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Another good reason to keep weight down - initial afib and progression from paroxysmal to chronic

Member Forum >> UnKnown >> Another good reason to keep weight down - initial afib and progression from paroxysmal to chronic

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Posted: 10/17/2008 8:44:30 PM
 
New research suggests that obesity not only increases the risk of first atrial fibrillation, it also increases the odds that paroxysmal atrial fibrillation will become permanent.
"This study extends our understanding of the relationship between obesity/left atrial size and atrial fibrillation. Specifically, there was a graded risk relationship between body mass index and progression from paroxysmal to permanent atrial fibrillation, and larger left atrial size augmented the risk of such progression," Dr. Teresa S. M. Tsang and associates write.
The study, which is reported in the European Heart Journal for September, involved 3248 patients in Olmsted County, Minnesota, who were diagnosed with paroxysmal atrial fibrillation between 1980 and 2000, and were followed through 2006.
During a median of 5.1 years, 557 subjects (17%) progressed to permanent atrial fibrillation, Dr. Tsang, from the Mayo Clinic in Rochester, Minnesota, and colleagues report.
On multivariate analysis, BMI was an independent predictor of progression to permanent atrial fibrillation. Relative to normal BMI, obesity and severe obesity increased the odds of progression by 54% (p = 0.0004) and 87% (p < 0.0001), respectively.
Echocardiographic assessment, which was performed in a subset of 744 patients, indicated that left atrial volume did not attenuate the association between BMI and progression to permanent atrial fibrillation.
"Studies of weight reduction, and of reversal of left atrial enlargement, may provide insight as to whether these interventions may lower the risk for the development of first atrial fibrillation, and reduce or delay the progression from paroxysmal to permanent atrial fibrillation," the research team suggests.
 
 
European Heart Journal Advance Access originally published online on July 8, 2008
European Heart Journal 2008 29(18):2227-2233;
Obesity as a risk factor for the progression of paroxysmal to permanent atrial fibrillation: a longitudinal cohort study of 21 years
Teresa S.M. Tsang1,*, Marion E. Barnes1, Yoko Miyasaka3, Stephen S. Cha2, Kent R. Bailey2, Grace C. Verzosa1, James B. Seward1 and Bernard J. Gersh1
1 Division of Cardiovascular Diseases and Internal Medicine, Rochester, MN, USA
2 Section of Biostatistics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
3 Cardiovascular Division, Department of Medicine II, Kansai Medical University, Osaka, Japan
Received 28 November 2007; revised 26 May 2008; accepted 19 June 2008; online publish-ahead-of-print 8 July 2008.

* Corresponding author. Tel: +1 507 266 4130, Fax: + 507 284 3968, Email: tsang.teresa@mayo.edu

Aims: Obesity has been shown to be a risk factor for first atrialfibrillation (AF), but whether it is associated with progressionfrom paroxysmal to permanent AF is unknown.
Methods and results: In this longitudinal cohort study, Olmsted County, MN residentsconfirmed to have developed paroxysmal AF during 1980–2000were identified and followed passively to 2006. The interrelationshipsof body mass index (BMI), left atrial (LA) size, and progressionto permanent AF were analysed. Of a total of 3248 patients (meanage 71 ± 15 years; 54% men) diagnosed with paroxysmalAF, 557 (17%) progressed to permanent AF (unadjusted incidence,36/1000 person-years) over a median follow-up period of 5.1years (interquartile range 1.2–9.4). Adjusting for ageand sex, BMI independently predicted the progression to permanentAF (hazard ratio, HR 1.04, CI 1.03–1.06; P < 0.0001).Compared with normal BMI (18.5–24.9 kg/m2), obesity (30–34.9kg/m2) and severe obesity ( 35 kg/m2) were associated with increasedrisk for progression [HR 1.54 (CI 1.2–2.0; P = 0.0004)and 1.87 (CI 1.4–2.5; P < 0.0001, respectively)]. BMIremained highly significant even after multiple adjustments.In the subgroup with echocardiographic assessment (n = 744),LA volume was incremental to BMI for independent predictionof progression after multiple adjustments, and did not weakenthe association between BMI and progression to permanent AF(HR 1.04; CI 1.02–1.05; P < 0.0001).
Conclusion: There was a graded risk relationship between BMI and progressionfrom paroxysmal to permanent AF. This relationship was not weakenedby LA volume, which was independent of and incremental to BMIfor the prediction of progression to permanent AF.
 
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