Risk Factors & Life Styles Interventions for Management of Atrial Fibrillation

1. Age is an important risk factors for various cardiovascular diseases. Aging is associated with increased AF burden, with a sharp incline after age 65 years. Overall, cumulative risk of Atrial fibrillation is 21% among men and 17% in women by age of 80. Cumulative risk of Atrial fibrillation is 11% among individuals by age of 80 among African American Risk for stroke also increases with aging with sharp incline after age of 65.

2. Ethnicity: Atrial fibrillation prevalence and incidence are higher in individuals with European origin with almost one in four after age of 40.Among Chinese population, incident has been reported around 2.8%. A study from Brazil has reported incidence of 2.4% above age of 65. An interesting study on male veterans with , age adjusted  prevalence of Atrial fibrillation has shown significant racial variation with prevalence of 5.7% among Whites, 3.6% among Asians and 3% in Hispanics.

3. Alcohol: Excessive alcohol drinking has been associated with dilation of heart and an important risk factor for the progression of Atrial Fibrillation. A meta-analysis found that low alcohol consumption defined as one drink/day was not associated with increased AF incidence. In United States over 17% of adult drinkers (≈37 million) are binge drinkers. A meta‐analysis of the association of alcohol consumption with incident AF demonstrated a convincing dose‐response relationship (adjusted relative risk by drinks per day was 1. 17% for 2, 26% for 3, 36% for 4, and 47%for 5 drinks a day.

A recent meta-analysis found almost 8% increased AF risk with each additional daily alcoholic drink suggesting a linear dose-response relationship. Lower AF incidence was associated with longer duration of alcohol abstinence among former heavy drinkers, and every decade of alcohol abstinence—with almost 20% decreased risk of incident AF (≈2%/y).

4. Weight Gain: Obesity is strongly associated with the risk of incident AF, with a 29% increase in AF incidence for every 5‐unit increase in body mass index. A meta‐analysis of the Adelaide groups 5 studies (4 observational and 1 RCT, total 548 patients) reported that at least 10% weight loss in overweight and obese individuals was accompanied by at least 71% less AF recurrence and significantly lower episode length and symptom severity.. Bariatric surgery programs have suggested that there is decrease in incidence of Atrial fibrillation after the surgery.

5.Exercise: Atrial fibrillation has J curve shaped response with exercise with higher incidence of Atrial fibrillation both with high endurance exercise and  sedentary life style, but moderate exercise leads to lower occurrence of Atrial fibrillation. In the Tromsø Study, compared with individuals without regular exercise history, individuals with moderate physical activity  had a 28% lower AF risk. In contrast to moderate physica, activity , a high volume of endurance exercise increases the risk of AF in elite athletes. The risk of AF development in athletes is 5 times higher.

6.Psychological Stress: The prevalence of chronic stress is ≈8% in United States, but in certain populations, its exposure is ≈40% (eg, military deployment, sexual assault, natural disaster, gun violence). There is evidence that relaxation strategies, including prayer, yoga, and meditation, transiently modify indices of autonomic activation and improve quality of life in patients with AF The role of stress reduction to prevent incident AF is less certain.

References:

1.https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.120.316340

2. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Atrial-Fibrillation-Management