Elsevier

American Heart Journal

Volume 155, Issue 2, February 2008, Pages 310-315
American Heart Journal

Clinical Investigation
Electrophysiology
Atrial fibrillation and obesity—results of a meta-analysis

https://doi.org/10.1016/j.ahj.2007.10.004Get rights and content

Background

Obesity has been shown to be associated with atrial enlargement and ventricular diastolic dysfunction, both of which are risk factors for atrial fibrillation (AF). However, the role of obesity as a risk factor for the development of AF is unknown. The study aims to evaluate the role of obesity as a risk factor for the development of AF.

Methods

The MEDLINE/ PUBMED and Cochrane databases were searched for studies in human subjects published in English language between 1966 and May 2007. Studies were included in our analyses if they were population-based cohort or postcardiac surgery cohort and investigated the incidence of AF in relation to the body mass index (BMI) categories.

Results

Of the 468 articles identified, 16 studies that enrolled a total of 123 249 individuals met the inclusion criteria. These 16 articles included 5 population-based cohort studies that enrolled 78 602 adult individuals from the United States and 3 European countries and 11 postcardiac surgery studies that enrolled 44 647 patients.

Based on the population-based cohort studies, obese individuals have an associated 49% increased risk of developing AF compared to nonobese individuals (relative risk 1.49, 95% CI 1.36-1.64). The risk of AF increased in parallel with greater BMI in this cohort. In contrast, in the postcardiac surgery studies, obese individuals do not have an associated increased risk of developing AF compared to nonobese individuals (relative risk 1.02, 95% CI 0.99-1.06).

Conclusions

Our findings demonstrate that obesity increased the risk of developing AF by 49% in the general population, and the risk escalated in parallel with increased BMI. Thus, AF evolves as yet another pathogenetic factor by which obesity may increase cardiovascular and cerebrovascular events.

Section snippets

Search strategy

Comprehensive searches of the MEDLINE and Cochrane databases were performed using Web-based search engines for human studies published in English between 1966 and May 2007. Search terms included obesity, overweight, body mass index, arrhythmia, atrial fibrillation, and their combinations. We checked the reference lists of reviewed articles, prior meta-analyses, and original studies identified by the search to find other potentially relevant studies.

Study selection

Studies were included in the analysis if they

Study selection

Of the 468 identified articles from the search, 16 studies that enrolled a total of 123 249 individuals met the inclusion criteria and were included in the analysis. The rest of the studies did not meet our inclusion criteria because they either did not provide any data regarding the link between BMI categories and incidence of AF or did not provide clear BMI cutoffs for their BMI categories. These 16 articles consisted of 5 population-based cohort studies24, 25, 26, 27, 28 that enrolled 78 602

Discussion

Our meta-analysis of the available data shows that the presence of overweight and obesity increases the risk of AF in the general population. This relationship was strengthened by the finding of a classification-dependent relationship between BMI and the risk of developing AF. Furthermore, these findings were consistent for both men and women.

The electrophysiologic mechanisms by which obesity may lead to AF remain to be elucidated. Traditionally, obesity is thought to be an indirect cause of

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    Dr Messerli served as an ad hoc consultant/speaker for the following organizations: Abbott, GSK, Novartis, Pfizer, AstraZeneca, Bayer, Boehringer Ingelheim, BMS, Forest, Sankyo, and Sanofi. Dr Somers is supported by grants HL 73211, HL 65176, and MO1-RR00585 from the National institutes of Health (Bethesda, MD). He serves as a consultant for Respironics, Cardiac Concepts, ResMed, and Sepracor.

    This work was presented in part at the 2007 Annual Scientific Session of the American College of Cardiology, New Orleans, LA.

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