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    Preventing Atrial Fibrillation: A Three-legged Stool

     

    Table 2. Controlling Cardiovascular Risk Factors and Treating Concurrent Cardiovascular Disease

    AF Cardiovascular Risk Factor

    Relationship to AF

    Clinician Intervention

    Obesity (worldwide):

    14% of men
    10% of women

    Obesity increased AF by 49%.

    BMI had linear association with AF risk – each unit increase in BMI increased AF by 4-8%.

    Weight gain from 20 yrs to midlife of 16-35% increased AF 34% and >35% increased AF by 61%.

    18% AF cases preventable by achieving optimal body weight.

    Success of AF ablation higher with weight loss.

    Achieve weight reduction:

    >10% weight loss: 46% freedom from AF.

    3-9% weight loss: 22% freedom from AF.

    <3% weight loss:

    13% freedom from AF.

    Hypertension or widened pulse pressure

    Every 10 mmHg increase in SBP increases AF by 11%.

    Population attributable risk 14-20%.

    Each 20 mmHg increase in pulse pressure (reflects aortic stiffness) increases AF by 26%.

    Treat BP – ARBs and ACEIs reduce risk in structural (ie, LVH, CHF) and functional heart disease.

    Diabetes

    DM increases AF risk by 34%.

    AF risk increases by 3% for each additional year of DM duration.

    Each 1% increase HbA1c increases AF by 13% (DM pts) and 5% (nonDM pts).

    Treating DM does not reduce AF risk – unclear if DM may be a “marker” of risk rather than causal.

    Dyslipidemia and statins

    Each 1-SD increase in LDL-C, AF risk reduced 10%.

    HDL-C and TGs not thought to influence AF risk; only LDL-C and TC.

    Treat dyslipidemia to prevent MI (as below).  Statins do not lower AF risk.

    Obstructive sleep apnea: ≥5 apneic episodes/hr of sleep

    OSA increased odds of AF 2.2X.

    Cause-effect relationship between OSA and AF has been established.

    In small study, CPAP reduced AF:

    Untreated OSA: 82% AF recurrence.

    CPAP-treated: 42% AF recurrence.

    No OSA: 53% AF recurrence.

    Myocardial infarction

    7-12% incidence of new-onset AF after MI.

    Prompt reperfusion reduces incidence.

    Heart failure (HFREF, HFPEF)

    ~33% of CHF patients with AF.

    CHF increases AF 4.5X in men and 5.9X in women.

    Treat risk factors for CHF, start GDMT for CHF.

    Next: Work at the population level

     

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