Body mass index and adverse events in patients with incident atrial fibrillation

Am J Med. 2013 Jul;126(7):640.e9-17. doi: 10.1016/j.amjmed.2012.11.024. Epub 2013 Apr 17.


Background: Obesity is associated with the development of atrial fibrillation and may impact atrial fibrillation-related outcomes. To date, no anthropometric measure is included in any risk stratification scheme for stroke and death in atrial fibrillation patients.

Methods: The prospective Danish Diet, Cancer and Health study is a cohort including 57,053 participants (27,178 men and 29,875 women) aged between 50 and 64 years. The study population for this study included the 3135 patients (2025 men and 1110 women) who developed incident atrial fibrillation during follow-up.

Results: Of the subjects with atrial fibrillation, 1414 (45%) had a body mass index (BMI) in the overweight category (BMI 25 to <30 kg/m(2)) and 767 (24%) were categorized as obese (BMI ≥30 kg/m(2)). During a median follow-up of 4.9 years, 609 deaths and 216 thromboembolic events (98% ischemic strokes) occurred. Using normal-weight patients as reference, the risk of a composite end point of "ischemic stroke, thromboembolism, or death" was significantly higher in overweight (crude hazard ratio [HR] 1.31; 95% confidence interval [CI], 1.09-1.56) and obese patients (crude HR 1.55; 95% CI 1.27-1.90). After adjustment for CHADS2 and CHA2DS2-VASc scores, the HRs for the composite end point were 1.21 (95% CI 1.02-1.45) and 1.31 (95% CI 1.10-1.56), respectively, for overweight and 1.25 (95% CI 1.03-1.53) and 1.36 (95% CI 1.11-1.65), respectively, for obese. Continuous analyses of BMI stratified by sex identified obese men and normal-weight women as the sex-specific "high-risk" categories.

Conclusion: Overweight and obesity are risk factors for "ischemic stroke, thromboembolism or death" in patients with atrial fibrillation, even after adjustment for CHADS2 and CHA2DS2-VASc scores. The association between BMI and outcomes among atrial fibrillation patients may be modified by sex.

MeSH terms

  • Aged
  • Atrial Fibrillation / complications*
  • Atrial Fibrillation / epidemiology
  • Body Mass Index
  • Cohort Studies
  • Denmark / epidemiology
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Obesity / complications*
  • Obesity / epidemiology
  • Overweight / complications*
  • Overweight / epidemiology
  • Proportional Hazards Models
  • Prospective Studies
  • Sex Factors
  • Stroke / epidemiology
  • Stroke / etiology*
  • Thromboembolism / epidemiology
  • Thromboembolism / etiology*