Higher BMI tied to early AF risk in young men
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Increasing BMI in young adult men is strongly associated with early atrial fibrillation as well as later worse clinical outcomes, including incident HF, stroke and all-cause mortality, among those diagnosed with AF, researchers reported.
Data suggest lower rates of all-cause mortality among adults with obesity and AF, a phenomenon known as the obesity paradox, Demir Djekic, MD, PhD, of the department of cardiology at Sahlgrenska University Hospital in Gothenburg, Sweden, and colleagues wrote in the Journal of the American Heart Association. However, what has been referred to as the obesity paradox may potentially be related to an older and sicker study population; recent data from a prospective cohort of middle-aged patients with AF did not show obesity to be associated with higher risk for poor clinical outcomes, whereas other studies have suggested overweight and obesity are risk factors for death and a composite endpoint of ischemic stroke, thromboembolism and death in patients with AF.
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“Accordingly, there is a need for further studies in this area, in particular among those diagnosed already when young, where a double burden of early obesity and AF may theoretically be more harmful than AF alone,” the researchers wrote.
In a register-based cohort study, Djekic and colleagues analyzed data from 1,704,467 men (mean age, 18 years) enrolled in compulsory military service in Sweden from 1969 to 2005. Researchers assessed height and weight, BP, fitness, muscle strength, intelligence quotient and medical disorders recorded at baseline. They also assessed incidence and clinical outcomes of AF using records from the National Inpatient Registry and the Cause of Death Register.
During a median follow-up of 32 years, there were 36,693 cases of AF, diagnosed at a mean age of 52 years. Compared with men with a BMI between 18.5 kg/m2 and 20 kg/m2, the adjusted HR for AF increased from 1.06 (95% CI, 1.03-1.1) in men with a BMI of 20 kg/m2 to less than 22.5 kg/m2 to 3.72 (95% CI, 2.44-5.66) among men with a BMI of 40 kg/m2 to 50 kg/m2.
Among men who were diagnosed with AF, 3,767 died, 3,251 developed HF and 921 had an ischemic stroke during a median 6 years of follow-up. Adjusted HRs for all-cause mortality, incident HF and ischemic stroke among men with AF and a baseline BMI of at least 30 kg/m2 compared with those with BMI less than 20 kg/m2 were 2.86 (95% CI, 2.3-3.56), 3.42 (95% CI, 2.5-4.68) and 2.34 (95% CI, 1.52-3.61), respectively.
“An increased risk was observed already at mildly elevated BMI within the normal range, with a three- to fourfold increase in risk among men with severe or morbid obesity, corresponding to BMI levels greater than 35 kg/m2, suggesting a causal role of adiposity on pathophysiological processes leading to AF,” the researchers wrote. “In addition, our data also suggest that adolescent obesity is prognostic of poorer outcomes in subjects later diagnosed with AF with respect to all-cause mortality, HF and ischemic stroke.”
The researchers noted that the true association of obesity with AF is challenging because of complex interactions of obesity with other factors associated with AF, such as poor diet, low physical activity, hypertension, diabetes, smoking, elevated lipids and sleep apnea.
“However, young obese individuals may not have accumulated these risk factors to the same extent as older cohorts, and the present study cohort accordingly provides a valuable opportunity to investigate the impact of obesity per se on AF,” the researchers wrote, adding that the relationship of AF with BMI in adolescence persisted independent of other factors and comorbidities.
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