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Thromb Haemost 2017; 117(05): 837-850
DOI: 10.1160/TH16-11-0825
Coagulation and Fibrinolysis
Schattauer GmbH

Are cardiovascular risk factors also associated with the incidence of atrial fibrillation?

A systematic review and field synopsis of 23 factors in 32 population-based cohorts of 20 million participants
Victoria Allan
1   Farr Institute of Health Informatics Research, Institute of Health Informatics, University College London, London, UK
,
Shohreh Honarbakhsh
2   The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust & Queen Mary, University of London, London, UK
,
Juan-Pablo Casas
1   Farr Institute of Health Informatics Research, Institute of Health Informatics, University College London, London, UK
,
Joshua Wallace
1   Farr Institute of Health Informatics Research, Institute of Health Informatics, University College London, London, UK
,
Ross Hunter
2   The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust & Queen Mary, University of London, London, UK
,
Richard Schilling
2   The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust & Queen Mary, University of London, London, UK
,
Pablo Perel
3   Centre for Global Non Communicable Diseases, London School of Hygiene & Tropical Medicine, London, UK
,
Katherine Morley
4   Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
,
Amitava Banerjee
1   Farr Institute of Health Informatics Research, Institute of Health Informatics, University College London, London, UK
,
Harry Hemingway
1   Farr Institute of Health Informatics Research, Institute of Health Informatics, University College London, London, UK
› Author Affiliations Financial support: This work was supported by the 10 funders of the Farr Institute of Health Informatics Research: The Medical Research Council (MRC) [K006584/1] in partnership with Arthritis Research UK; the British Heart Foundation; Cancer Research UK; the Economic and Social Research Council; the Engineering and Physical Sciences Research Council; the National Institute for Health Research; the National Institute for Social Care and Health Research (Welsh Assembly Government); the Chief Scientist Office (Scottish Government Health Directorates); and the Wellcome Trust, as well as the MRC PROGnosis RESearch Strategy Partnership [G0902393]. The study funders had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
Further Information

Publication History

Received: 02 November 2016

Accepted after major revision: 02 February 2017

Publication Date:
28 November 2017 (online)

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Summary

Established primary prevention strategies of cardiovascular diseases are based on understanding of risk factors, but whether the same risk factors are associated with atrial fibrillation (AF) remains unclear. We conducted a systematic review and field synopsis of the associations of 23 cardiovascular risk factors and incident AF, which included 84 reports based on 28 consented and four electronic health record cohorts of 20,420,175 participants and 576,602 AF events. We identified 3-19 reports per risk factor and heterogeneity in AF definition, quality of reporting, and adjustment. We extracted relative risks (RR) and 95 % confidence intervals [CI] and visualised the number of reports with inverse (RR [CI]<1.00), or direct (RR [CI]>1.00) associations. For hypertension (13/17 reports) and obesity (19/19 reports), there were direct associations with incident AF, as there are for coronary heart disease (CHD). There were inverse associations for non-White ethnicity (5/5 reports, with RR from 0.35 to 0.84 [0.82–0.85]), total cholesterol (4/13 reports from 0.76 [0.59–0.98] to 0.94 [0.90–0.97]; 8/13 reports with non-significant inverse associations), and diastolic blood pressure (2/11 reports from 0.87 [0.78–0.96] to 0.92 [0.85–0.99]; 5/11 reports with non-significant inverse associations), and direct associations for taller height (7/10 reports from 1.03 [1.02–1.05] to 1.92 [1.38–2.67]), which are in the opposite direction of known associations with CHD. A systematic evaluation of the available evidence suggests similarities as well as important differences in the risk factors for incidence of AF as compared with other cardiovascular diseases, which has implications for the primary prevention strategies for atrial fibrillation.

Keywords

Atrial fibrillation - risk factors - primary prevention - clinical guidelines - cardiovascular disease

 

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