Clinical Obesity and New-Onset Atrial Fibrillation: A Population-Based Cohort Study From the Kailuan Cohort

Using the clinical obesity concept recently proposed by the Lancet Diabetes & Endocrinology Commission, this study evaluated the impact of clinical obesity on new-onset atrial fibrillation (AF) in the general population.

Individuals who underwent first health examinations from June 2006 to October 2007 in Kailuan were included. Based on body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and presence of obesity-related organ/tissue dysfunction, participants were divided into no obesity, preclinical obesity, and clinical obesity groups.

A total of 98 730 participants free from AF at baseline were identified. Of these, 1343 developed new-onset AF over a median follow-up of 16.97 years. The AF incidence densities were 0.67, 0.68, and 1.25 per 1000 person-years in the no obesity, preclinical, and clinical obesity groups, respectively. Compared to the no obesity group, the clinical obesity (HR: 1.29, 95% CI: 1.12-1.47) group showed increased risks of new-onset AF. Clinical obesity remained associated with higher new-onset AF risk in participants aged < 45 years (HR: 2.34, 95% CI: 1.42-3.86) and 45- < 60 years (HR: 1.40, 95% CI: 1.14-1.71). In men, clinical obesity was associated with 35% higher risks of new-onset AF (HR: 1.34, 95% CI: 1.16-1.55). No significant association was observed between clinical obesity and new-onset AF in participants with a history of using anti-hypertensive agents (HR: 0.98, 95% CI: 0.73-1.30).

Clinical obesity is an independent risk factor for new-onset AF, with age- and sex-specific associations, while metabolic-targeted therapies were associated with attenuated obesity-associated new-onset AF risk.