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How can lifestyle changes and risk factor modification help the reduction and prevention of atrial fibrillation (AF)? A new paradigm for the future. Thanks for the recommendation @KoushikReddyMD @CircAHA @ACLifeMed
#cardiology #prevention #cardiotwitter
#cardiology #prevention #cardiotwitter
Background:
- AF has multiple modifiable risk factors including obesity, physical inactivity, OSA, DM, HTN
- Burgeoning health threat, associated with stroke, heart failure, and death
- Risk factor intervention for primary (AF risk/incidence) or secondary (AF burden reduction)
- AF has multiple modifiable risk factors including obesity, physical inactivity, OSA, DM, HTN
- Burgeoning health threat, associated with stroke, heart failure, and death
- Risk factor intervention for primary (AF risk/incidence) or secondary (AF burden reduction)
Obesity and AF:
- Conduction slowing, larger atrial size increases AF vulnerability
- Obesity-related HTN and diastolic dysfunction can stretch left atrial channels, increasing AF risk
- Bariatric surgery associated w/ reduced risk new AF and recurrence of AF s/p ablation
- Conduction slowing, larger atrial size increases AF vulnerability
- Obesity-related HTN and diastolic dysfunction can stretch left atrial channels, increasing AF risk
- Bariatric surgery associated w/ reduced risk new AF and recurrence of AF s/p ablation
Physical Activity and AF
- Better cardiorespiratory fitness has inverse relationship with AF burden in middle-aged/elderly people
- CARDIO-FIT: Every MET increase from baseline with 9% decline in AF after adjustment of factors
-<10% adults meet physical activity guidelines
- Better cardiorespiratory fitness has inverse relationship with AF burden in middle-aged/elderly people
- CARDIO-FIT: Every MET increase from baseline with 9% decline in AF after adjustment of factors
-<10% adults meet physical activity guidelines
Sleep disordered breathing (SDB) and AF
- OSA global prevalence ~1 billion. Untreated SDB has HR of 5.2 for CVD
- "Dose-relationship" b/w SDB severity and AF incidence, burden, and treatment response
- ORBIT-AF: CPAP compliance less progression of AF disease and more permanent AF
- OSA global prevalence ~1 billion. Untreated SDB has HR of 5.2 for CVD
- "Dose-relationship" b/w SDB severity and AF incidence, burden, and treatment response
- ORBIT-AF: CPAP compliance less progression of AF disease and more permanent AF
DM and AF
- Among 845,748 VA patients, 43,674 had AF and DM w/ independent association (p<0.0001)
- AF risk with longer DM duration, glycemic damage may be arrythmogenic
- STRONG Heart: Pt with DM had greater LV mass and wall thickness, higher pulse pressure, and stroke volume
- Among 845,748 VA patients, 43,674 had AF and DM w/ independent association (p<0.0001)
- AF risk with longer DM duration, glycemic damage may be arrythmogenic
- STRONG Heart: Pt with DM had greater LV mass and wall thickness, higher pulse pressure, and stroke volume
HTN and AF
- Elevated levels of angiotensin II and aldosterone leads to inflammation, fibrosis, and anisotropic conduction and fosters AF
- MRA treatment w/ reduced AF risk and recurrence in meta-analyses and observational studies
- Elevated levels of angiotensin II and aldosterone leads to inflammation, fibrosis, and anisotropic conduction and fosters AF
- MRA treatment w/ reduced AF risk and recurrence in meta-analyses and observational studies
Conclusions:
- Multi-disciplinary clinics have shown 35% relative risk reduction for end-point of CV hospitalization and mortality
- Multiple modifiable risk factors associated w/ AF
- Need for greater emphasis on lifestyle modification, prevention in the present and future
- Multi-disciplinary clinics have shown 35% relative risk reduction for end-point of CV hospitalization and mortality
- Multiple modifiable risk factors associated w/ AF
- Need for greater emphasis on lifestyle modification, prevention in the present and future
