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CLINICAL STATEMENTS AND GUIDELINES

January 2, 2024 Circulation. 2024;149:e1–e156. DOI: 10.1161/CIR.0000000000001193 e12

Joglar et al 2023 Guideline for the Diagnosis and Management of Atrial Fibrillation

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Table 3.  Risk Factors for Diagnosed AF

Condition Study Type Effect on Risk of AF Summary Risk of Incident AF Effect of LRFM Risk Factors Advancing age SR/MA Age per 5 y: ↑ risk (HR, 1.43-1.66)2,3 ↑ Risk N/A

MR Accelerated epigenetic age by MR: no association4

Smoking Single study Current smoking: ↑ risk (9.8%)5 ↑ Risk N/A

SR/MA Smoking: ↑ risk (HR, 1.21-1.43)2,6 MR Smoking initiation: ↑ risk (OR, 1.11)7

Physical activity SR/MA Sedentary lifestyle: ↑ risk (OR, 2.47)8

Guideline-recommended physical activity: ↓ risk (HR, 0.94)9 Elite athletes vs nonathletes: ↑ risk (OR, 2.46)10 U curve: Sedentary lifestyle and elite/extreme exercise: ↑ risk Exercise: ↓ AF burden, recurrence, symptoms; ↑ quality of life, functional capacity11–16

Alcohol Single studies Risk of AF episode within 4 h of 1 drink: ↑ risk (OR, 2.02)17

Greater access to alcohol law: ↑ risk18 ↑ Risk Randomized abstinence: ↓ AF recurrence and burden19

N-of-1 studies of alcohol avoidance: ↓ near-term AF20 Alcohol avoidance or reduction as part of a comprehensive LRFM program: ↓ AF burden, symptoms, progression of AF21–24

SR/MA Dose response (#drinks/d): ↑ risk (RR) 1: 1.08; 2: 1.17; 3: 1.33; 4: 1.36; 5: 1.4725 MR Genetically predicted heavy alcohol consumption (>35 U/wk for women and >50 U/wk for men): ↑ risk (OR, 1.11)7

Adiposity markers: weight, BMI, obesity Single study Obesity: population attributable fraction 12.7%-16.9%5,26 ↑ Risk Weight loss in overweight or obese patients with AF as part of a comprehensive LRFM program: ↓ AF symptoms, burden, recurrence, progression21–24

Bariatric surgery in class III obesity: associated with reversal of AF type, ↑ sinus rhythm postablation27–29 Weight loss in long-lasting persistent AF and obesity: ↔30

SR/MA BMI: RR, 1.28 per 5-unit ↑ in BMI31

Weight:2 HR, 1.12 per 15 kg ↑

MR Obesity3

Birthweight: 1.26 per SD ↑32 Childhood BMI (OR, 1.18)32 BMI 1.31 per unit BMI33

Height MA Height per 10 cm: ↑ risk (HR, 1.28)2 ↑ Risk N/A

SR/MA Increasing height: ↑ risk3 MR Increasing height: ↑ risk (OR per unit, 1.33)33

Hypertension and BP Single studies Elevated BP: ↑ risk, population attributable fraction, 21.6%5

Presence of hypertension treatment: ↑ risk (HR, 1.35-1.68), incidence 9.8%-19.5%; both AF and SBP decreased over time26 Hypertension: ↑ risk SBP: ↑ risk DBP: ↑↓↔ risk Renal denervation: ↓ AF postablation34

Mineralocorticoid receptor antagonists: ↓ AF burden35 BP control postablation: ↔36 Intensive BP control to SBP <120 mm Hg in patients with hypertension at high risk for CVD: ↓ AF risk37 BP control as part of a comprehensive LRFM program: ↓ AF burden21–24,38

MA BP: SBP: ↑ risk (HR per 20 mm Hg, 1.22);

DBP per 10 mm Hg ↓ risk (HR, 0.90); use of BP medications ↑ risk (HR, 1.42)2

SR/MA Hypertension: ↑ risk3 MR SBP33,39 ↑ risk; DBP mixed results ↔↑ risk39,40; pulse pressure ↑ risk40

Resting heart rate SR/MA Resting heart rate: J-shaped relationship with incident AF. Lowest risk at 68-80 bpm; <70 bpm (RR, 1.09 per 10 bpm ↓); >70 bpm (RR, per 10 bpm ↑ RR 1.06)41 Slow heart rate: ↑↓ variable risk

Higher heart rate: ↑↓ variable risk N/A

MR Heart rate: <65 bpm slower (HR ↑ risk); heart rate per 5 bpm ↑, 0.8242

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