Risk factor changes and incident atrial fibrillation among middle-aged men in the Malmö Preventive Project cohort

Abstract

Aims: To determine whether risk factor changes over 6 years were associated with the incidence of atrial fibrillation (AF) among middle-aged men in the Malmö Preventive Project (MPP) cohort.

Methods and results: In total, 5633 men (mean age 47.0 years at baseline) underwent two screening examinations, separated by an average of 6 years. The annual rate at which systolic blood pressure (SBP), diastolic blood pressure (DBP), weight, fasting blood glucose (FBG), blood glucose at 2-h oral glucose tolerance test (OGTT), and screening spirometry values changed was calculated and analysed in relation to incident AF, using Cox and competing risks regression to determine hazard ratios (HRs) and 95% confidence intervals (CIs). Mean follow-up time ± SD from rescreening was 22.3 ± 7.4 years. Significant associations were found between the annual increase of SBP (HR: 1.04, 95% CI: 1.01-1.07, P = 0.003 per mmHg), DBP (HR: 1.06, 95% CI: 1.01-1.1, P = 0.024 per mmHg), FBG (HR: 2.11, 95% CI: 1.44-3.12, P < 0.0001 per mmol/L), and weight (HR: 1.14, 95% CI: 1.05-1.24, P = 0.003 per kg) on the one hand and incident AF on the other, after full adjustment for baseline age, height, weight, SBP, FBG, smoking status, sedentary lifestyle, anti-hypertensive treatment, screening year, and low socioeconomic status.

Conclusion: The age-adjusted annual rates of increase in SBP, DBP, weight, and FBG in mid-life are associated with AF incidence in men. This raises the question of whether preventive measures directed at individuals with high annual increases, even within the normal range, would reduce AF incidence.

Keywords: Atrial fibrillation; Glucose; Population; Risk factors; Systolic blood pressure; Weight.