Staerk L, et al. - This community-based cohort study studied the link between risk factor burdens (categorized as optimal, borderline, or elevated) and the lifetime risk of atrial fibrillation. An optimal risk factor profile showed a link with a lifetime risk of atrial fibrillation of about 1 in 5, irrespective of index ages at 55, 65, or 75 years. In those with at least one elevated risk factor, this risk rose to more than 1 in 3.

Methods

• This was a community based cohort study using longitudinal data from the Framingham Heart Study.
• The enrollment consisted of subjects without atrial fibrillation at index ages 55, 65, and 75 years.
• The risk factors smoking, alcohol consumption, body mass index, blood pressure, diabetes, and history of heart failure or myocardial infarction were categorized as optimal (all risk factors were optimal), borderline (presence of borderline risk factors and absence of any elevated risk factor), or elevated (presence of at least one elevated risk factor) at index age.
• Lifetime risk of atrial fibrillation at index age up to 95 years, accounting for the competing risk of death served as the primary outcome.

Results

• There were 5,338 participants (2,531 (47.4%) men) at index age 55 years.
• Of these, 247 (4.6%) had an optimal risk profile, 1,415 (26.5%) had a borderline risk profile, and 3,676 (68.9%) an elevated risk profile.
• As the index ages rose, the incidence of elevated risk factors gradually rose as well. It was determined that the lifetime risk of atrial fibrillation was 37.0% (95% confidence interval 34.3% to 39.6%) for index age of 55 years.
• The lifetime risk of atrial fibrillation was 23.4% (12.8% to 34.5%) with an optimal risk profile, 33.4% (27.9% to 38.9%) with a borderline risk profile, and 38.4% (35.5% to 41.4%) with an elevated risk profile.
• A correlation was seen between candidates with at least one elevated risk factor and a minimum 37.8% lifetime risk of atrial fibrillation.
• A similar rise in lifetime risk across risk factor burden was seen at index ages 65 and 75 years.