Physical activity modifies the risk of atrial fibrillation in obese individuals: The HUNT3 study

Abstract

Background

Atrial fibrillation is the most common heart rhythm disorder, and high body mass index is a well-established risk factor for atrial fibrillation. The objective of this study was to examine the associations of physical activity and body mass index and risk of atrial fibrillation, and the modifying role of physical activity on the association between body mass index and atrial fibrillation.

Design

The design was a prospective cohort study.

Methods

This study followed 43,602 men and women from the HUNT3 study in 2006–2008 until first atrial fibrillation diagnosis or end of follow-up in 2015. Atrial fibrillation diagnoses were collected from hospital registers and validated by medical doctors. Cox proportional hazard regression analysis was performed to assess the association between physical activity, body mass index and atrial fibrillation.

Results

During a mean follow-up of 8.1 years (352,770 person-years), 1459 cases of atrial fibrillation were detected (4.1 events per 1000 person-years). Increasing levels of physical activity were associated with gradually lower risk of atrial fibrillation (p trend 0.069). Overweight and obesity were associated with an 18% (hazard ratio 1.18, 95% confidence interval 1.03–1.35) and 59% (hazard ratio 1.59, 95% confidence interval 1.37–1.84) increased risk of atrial fibrillation, respectively. High levels of physical activity attenuated some of the higher atrial fibrillation risk in obese individuals (hazard ratio 1.53, 95% confidence interval 1.03–2.28 in active and 1.96, 95% confidence interval 1.44–2.67 in inactive) compared to normal weight active individuals.

Conclusion

Overweight and obesity were associated with increased risk of atrial fibrillation. Physical activity offsets some, but not all, atrial fibrillation risk associated with obesity.

Keywords

Atrial fibrillation physical activity body mass index obesity

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References

Chugh

Havmoeller

Narayanan

et al.

Worldwide epidemiology of atrial fibrillation: A Global Burden of Disease 2010 study. Circulation 2014; 129: 837–847.

Krijthe

Kunst

Benjamin

et al.

Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J 2013; 34: 2746–2751.

Aune

Sen

Schlesinger

et al.

Body mass index, abdominal fatness, fat mass and the risk of atrial fibrillation: A systematic review and dose-response meta-analysis of prospective studies. Eur J Epidemiol 2017; 32: 181–192.

Fleming

Robinson

et al.

Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 766–781.

Gorenek

Pellicia

Benjamin

et al.

European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Europace 2017; 19: 190–225.

Azarbal

Stefanick

Salmoirago-Blotcher

et al.

Obesity, physical activity, and their interaction in incident atrial fibrillation in postmenopausal women. J Am Heart Assoc 2014; 3: 1–9.

Huxley

Misialek

Agarwal

et al.

Physical activity, obesity, weight change, and risk of atrial fibrillation: The Atherosclerosis Risk in Communities study. Circ Arrhythm Electrophysiol 2014; 7: 620–625.

Drca

Wolk

Jensen-Urstad

et al.

Physical activity is associated with a reduced risk of atrial fibrillation in middle-aged and elderly women. Heart 2015; 101: 1627–1630.

Everett

Conen

Buring

et al.

Physical activity and the risk of incident atrial fibrillation in women. Circ Cardiovasc Qual Outcomes 2011; 4: 321–327.

10.

Thelle

Selmer

Gjesdal

et al.

Resting heart rate and physical activity as risk factors for lone atrial fibrillation: A prospective study of 309,540 men and women. Heart 2013; 99: 1755–1760.

11.

Aizer

Gaziano

Cook

et al.

Relation of vigorous exercise to risk of atrial fibrillation. Am J Cardiol 2009; 103: 1572–1577.

12.

Skielboe

Marott

Dixen

et al.

Occupational physical activity, but not leisure-time physical activity increases the risk of atrial fibrillation: The Copenhagen City Heart Study. Eur J Prev Cardiol 2016; 23: 1883–1893.

13.

Krokstad

Langhammer

Hveem

et al.

Cohort profile: The HUNT study, Norway. Int J Epidemiol 2013; 42: 968–977.

14.

Kurtze

Rangul

Hustvedt

et al.

Reliability and validity of self-reported physical activity in the Nord-Trondelag Health Study: HUNT 1. Scand J Public Health 2008; 36: 52–61.

15.

Camm

Kirchhof

Lip

et al.

Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010; 31: 2369–2429.

16.

Malmo

Langhammer

Bønaa

et al.

Validation of self-reported and hospital-diagnosed atrial fibrillation: The HUNT study. Clin Epidemiol 2016; 8: 185–193.

17.

VanderWeele

. On the relative nature of overadjustment and unnecessary adjustment. Epidemiology 2009; 20: 496–499.

18.

Andersson

Alfredsson

Källberg

et al.

Calculating measures of biological interaction. Eur J Epidemiol 2005; 20: 575–579.

19.

Lavie

Pandey

Lau

et al.

Obesity and atrial fibrillation prevalence, pathogenesis, and prognosis: Effects of weight loss and exercise. J Am Coll Cardiol 2017; 70: 2022–2035.

20.

Myers

McAuley

Lavie

et al.

Physical activity and cardiorespiratory fitness as major markers of cardiovascular risk: Their independent and interwoven importance to health status. Prog Cardiovasc Dis 2015; 57: 306–314.

21.

Fleg

. Physical activity as anti-inflammatory therapy for cardiovascular disease. Prev Cardiol 2005; 8: 8–10.

22.

Conen

Ridker

Everett

et al.

A multimarker approach to assess the influence of inflammation on the incidence of atrial fibrillation in women. Eur Heart J 2010; 31: 1730–1736.

23.

Al Chekakie

Welles

Metoyer

et al.

Pericardial fat is independently associated with human atrial fibrillation. J Am Coll Cardiol 2010; 56: 784–788.

24.

Qureshi

Alirhayim

Blaha

et al.

Cardiorespiratory fitness and risk of incident atrial fibrillation: Results from the Henry Ford Exercise Testing (FIT) project. Circulation 2015; 131: 1827–1834.

25.

Grundvold

Skretteberg

Liestol

et al.

Importance of physical fitness on predictive effect of body mass index and weight gain on incident atrial fibrillation in healthy middle-age men. Am J Cardiol 2012; 110: 425–432.

26.

Karjalainen

Kujala

Kaprio

et al.

Lone atrial fibrillation in vigorously exercising middle aged men: Case-control study. BMJ 1998; 316: 1784–1785.

27.

Myrstad

Nystad

Graff-Iversen

et al.

Effect of years of endurance exercise on risk of atrial fibrillation and atrial flutter. Am J Cardiol 2014; 114: 1229–1233.

28.

Morseth

Graff-Iversen

Jacobsen

et al.

Physical activity, resting heart rate, and atrial fibrillation: The Tromso Study. Eur Heart J 2016; 37: 2307–2313.

29.

Svennberg

Engdahl

Al-Khalili

et al.

Mass screening for untreated atrial fibrillation: The STROKESTOP study. Circulation 2015; 131: 2176–2184.

30.

Rothman

Greenland

Lash

. Modern epidemiology, 3rd ed. Philadelphia: Lippincott Williams and Wilkins, 2008.

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