Department of Medicine, Division of Preventive and Behavioral Medicine
Behavior and Behavior Mechanisms | Cardiology | Cardiovascular Diseases | Clinical Epidemiology | Community Health | Community Health and Preventive Medicine | Epidemiology | Preventive Medicine | Public Health | Women's Health
BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased risk of stroke and death. Obesity is an independent risk factor for AF, but modifiers of this risk are not well known. We studied the roles of obesity, physical activity, and their interaction in conferring risk of incident AF.
METHODS AND RESULTS: The Women's Health Initiative (WHI) Observational Study was a prospective observational study of 93 676 postmenopausal women followed for an average of 11.5 years. Incident AF was identified using WHI-ascertained hospitalization records and diagnostic codes from Medicare claims. A multivariate Cox's hazard regression model adjusted for demographic and clinical risk factors was used to evaluate the interaction between obesity and physical activity and its association with incident AF. After exclusion of women with prevalent AF, incomplete data, or underweight body mass index (BMI), 9792 of the remaining 81 317 women developed AF. Women were, on average, 63.4 years old, 7.8% were African American, and 3.6% were Hispanic. Increased BMI (hazard ratio [HR], 1.12 per 5-kg/m(2) increase; 95% confidence interval [CI], 1.10 to 1.14) and reduced physical activity (>9 vs. 0 metabolic equivalent task hours per week; HR, 0.90; 95% CI, 0.85 to 0.96) were independently associated with higher rates of AF after multivariate adjustment. Higher levels of physical activity reduced the AF risk conferred by obesity (interaction P=0.033).
CONCLUSIONS: Greater physical activity is associated with lower rates of incident AF and modifies the association between obesity and incident AF.
atrial fibrillation, electrophysiology, epidemiology, exercise, obesity
Rights and Permissions
Copyright 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
DOI of Published Version
Azarbal F, Stefanick ML, Salmoirago-Blotcher E, Manson JE, Albert CM, LaMonte MJ, Larson JC, Li W, Martin LW, Nassir R, Garcia L, Assimes TL, Tharp KM, Hlatky MA, Perez MV. Obesity, physical activity, and their interaction in incident atrial fibrillation in postmenopausal women. J Am Heart Assoc. 2014 Aug 20;3(4):e001127. doi: 10.1161/JAHA.114.001127. Link to article on publisher's website
Journal of the American Heart Association
Azarbal, Farnaz; Stefanick, Marcia L.; Salmoirago-Blotcher, Elena; Manson, JoAnn E.; Albert, Christine M.; Lamonte, Michael J.; Larson, Joseph C.; Li, Wenjun; Martin, Lisa W.; Nassir, Rami; Garcia, Lorena; Assimes, Themistocles L.; Tharp, Katie M.; Hlatky, Mark A.; and Perez, Marco V., "Obesity, physical activity, and their interaction in incident atrial fibrillation in postmenopausal women" (2014). UMass Worcester Prevention Research Center Publications. 44.
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