Author + information
- Received March 7, 2017
- Revision received March 30, 2017
- Accepted April 11, 2017
- Published online July 31, 2017.
- Neal A. Chatterjee, MD, MSca,b,∗ (, )
- Claudia U. Chae, MD, MPHb,
- Eunjung Kim, MSca,
- M. Vinayaga Moorthy, PhDa,
- David Conen, MD, MPHa,c,
- Roopinder K. Sandhu, MD, MPHd,
- Nancy R. Cook, ScDa,
- I-Min Lee, MBBS, ScDa,e and
- Christine M. Albert, MD, MPHa,f
- aDivision of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- bCardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- cDepartment of Medicine, University Hospital, Basel, Switzerland
- dDivision of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- eDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- fDivision of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Neal A. Chatterjee, Cardiology Division, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114.
Objectives This study sought to identify modifiable risk factors and estimate the impact of risk factor modification on heart failure (HF) risk in women with new-onset atrial fibrillation (AF).
Background Incident HF is the most common nonfatal event in patients with AF, although strategies for HF prevention are lacking.
Methods We assessed 34,736 participants in the Women’s Health Study who were free of prevalent cardiovascular disease at baseline. Cox models with time-varying assessment of risk factors after AF diagnosis were used to identify significant modifiable risk factors for incident HF.
Results Over a median follow-up of 20.6 years, 1,495 women developed AF without prevalent HF. In multivariable models, new-onset AF was associated with an increased risk of HF (hazard ratio [HR]: 9.03; 95% confidence interval [CI]: 7.52 to 10.85). Once women with AF developed HF, all-cause (HR: 1.83; 95% CI: 1.37 to 2.45) and cardiovascular mortality (HR: 2.87; 95% CI: 1.70 to 4.85) increased. In time-updated, multivariable models accounting for changes in risk factors after AF diagnosis, systolic blood pressure >120 mm Hg, body mass index ≥30 kg/m2, current tobacco use, and diabetes mellitus were each associated with incident HF. The combination of these 4 modifiable risk factors accounted for an estimated 62% (95% CI: 23% to 83%) of the population-attributable risk of HF. Compared with women with 3 or 4 risk factors, those who maintained or achieved optimal risk factor control had a progressive decreased risk of HF (HR for 2 risk factors: 0.60; 95% CI: 0.37 to 0.95; 1 risk factor: 0.40; 95% CI: 0.25 to 0.63; and 0 risk factors: 0.14; 95% CI: 0.07 to 0.29).
Conclusions In women with new-onset AF, modifiable risk factors including obesity, hypertension, smoking, and diabetes accounted for the majority of the population risk of HF. Optimal levels of modifiable risk factors were associated with decreased HF risk. Prospective assessment of risk factor modification at the time of AF diagnosis may warrant future investigation.
The Women’s Health Study was supported by grants HL-043851, HL-080467, and HL-099355 from the National Heart, Lung, and Blood Institute; and grants CA-047988 and 182913 from the National Cancer Institute. The atrial fibrillation endpoint was supported by a Watkin's discovery award and HL-093613 from the National Heart, Lung, and Blood Institute. The heart failure endpoint was supported by the Elizabeth Anne and Karen Barlow Corrigan Women's Heart Health Program at Massachusetts General Hospital and the Donald W. Reynolds Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 7, 2017.
- Revision received March 30, 2017.
- Accepted April 11, 2017.
- 2017 American College of Cardiology Foundation