Hypothetical interventions and risk of atrial fibrillation by sex and education: application of the parametric g-formula in the Tromsø Study

• Published in: European journal of preventive cardiology 2023-11, Vol.30 (16), p.1791-1800
• Main Authors: Nilsen, Linn, Sharashova, Ekaterina, Løchen, Maja-Lisa, Danaei, Goodarz, Wilsgaard, Tom
• Format: Article
• Language: English
• ISSN: 2047-4873; 2047-4881; 2047-4881
• DOI: 10.1093/eurjpc/zwad240

Abstract Aims To use the parametric g-formula to estimate the long-term risk of atrial fibrillation (AF) by sex and education under hypothetical interventions on six modifiable risk factors. Methods and results We estimated the risk reduction under hypothetical risk reduction strategies for smoking, physical activity, alcohol intake, body mass index, systolic, and diastolic blood pressure in 14 923 women and men (baseline mean age 45.8 years in women and 47.8 years in men) from the population-based Tromsø Study with a maximum of 22 years of follow-up (1994–2016). The estimated risk of AF under no intervention was 6.15% in women and 13.0% in men. This cumulative risk was reduced by 41% (95% confidence interval 17%, 61%) in women and 14% (−7%, 30%) in men under joint interventions on all risk factors. The most effective intervention was lowering body mass index to ≤ 25 kg/m2, leading to a 16% (4%, 25%) lower risk in women and a 14% (6%, 23%) lower risk in men. We found significant sex-differences in the relative risk reduction by sufficient physical activity, leading to a 7% (-4%, 18%) lower risk in women and an 8% (−2%, −13%) increased risk in men. We found no association between the level of education and differences in risk reduction by any of the interventions. Conclusion The population burden of AF could be reduced by modifying lifestyle risk factors. Namely, these modifications could have prevented 41% of AF cases in women and 14% of AF cases in men in the municipality of Tromsø, Norway during a maximum 22-year follow-up period. Lay Summary The heart normally has a regular rhythm. However, in an increasing number of adults worldwide, the rhythm is irregular, which is known as arrhythmia. Atrial fibrillation, or AF, is the most common type of arrhythmia. We know that the risk of AF may be related to lifestyle. In this project, we investigated how much the risk of AF in the population could have been reduced by improvements in smoking habits, physical activity level, alcohol intake, body mass index (BMI), and blood pressure. We found that the risk could have been reduced by 41% in women and 14% in men if everyone quit smoking, was sufficiently physically active, limited their alcohol intake to two units per week, lowered their BMI to 25 kg/m2, and lowered their blood pressure to 130/80 mm Hg. Reducing BMI was the most effective intervention to prevent AF. Graphical Abstract Graphical Abstract