Risk factors for atrial fibrillation

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Presentation transcript:

Risk factors for atrial fibrillation Dr Nicole Lowres Postdoctoral Research Fellow Heart Research Institute Charles Perkins Centre, University of Sydney A growing body of evidence supporting the need for atrial fibrillation screening

Future prevalence of AF Add extra references to slide text box Australia (≥55 years age) Iceland United States Projected incidence Projected incidence ______ Miyasaka, J Am Coll Cardiol. 2007;49:986-992. ______ Go, JAMA. 2001;285:2370-2375. Stefansdottir, Europace. 2011;13:1110-17. Ball, Med J Aust 2015; 202: 32-5

Association of risk factors with AF Lau. Circulation. 2017;136:583-596 .

Pathophysiological threshold in atrial substrate Maesen. Europace. 2012;14:159-174.

Physiological changes Lau. Circulation. 2017;136:583-596 .

Obesity causes tissue changes Fibrosis tissue Inflammatory infiltrate Lipidosis Abed. Heart Rhythm. 2013;10:90-100.

Mechanisms Lau. Circulation. 2017;136:583-596 . Reduced action potential duration Lau. Circulation. 2017;136:583-596 .

Obesity Karasoy. Europace. 2013;15:781-6. Results of crude and multivariable Cox regression analyses according to BMI (kg/m2). Crude models were adjusted for age and year of inclusion. Multivariable models were adjusted for age, hyperthyroidism, and previous use of beta-blockers. X-axis shows HR of AF. CI, confidence interval. Karasoy. Europace. 2013;15:781-6.

Weight loss Pathak. J Am Coll Cardiol. 2015;65:2159-69.

Subclinical Hypertension Hazard Ratio For each 10-mmHg decrease in systolic blood pressure, the hazard ratio is reported as 0.87 (95% confidence interval [CI], 0.83-0.91) Systolic blood pressure (mmHg)

Obstructive sleep apnoea Linz. JAMA Cardiology. 2018;3:532-40.

Obstructive sleep apnoea Nalliah J Cardiovasc Electrophysiol. 2016;27:1001-10

Effect of CPAP treatment Nalliah J Cardiovasc Electrophysiol. 2016;27:1001-10

Physical activity and relative risk of AF La Gersh et al, Eur Heart J, 2013 Multivariable relative risks* of atrial fibrillation by exercise at age 30 years (A) and at baseline (B) in the cohort of Swedish men, 1998–2009 *Multivariable relative risks were adjusted for the same variables as in table 2. Drca N et al, Heart, 2014

Exercise and AF risk Volumes of 5 to 20 MET-h/week – reduction in risk1 Endurance training >2,000 hours increases risk2 Progressive increase with cumulated activity Exercise “deconditioning” leads to reversal of structural changes back to normal substrate 1. Ricci. Eur J Prevent Cardiol. 2018;25:857-866. 2. Guasch, J Am Coll Cardiol. 2013;62:68-77

Alcohol: Pathophysiological pathway Voskoboinik J Am Coll Cardiol. 2016;68:2567-76.

Alcohol Relative risks of atrial fibrillation per 1 drink/day increment in alcohol consumption Larsson. J Am Coll Cardiol. 2014;64:281-289.

Alcohol consumption Voskoboinik J Am Coll Cardiol. 2016;68:2567-76.

Smoking status and cigarette-years Mean cigarette-years Incidence rate Hazard ratio (95% CI) Never 28 1 Former <800 302 33 1.16 (0.96-1.40) Former 800 1197 55 1.89 (1.47-2.42) Current <800 452 42 1.85 (1.49-2.30) Current 800 1149 58 2.31 (1.83-2.92) Chamberlain. Heart Rhythm. 2011;8:1160-1166.

Cigarette smoking Aune. Eur J Prevent Cardiol. 2018;0:2047487318780435.

Caffeine exposure Caldeira. Heart. 2013;99:1383-1389. Risk of atrial fibrillation according to caffeine exposure. Caldeira. Heart. 2013;99:1383-1389.

Menezes. Prog Cardiovasc Dis. 2015;58:117-25.

Questions

Metabolic syndrome and obstructive sleep apnoea – catheter ablation outcomes Kaplan–Meier curve comparing recurrence across Group 1 and the 3 subpopulations of Group 2 (MS‐only, OSA‐only, no MS/OSA) shows significantly higher failure in MS+OSA population. © IF THIS IMAGE HAS BEEN PROVIDED BY OR IS OWNED BY A THIRD PARTY, AS INDICATED IN THE CAPTION LINE, THEN FURTHER PERMISSION MAY BE NEEDED BEFORE ANY FURTHER USE. PLEASE CONTACT WILEY'S PERMISSIONS DEPARTMENT ON PERMISSIONS@WILEY.COM OR USE THE RIGHTSLINK SERVICE BY CLICKING ON THE 'REQUEST PERMISSION' LINK ACCOMPANYING THIS ARTICLE. WILEY OR AUTHOR OWNED IMAGES MAY BE USED FOR NON-COMMERCIAL PURPOSES, SUBJECT TO PROPER CITATION OF THE ARTICLE, AUTHOR, AND PUBLISHER. Mohanty. J Cardiovasc Electrophysiol. 2014;25:930-8.

Pathophysiological links between obesity and AF

Obesity slows conduction velocity in atria Abed. Heart Rhythm. 2013;10:90-100.

Hypertension leads to progressive atrial remodeling Fibrosis tissue Infiltrate Lau. Heart Rhythm. 2010;7:1282-90.

Hypertension leads to a reduction in conduction velocity Lau. Heart Rhythm. 2010;7:1282-90.

Atrial remodeling in obstructive sleep apnoea Dimitri. Heart Rhythm. 2012;9:321-7.

Obstructive sleep apnoea (OSA) Main mechanisms contributing to remodeling and AF Nalliah J Cardiovasc Electrophysiol. 2016;27:1001-10

Mechanisms Lau. Circulation. 2017;136:583-596 .

Type 2 Diabetes Mellitus and Risk of AF Huxley Am J Cardiol. 2011;108:56-62.

Weight fluctuation Pathak. J Am Coll Cardiol. 2015;65:2159-69.