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Risk Factors for the Development of New-Onset Persistent Atrial Fibrillation: Subanalysis of the VITAL Study
Melissa E Middeldorp1, Roopinder K Sandhu1, Jessica Mao1
1Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.E.M., R.K.S., J.M., C.M.A.).
Circulation. Arrhythmia and Electrophysiology
|November 29, 2023
Summary
Persistent atrial fibrillation (AF) is more common than previously thought at diagnosis. Older age, male sex, obesity, and higher education are key risk factors for persistent AF, identifying a high-risk group for interventions.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Sustained atrial fibrillation (AF) has poorer outcomes than paroxysmal AF.
- Risk factors for persistent AF at initial diagnosis are not well understood.
- Identifying these factors is crucial for early intervention.
Purpose of the Study:
- To define risk factors associated with new-onset persistent atrial fibrillation (AF).
- To differentiate risk factors for persistent versus paroxysmal AF at diagnosis.
Main Methods:
- Prospective examination of lifestyle, clinical, and socioeconomic factors in 25,119 participants (VITAL rhythm study).
- AF pattern (persistent vs. paroxysmal) was assessed at diagnosis.
- Multivariable competing risk models were used to analyze associations.
Main Results:
- Over one-third of new AF cases were persistent.
- Factors associated with persistent AF included older age, male sex, White race, higher BMI (obesity), hypertension, smoking, heavy alcohol intake, and postcollege education.
- Older age, male sex, obesity, and postcollege education were preferentially associated with persistent AF compared to paroxysmal AF.
Conclusions:
- Persistent AF is a significant proportion of new-onset AF in individuals without prior cardiovascular disease.
- Older age, male sex, obesity, and postcollege education identify a high-risk subset for persistent AF.
- These findings can inform population-based interventions for atrial fibrillation.
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