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Cited by 32Cardiovascular Effects of ExerciseAtrial Fibrillation Management and OutcomesPhysical Activity and Health

Risk of atrial fibrillation and stroke among older men exposed to prolonged endurance sport practice: a 10-year follow-up. The Birkebeiner Ageing Study and the Tromsø Study

Open access
Johansen, Kristoffer Robin, Ranhoff, Anette Hylen, Sørensen, Eivind, Nes, Bjarne M, Heitmann, Kim Arne, Apelland, Turid, Bucher Sandbakk, Silvana, Wilsgaard, Tom +4 more·2022·Open Heart
DOI 10.1136/openhrt-2022-002154PMC PMC9677011
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Abstract

AIMS: Endurance sport practice is associated with a high prevalence of atrial fibrillation (AF), which increases the risk of stroke in the general population. However, stroke risk in endurance athletes with AF is sparsely investigated. Most studies have been limited by design and are largely restricted to younger and middle-aged populations. Thus, we aimed to investigate AF and stroke risk in older athletes exposed to prolonged endurance training. METHOD: During a 10-year period, 505 male athletes aged ≥65 years frequently participating in a long-distance ski race were compared with 1867 men of the same age from the general population. The main exposure was endurance sport practice with self-reported AF and stroke as outcomes. Stroke risk was further examined by joint modelling of AF and endurance practice. Statistical analysis was conducted with a modified Poisson model. RESULTS: Athletes (median age: 68, range: 65-90) participated in a long-distance ski race over a median of 14 years (range: 1-53). Prevalence (28.5% vs 17.8%) and adjusted risk of AF (risk ratio (RR): 1.88, 95% CI: 1.49 to 2.37) were higher in athletes compared with non-athletes, whereas the prevalence (5.4% vs 9.7%) and risk of stroke were lower (RR: 0.60, 95% CI: 0.37 to 0.95). Compared with athletes without AF, risk of stroke was twofold in athletes (RR: 2.38, 95% CI: 1.08 to 5.24) and nearly fourfold in non-athletes (RR: 3.87, 95% CI: 1.98 to 7.57) with AF. CONCLUSION: Although older male endurance athletes experienced an increased risk of AF, the long-term risk of stroke was substantially reduced compared with non-athletes.

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  • Although the prevalence of AF increases with age, the relative risk for athletes compared to nonathletes is higher in younger athletes.

    “Moreover, although the prevalence of AF increases with age, the relative risk for athletes compared to nonathletes seems to be higher in younger athletes [22,23].”

    From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [22]

    The Discussion (Long-term endurance sport practice and risk of atrial fibrillation; page unavailable) compares an 11% increase in middle-aged skiers with a near-twofold increase in this study’s older athletes. It suggests the athlete–nonathlete risk difference may be magnified with age—the opposite of the claimed age pattern. The Results report elevated AF risk in older athletes but do not show a higher relative risk in younger athletes. (LLM, conf=0.88)

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  • Preliminary evidence suggests that the risk of atrial fibrillation-associated events such as stroke or mortality might be lower in athletes than in the general population.

    “preliminary evidence suggests that the risk of AF-associated events (e.g.stroke, mortality) might be lower in athletes than in the general population.43,44”

    From Exercise benefits in cardiovascular diseases: From mechanisms to clinical implementation (2023) · cites this paper as [43]

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Authors
Johansen, K. R., Ranhoff, A. H., Sørensen, E., Nes, B. M., Heitmann, K. A., Apelland, T., Bucher Sandbakk, S., Wilsgaard, T., Løchen, M.-L., Thelle, D. S., Morseth, B., & Myrstad, M.
Affiliations
  • University Hospital of North Norway (NO)
  • Diakonhjemmet Hospital (NO)
  • Vestre Viken Hospital Trust (NO)
  • Norwegian University of Science and Technology (NO)
  • UiT The Arctic University of Norway (NO)
  • Department for Teacher Education, Norwegian University of Science and Technology, Trondheim, Norway
  • University of Oslo (NO)
Corresponding author
Johansen, Kristoffer Robin
ORCID
Venue
Open Heart
Publisher
BMJ
Published
2022-11
Volume
9
Issue
2
Pages
e002154
ISSN
2053-3624 (ISSN-L)
DOI
10.1136/openhrt-2022-002154
PMC
PMC9677011
OpenAlex
W4309268931
Cited by
32
References
34
Citations by year
2026: 8 · 2025: 10 · 2024: 7 · 2023: 7
FWCI
4.18
Type
journal article
Language
en
Open access
Licence
Locations
  • Open Heart (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by-nc)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
Funders
Northern Norway Regional Health Authority (HNF1568-21)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
Keywords
atrial fibrillation, stroke risk, endurance athletes, older men, long-distance skiing, endurance training, long-term follow-up, Tromsø Study
MeSH terms
Aged, Aging, Atrial Fibrillation, Follow-Up Studies, Humans, Male, Middle Aged, Physical Endurance, Stroke

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