Metabolic Syndrome and Risk of Development of Atrial Fibrillation: The Niigata Preventive Medicine Study
Open accessAbstract
Background— The metabolic syndrome consists of a cluster of atherosclerotic risk factors, many of which also have been implicated in the genesis of atrial fibrillation (AF). However, the precise role of the metabolic syndrome in the development of AF is unknown. Methods and Results— This prospective, community-based, observational cohort study was based on an annual health check-up program in Japan. We studied 28 449 participants without baseline AF. We used 2 different criteria for the metabolic syndrome—the guidelines of the National Cholesterol Education Program Third Adult Treatment Panel (NCEP-ATP III) and those of the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI)—to study the risk of development of new-onset AF. The metabolic syndrome was present in 3716 subjects (13%) and 4544 subjects (16%) using the NCEP-ATP III and AHA/NHLBI definitions, respectively. During a mean follow-up of 4.5 years, AF developed in 265 subjects (105 women). Among the metabolic syndrome components, obesity (age- and sex-adjusted hazard ratio [HR], 1.64), elevated blood pressure (HR, 1.69), low high-density lipoprotein cholesterol (HR, 1.52), and impaired insulin tolerance (HR, 1.44 [NCEP-ATP III] and 1.35 [AHA/NHLBI]) showed an increased risk for AF. The association between the metabolic syndrome and AF remained significant in subjects without treated hypertension or diabetes by the NCEP-ATP III definition (HR, 1.78) but not by the AHA/NHLBI definition (HR, 1.28). Conclusions— The metabolic syndrome was associated with increased risk of AF. The metabolic derangements of the syndrome may be important in the pathogenesis of AF.
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Diabetes is probably not the most potent independent risk factor for stroke in atrial fibrillation compared with the other items in the CHA2DS2-VASc score.
“Diabetes is probably not the most potent independent risk factor for stroke in AF compared with the other items in the CHA 2 DS 2 -VASc score, but it is included in this risk-stratification tool, giving a point alongside most other items.600,618,[622][623][624]”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [600]
Patients with diabetes may have a lower risk of inappropriate therapy or implantable cardioverter-defibrillator shock.
“In contrast, patients with diabetes may have a lower risk of inappropriate therapy or ICD shock, since they may be more sedentary with consequently less frequent exercise-induced sinus tachycardia and also lower incidence of lead fracture.600,658,659”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [600]
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Cites
Grundy, S. M., Bilheimer, D. W., Chait, A., Clark, L. T., Denke, M. A., Havel, R. J., Hazzard, W. R., Hulley, S. B., Hunninghake, D. B., Kreisberg, R. A., et al. (1993) · JAMA · doi:10.1001/jama.269.23.3015 · Cited by 27,944 · see citing works
Expert Panel on Detection, E. (2001) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.285.19.2486 · Cited by 26,011 · see citing works
Grundy, S. M., Cleeman, J. I., Daniels, S. R., Donato, K. A., Eckel, R. H., Franklin, B. A., Gordon, D. J., Krauss, R. M., Savage, P. J., Smith, S. C., et al. (2005) · Circulation · doi:10.1161/circulationaha.105.169404 · Cited by 11,961 · see citing works
Atrial fibrillation as an independent risk factor for stroke: the Framingham study
Wolf, P. A., Abbott, R. D., & Kannel, W. B. (1991) · Stroke · doi:10.1161/01.str.22.8.983 · Cited by 7,388 · see citing works
Go, A. S., Hylek, E. M., Phillips, K. A., Chang, Y., Henault, L. E., Selby, J. V., & Singer, D. E. (2001) · JAMA · doi:10.1001/jama.285.18.2370 · Cited by 6,205 · see citing works
The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men
Lakka, H.-M. (2002) · JAMA · doi:10.1001/jama.288.21.2709 · Cited by 5,033 · see citing works
Prevalence of Chronic Kidney Disease in the United States
Coresh, J., Selvin, E., Stevens, L. A., Manzi, J., Kusek, J. W., Eggers, P., Van Lente, F., & Levey, A. S. (2007) · JAMA · doi:10.1001/jama.298.17.2038 · Cited by 4,895 · see citing works
Impact of Atrial Fibrillation on the Risk of Death: The Framingham Heart Study
Benjamin, E. J., Wolf, P. A., D’Agostino, R. B., Silbershatz, H., Kannel, W. B., & Levy, D. (1998) · Circulation · doi:10.1161/01.cir.98.10.946 · Cited by 4,575 · see citing works
Atrial Fibrillation Begets Atrial Fibrillation
WIJFFELS, M. C. E. F., Kirchhof, C. J. H. J., Dorland, R., & Allessie, M. A. (1995) · Circulation · doi:10.1161/01.cir.92.7.1954 · Cited by 3,500 · see citing works
Miyasaka, Y., Barnes, M. E., Gersh, B. J., Cha, S. S., Bailey, K. R., Abhayaratna, W. P., Seward, J. B., & Tsang, T. S. M. (2006) · Circulation · doi:10.1161/circulationaha.105.595140 · Cited by 2,564 · see citing works
Epidemiologic Features of Chronic Atrial Fibrillation
Kannel, W. B., Abbott, R. D., Savage, D. D., & McNamara, P. M. (1982) · New England Journal of Medicine · doi:10.1056/nejm198204293061703 · Cited by 2,304 · see citing works
Ridker, P. M., Buring, J. E., Cook, N. R., & Rifai, N. (2003) · Circulation · doi:10.1161/01.cir.0000055014.62083.05 · Cited by 2,292 · see citing works
Lifetime Risk for Development of Atrial Fibrillation: The Framingham Heart Study
Lloyd-Jones, D. M., Wang, T. J., Leip, E. P., Larson, M. G., Levy, D., Vasan, R. S., D’Agostino, R. B., Massaro, J. M., Beiser, A., Wolf, P. A., et al. (2004) · Circulation · doi:10.1161/01.cir.0000140263.20897.42 · Cited by 2,041 · see citing works
Kannel, W. B., Wolf, P. A., Benjamin, E. J., & Levy, D. (1998) · The American Journal of Cardiology · doi:10.1016/s0002-9149(98)00583-9 · Cited by 2,033 · see citing works
New Criteria for `Obesity Disease' in Japan
The Examination Committee of Criter (2002) · Circulation Journal · doi:10.1253/circj.66.987 · Cited by 1,650 · see citing works
Stewart, S., Hart, C. L., Hole, D. J., & McMurray, J. J. V. (2002) · The American Journal of Medicine · doi:10.1016/s0002-9343(02)01236-6 · Cited by 1,562 · see citing works
Incidence of and risk factors for atrial fibrillation in older adults
Psaty, B. M., Manolio, T. A., Kuller, L. H., Kronmal, R. A., Cushman, M., Fried, L. P., White, R., Furberg, C. D., & Rautaharju, P. M. (1997) · Circulation · doi:10.1161/01.cir.96.7.2455 · Cited by 1,462 · see citing works
Electrical, contractile and structural remodeling during atrial fibrillation
Allessie, M. A. (2002) · Cardiovascular Research · doi:10.1016/s0008-6363(02)00258-4 · Cited by 1,455 · see citing works
Obesity and the risk of new-onset atrial fibrillation
Wang, T. J. (2004) · JAMA · doi:10.1001/jama.292.20.2471 · Cited by 1,427 · see citing works
C-Reactive Protein Elevation in Patients With Atrial Arrhythmias
Chung, M. K., Martin, D. O., Sprecher, D. L., Wazni, O. M., KANDERIAN, A. S., Carnes, C. A., Bauer, J. A., TCHOU, P. J., Niebauer, M. J., Natale, A., et al. (2001) · Circulation · doi:10.1161/hc4901.101760 · Cited by 1,375 · see citing works
Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study.
Vaziri, S. M., Larson, M. G., Benjamin, E. J., & Levy, D. (1994) · Circulation · doi:10.1161/01.cir.89.2.724 · Cited by 1,073 · see citing works
Ninomiya, J. K., L'Italien, G. J., Criqui, M. H., Whyte, J. L., Gamst, A. C., & Chen, R. S. (2003) · Circulation · doi:10.1161/01.cir.0000108926.04022.0c · Cited by 793 · see citing works
New Criteria for `Obesity Disease' in Japan
Oda, E. (2006) · Circulation Journal · doi:10.1253/circj.70.150 · Cited by 783 · see citing works
Rensma, P., Allessie, M., Lammers, W., Bonke, F. I., & Schalij, M. (1988) · Circulation Research · doi:10.1161/01.res.62.2.395 · Cited by 686 · see citing works
Impaired Myofibrillar Energetics and Oxidative Injury During Human Atrial Fibrillation
Mihm, M. J., Yu, F., Carnes, C. A., Reiser, P. J., McCarthy, P. M., Wagoner, D. R. V., & Bauer, J. A. (2001) · Circulation · doi:10.1161/01.cir.104.2.174 · Cited by 667 · see citing works
Ford, E. S. (2004) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2003.12.022 · Cited by 501 · see citing works
The Metabolic Syndrome and Antioxidant Concentrations
Ford, E. S., Mokdad, A. H., Giles, W. H., & Brown, D. W. (2003) · Diabetes · doi:10.2337/diabetes.52.9.2346 · Cited by 458 · see citing works
Hobbs, F., Fitzmaurice, D., Mant, J., Murray, E., Jowett, S., Bryan, S., Raftery, J., Davies, M., & Lip, G. (2005) · Health Technology Assessment · doi:10.3310/hta9400 · Cited by 437 · see citing works
Movahed, M. R., Hashemzadeh, M., & Jamal, M. M. (2005) · International Journal of Cardiology · doi:10.1016/j.ijcard.2005.02.050 · Cited by 378 · see citing works
Myocardial cell death in fibrillating and dilated human right atria
Aimé, C., Folliguet, T. A., Rücker‐Martin, C., Krajewska, M., Krajewski, S., Heimburger, M., Aubier, M., Mercadier, J.-J., Reed, J. C., & Hatem, S. N. (1999) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(99)00382-4 · Cited by 300 · see citing works
Influence of Blood Pressure on Left Atrial Size
Vaziri, S. M., Larson, M. G., Lauer, M. S., Benjamin, E. J., & Levy, D. A. (1995) · Hypertension · doi:10.1161/01.hyp.25.6.1155 · Cited by 298 · see citing works
Effects of chronic atrial fibrillation on gap junction distribution in human and rat atria
Polontchouk, L., Haefliger, J., Ebelt, B., Schaefer, T., Stuhlmann, D., Mehlhorn, U., Kuhn‐Régnier, F., de Vivie, E. R., & Dhein, S. (2001) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(01)01443-7 · Cited by 292 · see citing works
Dernellis, J. M. (2004) · European Heart Journal · doi:10.1016/j.ehj.2004.04.025 · Cited by 290 · see citing works
Risk of New-Onset Atrial Fibrillation in Relation to Body Mass Index
Dublin, S. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.21.2322 · Cited by 268 · see citing works
The relationship of human atrial cellular electrophysiology to clinical function and ultrastructure.
Mary-Rabine, L., Albert, A., Pham, T. D., Hordof, A. J., Fenoglio, J. J., Malm, J. R., & Rosen, M. R. (1983) · Circulation Research · doi:10.1161/01.res.52.2.188 · Cited by 227 · see citing works
Obesity and type 2 diabetes in Japanese patients
Sone, H., Ito, H., Ohashi, Y., Akanuma, Y., & Yamada, N. (2003) · The Lancet · doi:10.1016/s0140-6736(03)12151-4 · Cited by 198 · see citing works
Gene expression profiling of oxidative stress on atrial fibrillation in humans
Kim, Y., Lee, J. H., Lim, D., et al. (2003) · Experimental & Molecular Medicine · doi:10.1038/emm.2003.45 · Cited by 176 · see citing works
Ohsawa, M., Okayama, A., Sakata, K., Kato, K., Itai, K., Onoda, T., & Ueshima, H. (2005) · Journal of Epidemiology · doi:10.2188/jea.15.194 · Cited by 135 · see citing works
Effect of C-reactive protein reduction on paroxysmal atrial fibrillation
Dernellis, J. M., & Panaretou, M. (2005) · American Heart Journal · doi:10.1016/j.ahj.2005.06.032 · Cited by 119 · see citing works
Hirani, V., Zaninotto, P., & Primatesta, P. (2007) · Public Health Nutrition · doi:10.1017/s1368980007000845 · Cited by 81 · see citing works
Barbier, P., Alioto, G., & Guazzi, M. D. (1994) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(94)90558-4 · Cited by 79 · see citing works
Pisciotta, L., Hamilton‐Craig, I. R., Tarugi, P., Bellocchio, A., Fasano, T., Alessandrini, P., Bon, G. B., Siepi, D., Mannarino, E., Cattin, L., et al. (2003) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2003.11.009 · Cited by 69 · see citing works
Watanabe, H., Tanabe, N., Makiyama, Y., Chopra, S. S., Okura, Y., Suzuki, H., Matsui, K., Watanabe, T., Kurashina, Y., & Aizawa, Y. (2006) · American Heart Journal · doi:10.1016/j.ahj.2006.05.032 · Cited by 57 · see citing works
Self-citationImpact of the Metabolic Syndrome on Atrial Size in Patients With New-Onset Atrial Fibrillation
Nicolaou, V. N., Papadakis, J. E., Karatzis, E. N., Dermitzaki, S. I., Tsakiris, A. K., & Skoufas, P. D. (2007) · Angiology · doi:10.1177/0003319706297913 · Cited by 50 · see citing works
Appropriate body-mass index for Asians
Patel, J., Hughes, E. A., Mackness, M., et al. (2003) · The Lancet · doi:10.1016/s0140-6736(03)12150-2 · Cited by 43 · see citing works
Reversible ocular myasthenia gravis or mitochondrial myopathy from statins?
Engel, W. K. (2003) · The Lancet · doi:10.1016/s0140-6736(03)12152-6 · Cited by 21 · see citing works
Korantzopoulos, P. G., Kokkoris, S., & Papaioannides, D. (2005) · Cardiology · doi:10.1159/000087636 · Cited by 19 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol. 1998;82:2N-9N.
- Fujishima F. Cardiac diseases as risk factors for cerebrovascular diseases [in Japanese]. Junkankisenmoni. 1998;6:19 -26.
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Ndumele, C. E., Rangaswami, J., Chow, S. L., Neeland, I. J., Tuttle, K. R., Khan, S. S., Coresh, J., Mathew, R. O., Baker-Smith, C. M., Carnethon, M. R., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001184 · Cited by 2,208 · see citing works
2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes.
Marx, N., Federici, M., Schütt, K., Müller-Wieland, D., Ajjan, R. A., Antunes, M. J., Christodorescu, R. M., Crawford, C., Di Angelantonio, E., Eliasson, B., et al. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad192 · Cited by 1,642 · see citing works
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Rahman, F., Kwan, G. F., & Benjamin, E. J. (2014) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2014.118 · Cited by 731 · see citing works
Atrial fibrillation is independently associated with senile, vascular, and Alzheimer's dementia
Bunch, T. J., Weiss, J. P., Crandall, B. G., May, H. T., Bair, T. L., Osborn, J. S., Anderson, J. L., Muhlestein, J. B., Horne, B. D., Lappe, D. L., et al. (2010) · Heart Rhythm · doi:10.1016/j.hrthm.2009.12.004 · Cited by 405 · see citing works
Poirier, P., Cornier, M.-A., Mazzone, T., Stiles, S., Cummings, S., Klein, S., McCullough, P. A., Ren Fielding, C., & Franklin, B. A. (2011) · Circulation · doi:10.1161/cir.0b013e3182149099 · Cited by 339 · see citing works
Diabetes mellitus, glycemic control, and risk of atrial fibrillation
Dublin, S., Glazer, N. L., Smith, N. L., Psaty, B. M., Lumley, T., Wiggins, K. L., Page, R. L., & Heckbert, S. R. (2010) · Journal of General Internal Medicine · doi:10.1007/s11606-010-1340-y · Cited by 310 · see citing works
Chang, S.-H., Wu, L.-S., Chiou, M.-J., Liu, J.-R., Yu, K.-H., Kuo, C.-F., Wen, M.-S., Chen, W.-J., Yeh, Y.-H., & See, L.-C. (2014) · Cardiovascular Diabetology · doi:10.1186/s12933-014-0123-x · Cited by 225 · see citing works
Predictors for atrial fibrillation detection after cryptogenic stroke: Results from CRYSTAL AF
Thijs, V. N., Brachmann, J., Morillo, C. A., Passman, R. S., Sanna, T., Bernstein, R. A., Diener, H.-C., Di Lazzaro, V., Rymer, M. M., Hogge, L., et al. (2016) · Neurology · doi:10.1212/wnl.0000000000002282 · Cited by 170 · see citing works
Adaptation and maladaptation of the heart in obesity
Harmancey, R., Wilson, C. R., & Taegtmeyer, H. (2008) · Hypertension · doi:10.1161/hypertensionaha.108.110031 · Cited by 121 · see citing works
Buiten, M. S., de Bie, M. K., Rotmans, J. I., Gabreëls, B. A., van Dorp, W., Wolterbeek, R., Trines, S. A., Schalij, M. J., Jukema, J. W., Rabelink, T. J., et al. (2014) · Heart · doi:10.1136/heartjnl-2013-305417 · Cited by 119 · see citing works
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Schoen, T., Pradhan, A. D., Albert, C. M., & Conen, D. (2012) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2012.06.030 · Cited by 106 · see citing works
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Chao, T.-F., Liu, C.-J., Chen, S.-J., Wang, K.-L., Lin, Y.-J., Chang, S.-L., Lo, L.-W., Hu, Y.-F., Tuan, T.-C., Chen, T.-J., et al. (2014) · Circulation Journal · doi:10.1253/circj.cj-14-0222 · Cited by 25 · see citing works
Bharaj, I. S., Brar, A. S., Kahlon, J., Singh, A., Hotwani, P., Kumar, V., Sohal, A., & Batta, A. (2025) · World Journal of Cardiology · doi:10.4330/wjc.v17.i6.106147 · Cited by 19 · see citing works
- Authors
- Watanabe, H., Tanabe, N., Watanabe, T., Darbar, D., Roden, D. M., Sasaki, S., & Aizawa, Y.
- Affiliations
- Vanderbilt University (US)
- Venue
- Circulation
- Published
- 2008-03-11
- Volume
- 117
- Issue
- 10
- Pages
- 1255-1260
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC2637133
- OpenAlex
- W2010305313
- Cited by
- 427
- References
- 47
- Citations by year
- 2026: 15 · 2025: 14 · 2024: 8 · 2023: 21 · 2022: 21 · 2021: 30 · 2020: 27 · 2019: 21 · 2018: 24 · 2017: 21 · 2016: 20 · 2015: 24 · 2014: 41 · 2013: 28 · 2012: 28
- FWCI
- 20.12
- Type
- journal article
- Language
- en
- Update notices
- correction (2010-08-17)
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Vanderbilt University
- School of Medicine, Vanderbilt University
- National Heart, Lung, and Blood Institute (K23HL075266, U01HL065962)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- metabolic syndrome, atrial fibrillation, new-onset atrial fibrillation, obesity, hypertension, low HDL cholesterol, impaired fasting glucose, NCEP ATP III criteria, AHA/NHLBI criteria, atherosclerosis risk factors, atrial fibrillation pathogenesis
- MeSH terms
- Aged, Atrial Fibrillation, Female, Humans, Male, Middle Aged, Risk Factors, Cohort Studies, Incidence, Multivariate Analysis, Proportional Hazards Models, Observation, Metabolic Syndrome
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