The interplay among body weight, blood pressure, and cardiorespiratory fitness in predicting atrial fibrillation

Abstract

Background: Hypertension, obesity, and low cardiorespiratory fitness (CRF) are known risk predictors for the development of atrial fibrillation (AF) that often interrelate with each other. We examined the interplay of these 3 risk indicators with the occurrence of AF in patients without known cardiovascular disease. Methods: A retrospective analysis of 13,042 patients underwent exercise stress testing (EST). The occurrence of AF during the median follow-up period of 6.8 years was investigated in relation to the presence of obesity (body mass index ≥30 kg/m2), hypertension (blood pressure ≥140/90 mmHg or history of hypertension), or low CRF (exercise capacity <8 metabolic equivalents). Cox proportional hazards models were used to evaluate the individual and combined association between the 3 risk indicators and AF. Results: The mean age of the study population was 58 ± 9 years; 49% were women. AF occurred in 499 patients (3.8%). Obesity [hazard ratio (95% confidence interval)], 1.36 (1.12–1.65), hypertension, 1.47 (1.19–1.82), and low CRF, 1.32 (1.06–1.64), were independent risk predictors for AF after multivariable adjustment, including after adjusting for each other and also when the risk predictors were analyzed as continuous variables. In a combined model, a gradual increase in the risk of AF was observed, reaching an adjusted hazard ratio of 2.53 (1.77–3.62) in those with all 3 compared with neither risk indicators. P-for-interaction between hypertension and obesity, or hypertension and low CRF was nonsignificant. Conclusions: Obesity, low CRF, and hypertension are independently associated with an excess risk of developing AF in patients without known cardiovascular disease, both individually and more so when coexisting together.

Keywords

• Atrial fibrillation
• Hypertension
• Obesity
• Exercise testing
• Cardiorespiratory fitness