Cardiovascular risk factors prevalent many years before AF diagnosis
medwireNews: Cardiovascular risk factors can be present in patients with atrial fibrillation (AF) more than 15 years before an AF diagnosis, with each having its own trajectory, US researchers report.
The analysis of data from the Atherosclerosis Risk in Communities study showed that prevalence of stroke, myocardial infarction (MI) and heart failure (HF) begins to increase steeply during the 5 to 10 years prior to AF diagnosis.
By contrast, the rates of diabetes, hypertension and obesity increased steadily over time.
“These results underscore the role of factors such as hypertension and obesity in contributing to the development of the atrial substrate that eventually leads to the clinical onset of AF and the need to act earlier in the pathogenic process to prevent this common arrhythmia”, say Faye Norby and co-authors of the study.
They compared the timing and trajectories of cardiovascular risk factor development over 25 years in 2456 individuals with incident AF and 6414 matched controls.
Compared with controls, patients with AF had higher body mass index and a greater prevalence of current smoking, hypertension, diabetes mellitus, HF, MI and stroke in the year of diagnosis.
And this increased prevalence was present from the beginning of follow-up even after adjustment for age and gender. Furthermore, rates of obesity, smoking and HF were significantly higher among the patients who developed AF versus controls from at least 17.5 years before they developed AF.
A second analysis, comprising 10,559 individuals who were initially AF-free (mean age, 67 years; 52% men) identified four or five distinct trajectory groups for each of the cardiovascular risk factors. In general these included a group without the condition during follow-up, a group with prevalence close to 100% and intermediate groups in which the prevalence increased at different rates during 15-year median follow-up period.
During this period, 1507 individuals developed AF, with the risk highest among individuals in the trajectory group with the highest prevalence of each individual risk factor, the researchers report in Circulation.
Norby and co-authors say their findings highlight “the need to establish preventive strategies that address risk factors decades before AF diagnosis.”
By Laura Cowen
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