Personalized Care Focused on Lifestyle Factors May Reduce Risk of Atrial Fibrillation
Atrial fibrillation, often abbreviated as AFib, is a common heart condition characterized by an irregular and chaotic heartbeat, boosting the risk of strokes and other health problems. While some risk factors, like age and genetics, are non-modifiable, several lifestyle factors, comorbid conditions, and socioeconomic aspects can be managed to lower the risk.
Beyond well-known cardiovascular health risk factors such as physical activity, diet, and smoking, certain chronic conditions, like cardiovascular, respiratory, metabolic, and mental health issues, increase the risk of AFib too.
A recent review pooled data from prior studies, highlighting the significance of lifestyle factors, comorbidities, and socioeconomic factors in AFib risk. The review emphasized the importance of a multi-disciplinary, personalized approach to better manage AFib and reduce the risks of mortality and other health issues.
Cardiac electrophysiologist Dr. Stephen Tang, MD, board-certified and uninvolved in the study, explained to Medical News Today, "The comprehensive management of AFib transcends oral anticoagulation for stroke prevention or rate control with medication or ablation. This condition is driven by numerous risk factors and comorbidities. If these aren't controlled, AFib will persist, despite ablation. Identifying and optimizing these risks is essential for long-term AFib management."
Risk factors and AFib treatments
AFib is an arrhythmia caused by the irregular beating of the left upper heart chamber, or atrium. This irregular heartbeat can form blood clots in the atrium, which could travel to the brain and cause a stroke. Genetic, sex, and age are unchangeable risk factors for AFib, but its other risk factors include:
- Lifestyle factors
- Comorbids
- Socioeconomic factors
Medications and lifestyle adjustments can help manage AFib. Blood thinners (anticoagulants) can reduce blood clot formation and the risk of stroke. NOACs, non-vitamin K antagonist oral anticoagulants, have become the preferred first-line treatment for AFib. Other drugs, such as beta-blockers and calcium channel blockers, are useful for controlling the heart rate. In some cases, catheter ablation may be necessary to restore a normal heart rhythm when other methods fail.
Influence of lifestyle factors on AFib risk
Similar to other cardiovascular conditions, an inactive lifestyle, obesity, smoking, and excessive alcohol consumption can increase the risk of AFib.
Physical activity
Adequate physical activity lowers the risk of AFib, while sedentary living increases it. Regular moderate-to-vigorous workouts and high-intensity interval training can help reduce AFib's impact on morbidity and improve life quality. However, evidence supporting the role of exercise in preventing strokes is limited.
Obesity
Obesity not only increases the risk of AFib but also worsens complications during catheter ablation, stroke, and death. Therefore. weight loss can decrease the risk of AFib recurrence and complications.
Smoking and alcohol consumption
Smoking and heavy alcohol consumption lead to an increased AFib risk. Moderate-to-heavy alcohol consumption increases AFib risk in a dose-dependent manner, while data on low-level alcohol intake is mixed.
Health conditions co-occurring with AFib
Certain chronic cardiovascular, respiratory, mental health conditions can increase the risk of AFib and complications related to it.
Obstructive sleep apnea
Obstructive sleep apnea (OSA) is estimated to affect 21-74% of individuals with AFib. OSA disruptions in breathing alter the heart's structure and electrical properties, elevating the risk of blood clots. Managing OSA with a continuous positive airway pressure (CPAP) machine can decrease the risk of developing AFib, and improving OSA conditions after catheter ablation can reduce recurrences.
Cardiovascular conditions
Pre-existing cardiovascular conditions such as hypertension, coronary artery disease, cardiomyopathies, and heart failure increase the risk of AFib. Treating comorbid cardiovascular conditions, such as hypertension more effectively, can help prevent AFib recurrence and complications like stroke. Anticoagulant therapy or catheter ablation is crucial to reduce complications associated with these conditions.
Metabolic conditions
Diabetes increases the risk of AFib incidence and complications. While there is mixed data on the relationship between high cholesterol, low-density lipoproteins, and AFib, higher levels of triglycerides are associated with AFib risk.
Kidney function
Nearly half of AFib patients show impaired renal function, interfering with the metabolism of anticoagulant drugs and increasing the risk of adverse effects. Renal impairment also elevates the risk of complications during catheter ablation.
Respiratory conditions
Chronic obstructive pulmonary disease (COPD) is linked to a two-fold increased risk of AFib. Some COPD medications, like tachyarrhythmia inducers, may worsen AFib, while others, like corticosteroids, do not impact AFib. Short-term exposure to air pollution has been linked to an increased AFib risk too.
Mental health
Psychological factors like stress and depression increase the AFib risk. Individuals using antidepressants may have a higher risk of developing AFib, while adverse effects decrease as depressive symptoms improve. While there is no clear evidence of cognitive impairment and dementia as AFib risk factors, dementia is associated with unfavorable outcomes in people with AFib.
Mental health conditions might influence adherence to medications and potentially lead to drug interactions between AFib and mental health medications. This may contribute to a lower rate of anticoagulant therapy uptake among individuals with mental health issues.
The impact of comorbid conditions and polypharmacy
Individuals with multiple comorbidities are more likely to experience complications related to AFib, such as stroke and mortality. The use of multiple medications increases the risk of adverse effects and drug-drug interactions. Non-vitamin K antagonist oral anticoagulants are associated with fewer adverse events than warfarin in AFib patients, provided precautions are taken.
Other risk factors for AFib
In addition to lifestyle factors and comorbid conditions, factors such as sex, socioeconomic status, and ethnicity can influence AFib risk. Studies conducted in Europe suggest that South Asian and African individuals have a lower risk of AFib compared to white individuals, while US data indicate a higher risk among white individuals. The sex-based prevalence of AFib is higher in men, but women experience more complications like stroke and mortality. Women may receive less anticoagulant therapy due to a lack of social support and healthcare access required to monitor warfarin doses. Low socioeconomic status also increases the risk of heart failure, stroke, and mortality in individuals with pre-existing AFib.
- The review emphasized the significance of addressing lifestyle factors, comorbidities, and socioeconomic factors in managing Atrial Fibrillation (AFib) and reducing risks of mortality and health issues.
- Dr. Stephen Tang explained that comprehensive management of AFib requires identifying and optimizing numerous risk factors and comorbidities, as uncontrolled ones can lead to AFib persisting despite interventions like catheter ablation.
- Similar to other cardiovascular conditions, an inactive lifestyle, obesity, smoking, and excessive alcohol consumption can increase the risk of AFib.
- Obesity not only increases the risk of AFib but also worsens complications during catheter ablation, stroke, and death, so weight loss can decrease the risk of AFib recurrence and complications.
- Certain chronic cardiovascular, respiratory, mental health conditions, such as hypertension, coronary artery disease, obstructive sleep apnea, diabetes, chronic obstructive pulmonary disease (COPD), and mental health disorders like stress and depression, can co-occur with AFib and increase the risk of AFib and related complications.
- The use of multiple medications for comorbid conditions increases the risk of adverse effects and drug-drug interactions, which can contribute to complications and decreased adherence to anticoagulant therapy in individuals with mental health issues.
- Beyond genetic, sex, and age, other risk factors for AFib include socioeconomic factors, with low socioeconomic status increasing the risk of heart failure, stroke, and mortality in individuals with pre-existing AFib.
