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Body Mass Index and Adverse Events in Patients with Incident Atrial Fibrillation
Abstract
Background Obesity is associated with the development of atrial fibrillation and may impact atrial fibrillation-related outcomes. To date, no anthropometric measure is included in any risk stratification scheme for stroke and death in atrial fibrillation patients.Methods The prospective Danish Diet, Cancer and Health study is a cohort including 57,053 participants (27,178 men and 29,875 women) aged between 50 and 64 years. The study population for this study included the 3135 patients (2025 men and 1110 women) who developed incident atrial fibrillation during follow-up.Results Of the subjects with atrial fibrillation, 1414 (45%) had a body mass index (BMI) in the overweight category (BMI 25 to <30 kg/m(2)) and 767 (24%) were categorized as obese (BMI ≥30 kg/m(2)). During a median follow-up of 4.9 years, 609 deaths and 216 thromboembolic events (98% ischemic strokes) occurred. Using normal-weight patients as reference, the risk of a composite end point of "ischemic stroke, thromboembolism, or death" was significantly higher in overweight (crude hazard ratio [HR] 1.31; 95% confidence interval [CI], 1.09-1.56) and obese patients (crude HR 1.55; 95% CI 1.27-1.90). After adjustment for CHADS2 and CHA2DS2-VASc scores, the HRs for the composite end point were 1.21 (95% CI 1.02-1.45) and 1.31 (95% CI 1.10-1.56), respectively, for overweight and 1.25 (95% CI 1.03-1.53) and 1.36 (95% CI 1.11-1.65), respectively, for obese. Continuous analyses of BMI stratified by sex identified obese men and normal-weight women as the sex-specific "high-risk" categories.Conclusion Overweight and obesity are risk factors for "ischemic stroke, thromboembolism or death" in patients with atrial fibrillation, even after adjustment for CHADS2 and CHA2DS2-VASc scores. The association between BMI and outcomes among atrial fibrillation patients may be modified by sex.
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“Obesity may also be a risk factor for ischaemic stroke, thromboembolism, and death in AF patients.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [292]
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Metadata
- Authors
- Overvad, T. F., Rasmussen, L. H., Skjøth, F., Overvad, K., Lip, G. Y. H., & Larsen, T. B.
- Affiliations
- Birmingham City Hospital (GB)
- Aalborg University Hospital (DK)
- Aarhus University (DK)
- Corresponding author
- Larsen, Torben Bjerregaard
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2013-07
- Volume
- 126
- Issue
- 7
- Pages
- 640.e9-640.e17
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W2096795943
- Cited by
- 127
- References
- 42
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 6 · 2023: 14 · 2022: 11 · 2021: 19 · 2020: 8 · 2019: 10 · 2018: 12 · 2017: 4 · 2016: 13 · 2015: 9 · 2014: 5 · 2013: 1
- FWCI
- 6.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
- Keywords
- body mass index, obesity, overweight, atrial fibrillation, incident atrial fibrillation, ischemic stroke, thromboembolism, mortality, risk stratification, CHA2DS2-VASc score, CHADS2 score, sex differences, stroke risk factors, anthropometric measures
- MeSH terms
- Aged, Atrial Fibrillation, Denmark, Female, Humans, Male, Middle Aged, Obesity, Prospective Studies, Sex Factors, Thromboembolism, Cohort Studies, Body Mass Index, Incidence, Proportional Hazards Models, Stroke, Overweight
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