. The combination of these 4 modifiable risk factors accounted for an estimated 62% (95% CI: 23% to 83%) of the population-attributable risk of HF. Compared with women with 3 or 4 risk factors, those who maintained or achieved optimal risk factor control had a progressive decreased risk of HF (HR for 2 risk factors: 0.60; 95% CI: 0.37 to 0.95; 1 risk factor: 0.40; 95% CI: 0.25 to 0.63; and 0 risk factors: 0.14; 95% CI: 0.07 to 0.29).
Conclusions:
In women with new-onset AF, modifiable risk factors including obesity, hypertension, smoking, and diabetes accounted for the majority of the population risk of HF. Optimal levels of modifiable risk factors were associated with decreased HF risk. Prospective assessment of risk factor modification at the time of AF diagnosis may warrant future investigation.
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