Absolute and Attributable Risks of Atrial Fibrillation in Relation to Optimal and Borderline Risk Factors: The Atherosclerosis Risk in Communities (ARIC) Study
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Background—: Atrial fibrillation (AF) is an important risk factor for stroke and overall mortality, but information about the preventable burden of AF is lacking. The aim of this study was to determine what proportion of the burden of AF in blacks and whites could theoretically be avoided by the maintenance of an optimal risk profile. Methods and Results—: This study included 14 598 middle-aged Atherosclerosis Risk in Communities (ARIC) Study cohort members. Previously established AF risk factors, namely high blood pressure, elevated body mass index, diabetes mellitus, cigarette smoking, and prior cardiac disease, were categorized into optimal, borderline, and elevated levels. On the basis of their risk factor levels, individuals were classified into 1 of these 3 groups. The population-attributable fraction of AF resulting from having a nonoptimal risk profile was estimated separately for black and white men and women. During a mean follow-up of 17.1 years, 1520 cases of incident AF were identified. The age-adjusted incidence rates were highest in white men and lowest in black women (7.45 and 3.67 per 1000 person-years, respectively). The overall prevalence of an optimal risk profile was 5.4% but varied according to race and gender: 10% in white women versus 1.6% in black men. Overall, 56.5% of AF cases could be explained by having ≥1 borderline or elevated risk factors, of which elevated blood pressure was the most important contributor. Conclusion—: As with other forms of cardiovascular disease, more than half of the AF burden is potentially avoidable through the optimization of cardiovascular risk factors levels.
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Globally, the prevalence of valvular heart disease among individuals with AF is still greater than 25%, largely caused by the higher incidence of rheumatic heart disease in low-income and middle-income countries.
“However, globally, the prevalence of valvular heart disease among individuals with AF is still greater than 25%,38,39 largely caused by the higher incidence of rheumatic heart disease in low-income and middle-income countries.”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [38]
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- Authors
- Huxley, R. R., Lopez, F. L., Folsom, A. R., Agarwal, S. K., Loehr, L. R., Soliman, E. Z., Maclehose, R., Konety, S., & Alonso, A.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- From the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (R.R.H., F.L.L., A.R.F., R.M., S.K., A.A.); University of North Carolina at Chapel Hill (S.K.A., L.R.L.); and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC (E.Z.S.).
- ORCID
- Venue
- Circulation
- Published
- 2011-04-12
- Volume
- 123
- Issue
- 14
- Pages
- 1501-1508
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC3181498
- OpenAlex
- W2103447466
- Cited by
- 697
- References
- 25
- Citations by year
- 2026: 29 · 2025: 50 · 2024: 66 · 2023: 69 · 2022: 50 · 2021: 83 · 2020: 60 · 2019: 51 · 2018: 42 · 2017: 34 · 2016: 31 · 2015: 33 · 2014: 34 · 2013: 20 · 2012: 31
- FWCI
- 21.48
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eSpace (Curtin University) (submittedVersion)
- Funders
- National Institutes of Health (5rc1hl099452-02, n01hc55021-47-0-1, n01hc55020-39-0-0, n01hc55016-37-0-0, n01hc055022-024, n01hc55019-35-0-1, n01hc55018-38-0-1, n01hc55015-48-0-1)
- National Heart, Lung, and Blood Institute (N01-HC55022, N01 HC055016, N01-HC-55018, N01 HC 55020, N01 HC 55019, N01 HC055020, N01 HC055018, RC1-HL09945, N01-HC55016, N01 HC055022, N01 HC055019, N01‐HC‐55015, N01-HC55021, N01 HC055021, N01 HC055015, RC1-HL099452)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- atrial fibrillation, population attributable fraction, cardiovascular risk factors, blood pressure, body mass index, diabetes mellitus, cigarette smoking, racial differences, sex differences, Atherosclerosis Risk in Communities Study
- MeSH terms
- Atrial Fibrillation, Female, Humans, Hypertension, Male, Middle Aged, Obesity, Prospective Studies, Risk Factors, Sex Characteristics, Smoking, Cohort Studies, Prevalence, Stroke, Black People, White People, Diabetes Complications, Atherosclerosis
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