Body Mass Index in Adolescence and Long-Term Risk of Early Incident Atrial Fibrillation and Subsequent Mortality, Heart Failure, and Ischemic Stroke

• Published in: Journal of the American Heart Association Vol. 11; no. 21; p. e025984
• Main Authors: Djekic, Demir, Lindgren, Martin, Åberg, N David, Åberg, Maria, Fengsrud, Espen, Poci, Dritan, Adiels, Martin, Rosengren, Annika
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 01.11.2022; Wiley
• Subjects: adolescence and ischemic stroke; Adolescent; Adult; atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Body Mass Index; Cohort Studies; heart failure; Heart Failure - diagnosis; Humans; Incidence; Ischemic Stroke; Male; Middle Aged; mortality; Original Research; Risk Factors; Stroke - complications; Stroke - epidemiology; Young Adult; mortality; heart failure; atrial fibrillation; body mass index; adolescence and ischemic stroke
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.121.025984

Background We sought to determine the role of obesity in adolescent men on development of atrial fibrillation (AF) and subsequent associated clinical outcomes in subjects diagnosed with AF. Methods and Results We conducted a nationwide, register-based, cohort study of 1 704 467 men (mean age, 18.3±0.75 years) enrolled in compulsory military service in Sweden from 1969 through 2005. Height and weight, blood pressure, fitness, muscle strength, intelligence quotient, and medical disorders were recorded at baseline. Records obtained from the National Inpatient Registry and the Cause of Death Register were used to determine incidence and clinical outcomes of AF. During a median follow-up of 32 years (interquartile range, 24-41 years), 36 693 cases (mean age at diagnosis, 52.4±10.6 years) of AF were recorded. The multivariable-adjusted hazard ratio (HR) for AF increased from 1.06 (95% CI, 1.03-1.10) in individuals with body mass index (BMI) of 20.0 to <22.5 kg/m to 3.72 (95% CI, 2.44-5.66) among men with BMI of 40.0 to 50.0 kg/m , compared with those with BMI of 18.5 to <20.0 kg/m . During a median follow-up of ≈6 years in patients diagnosed with AF, we identified 3767 deaths, 3251 cases of incident heart failure, and 921 cases of ischemic stroke. The multivariable-adjusted HRs for all-cause mortality, incident heart failure, and ischemic stroke in AF-diagnosed men with baseline BMI >30 kg/m compared with those with BMI <20 kg/m were 2.86 (95% CI, 2.30-3.56), 3.42 (95% CI, 2.50-4.68), and 2.34 (95% CI, 1.52-3.61), respectively. Conclusions Increasing BMI in adolescent men is strongly associated with early AF, and with subsequent worse clinical outcomes in those diagnosed with AF with respect to all-cause mortality, incident heart failure, and ischemic stroke.