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    Preventing Atrial Fibrillation: A Three-legged Stool

    As the incidence of atrial fibrillation (AF) increases in step with the aging population, physicians are looking more closely at strategies to prevent the arrhythmia, as they continue to treat their patients already diagnosed. Targeting the causes, it is hoped, will help manage overall disease burden.

    A recent comprehensive and thorough review in JACC highlights and categorizes prevention strategies into three major approaches, as summarized in the 2 tables and short description that follow.

    Table 1. Targeting Modifiable Lifestyle Risk Factors

    AF Modifiable Lifestye Factor

    Relationship to AF

    Clinician Intervention

    Alcohol

    >50% of US adults consume regularly

    >21 drinks/wk increased AF by 39%.

    >35 drinks/wk increased AF by 45% -90%.

    In women, ≥2 drinks/day increased AF by 60%.

    1.5 drinks/day increased AF by 25-46%.

    Each drink/day increased AF by ~8%.

    Counsel on avoiding unhealthy drinking and how even light to moderate drinking can increase AF risk.

    Physical activity and cardiorespiratory fitness

    Mixed data about relationship between exercise and AF.

    Overall, vigorous exercise may be associated with ↑ AF; moderate activity appears protective.

    Avoid sedentary lifestyle

    Psychosocial

    Anger, tension, hostility increase AF by 10-30%.

    Panic disorder increased AF by 73%.

    Job strain increased AF by 23%.

    Stress triggered 54% of AF episodes.

    Happiness had protective effect (88% lower risk of AF after adjustment).

    Encourage positive emotions; treat depression, anxiety, stress promptly.

    Smoking

    Current or former smoking increased AF by 51%; risk decreases after quitting smoking.

    Secondhand smoke associated with higher risk.

    Up to 12% AF cases avoided with quitting smoking.

    Offer smoking cessation interventions.

    Healthy diet

    Obesity, DM, dyslipidemia (see Table 2) associated with AF.

    Counsel on healthy food choices and maintenance of healthy weight.

    Next: Controlling CV Risk Factors, Treating CVD

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