Author + information
- Received October 7, 2009
- Revision received February 8, 2010
- Accepted February 9, 2010
- Published online May 25, 2010.
- Usha B. Tedrow, MD, MSc⁎,†,⁎ (, )
- David Conen, MD, MPH⁎,§,
- Paul M. Ridker, MD, MPH†,‡,
- Nancy R. Cook, ScD‡,
- Bruce A. Koplan, MD, MPH⁎,†,
- JoAnn E. Manson, MD, DrPH‡,
- Julie E. Buring, ScD‡ and
- Christine M. Albert, MD, MPH⁎,†,‡
- ↵⁎Reprint requests and correspondence:
Dr. Usha B. Tedrow, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115
Objectives The purpose of this study was to characterize the relationship between changes in body mass index (BMI) and incident atrial fibrillation (AF) in a large cohort of women.
Background Obesity and AF are increasing public health problems. The importance of dynamic obesity-associated AF risk is uncertain, and mediators are not well characterized.
Methods Cases of AF were confirmed by medical record review in 34,309 participants in the Women's Health Study. Baseline and updated measures of BMI were obtained from periodic questionnaires.
Results During 12.9 ± 1.9 years of follow-up, 834 AF events were confirmed. BMI was linearly associated with AF risk, with a 4.7% (95% confidence interval [CI]: 3.4 to 6.1, p < 0.0001) increase in risk with each kilogram per square meter. Adjustment for inflammatory markers minimally attenuated this risk. When updated measures of BMI were used to estimate dynamic risk, overweight (hazard ratio [HR]: 1.22; 95% CI: 1.02 to 1.45, p = 0.03), and obesity (HR: 1.65; 95% CI: 1.36 to 2.00; p < 0.0001) were associated with adjusted short-term increases in AF risk. Participants becoming obese during the first 60 months had a 41% adjusted increase in risk of the development of AF (p = 0.02) compared with those maintaining BMI <30 kg/m2. The prevalence of overweight and obesity increased over time. The adjusted proportion of incident AF attributable to short-term elevations in BMI was substantial (18.3%).
Conclusions In this population of apparently healthy women, BMI was associated with short- and long-term increases in AF risk, accounting for a large proportion of incident AF independent of traditional risk factors. A strategy of weight control may reduce the increasing incidence of AF. (Women's Health Study [WHS]: A Randomized Trial of Low-Dose Aspirin and Vitamin E in the Primary Prevention of Cardiovascular Disease and Cancer; NCT00000479).
The study was supported by grants from the Watkins and Harris Family Foundationto Dr. Tedrow and HL-093613from the National Heart, Lung and Blood Instituteto Dr. Albert. The Women's Health Study was supported by grants HL-043851and HL-080467from the National Heart, Lung and Blood Instituteand CA-047988from the National Cancer Institute(Dr. Buring, Principal Investigator). The Donald W. Reynolds Foundation, Las Vegas, NV, funded the biomarker measurements (Dr. Ridker). The funding organizations had no role in the design and conduct of the study or the preparation, review, or approval of the paper. Dr. Tedrow has served as a consultant for St. Jude Medical and received grant monies from Biosense Webster; both are unrelated to the current study.
- Received October 7, 2009.
- Revision received February 8, 2010.
- Accepted February 9, 2010.
- American College of Cardiology Foundation