Epidemiology and modifiable risk factors for atrial fibrillation

• Published in: Nature reviews cardiology Vol. 20; no. 6; pp. 404 - 417
• Main Authors: Elliott, Adrian D., Middeldorp, Melissa E., Van Gelder, Isabelle C., Albert, Christine M., Sanders, Prashanthan
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.06.2023; Nature Publishing Group
• Subjects: 692/4019/592/75/29/1309; 692/499; Atrial Fibrillation - epidemiology; Cardiac arrhythmia; Cardiac Imaging; Cardiac Surgery; Cardiology; Comorbidity; Epidemiology; Humans; Life Style; Medicine; Medicine & Public Health; Prevention; Review Article; Risk Factors
• ISSN: 1759-5002; 1759-5010
• DOI: 10.1038/s41569-022-00820-8

The global prevalence of atrial fibrillation (AF) has increased substantially over the past three decades and is currently approximately 60 million cases. Incident AF and its clinical consequences are largely the result of risk factors that can be modified by lifestyle changes. In this Review, we provide evidence that the lifetime risk of AF is modified not only by sex and race but also through the clinical risk factor and comorbidity burden of individual patients. We begin by summarizing the epidemiology of AF, focusing on non-modifiable and modifiable risk factors, as well as targets and strategies for the primary prevention of AF. Furthermore, we evaluate the role of modifiable risk factors in the secondary prevention of AF as well as the potential effects of risk factor interventions on the frequency and severity of subsequent AF episodes. We end the Review by proposing strategies that require evaluation as well as global policy changes that are needed for the prevention of incident AF and the management of recurrent episodes in patients already affected by AF. The global prevalence of atrial fibrillation (AF) is increasing, largely as a result of a rise in modifiable risk factors. In this Review, Sanders and colleagues summarize the epidemiology of AF and discuss lifestyle changes and risk factor interventions for the primary and secondary prevention of AF. Key points The global prevalence of atrial fibrillation (AF) is approximately 60 million cases and contributes to >8 million disability-adjusted life years. The lifetime risk of AF is approximately 33%, with estimates modified by patient-level factors such as age, sex, race and burden of clinical risk factors. Modifiable risk factors, including hypertension, type 2 diabetes mellitus and physical inactivity, increase the lifetime risk of AF, independent of genetic risk. Novel risk factors for AF include epigenetic markers of biological age and body composition. Evidence is accumulating that risk factor interventions reduce incident AF and have a central role in the secondary prevention of AF episodes. Future research should focus on risk factor management for the primary and secondary prevention of AF and major policy changes to reduce the global burden of AF.