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Older overweight men are more likely to have asymptomatic atrial fibrillation

Presenter: Jessica Mao, MD, Cedars Sinai Medical Center, Los Angeles, CA

Predictors of new onset asymptomatic atrial fibrillation: A vital rhythm study. Presentation number 1348-143. Presented March 4, 2023.


Older, overweight men are at higher risk for presenting with asymptomatic atrial fibrillation and may benefit from targeted screening. Atrial fibrillation is frequently asymptomatic and is often only diagnosed after a sentinel event, such as stroke or heart failure, but it can have significant clinical implications, according to Jessica Mao, MD, of the Cedars Sinai Medical Center, Los Angeles, CA.

Patients with atrial fibrillation suffer a variety of symptoms, including chest pain, palpitations, shortness of breath, and fatigue. Yet, some patients have no symptoms, a so- called “silent” atrial fibrillation. The incidence of asymptomatic atrial fibrillation may be greater than previously perceived.

“There is a paucity of data about which subsets of the population are most at risk for presenting with asymptomatic atrial fibrillation,” Mao said.

Researchers from Cedars Sinai Medical Center and Brigham and Women’s Hospital in Boston, MA, prospectively examined the differential associations between atrial fibrillation risk factors and asymptomatic versus symptomatic atrial fibrillation among the 25,094 patients without a history of cardiovascular disease or atrial fibrillation who were enrolled in the Vitamin D and Omega-3 Trial (VITAL) Rhythm study. This randomized clinical trial examined the effects of vitamin D and omega-3 fatty acid supplementation on the incident of atrial fibrillation among men 50 years or older and women 55 years or older without a prior history of prevalent atrial fibrillation, cardiovascular disease, or cancer at baseline.

Previously, researchers have conducted studies looking for sex differences in atrial fibrillation incidence and whether atrial fibrillation risk factors differ by gender. In several studies, women had a lower incidence of atrial fibrillation than men, but it was unclear whether this difference was independent of sex differences in prevalent cardiovascular disease, body size, and other risk factors.

In this new review of data from the VITAL Rhythm study, incident atrial fibrillation events were ascertained, adjudicated, and categorized as asymptomatic or symptomatic at the time of diagnosis through medical record review. Researchers used multivariable competing risk proportional hazards regression models predicting asymptomatic versus symptomatic atrial fibrillation to determine and compare risk factor associations.

After a median follow-up of 5.3 years, 898 patients (3.6%) had atrial fibrillation; 343 of these patients (38%) were asymptomatic at the time of the diagnosis. In multivariable models, age (hazard ratio [HR] 1.11), male sex (HR 2.08), weight (HR 1.29), and obesity (BMI >30 kg/m2; HR 2.37) were significantly associated with the development of asymptomatic atrial fibrillation, with stronger associations compared to symptomatic atrial fibrillation.

Although height, hypertension, and alcohol use were also significantly associated with increased risk of asymptomatic atrial fibrillation, the associations did not differ significantly from symptomatic atrial fibrillation.

In conclusion, Mao said, “In a prospective cohort without baseline atrial fibrillation or cardiovascular disease, more than one-third of those with atrial fibrillation at the time of diagnosis were asymptomatic. Subjects who were older, male, and had higher BMI were more likely to have asymptomatic atrial fibrillation and represent a subset of the population who may benefit from targeted atrial fibrillation screening to allow early diagnosis and treatment.”

References

Rho RW, Page RL. Asymptomatic atrial fibrillation. Prog Cardiovasc Dis 2005; 48(2):79-87. doi:10.1016/j.pcad.2005.06.005

Siddiqi HK, Vinayagamoorthy M, Gencer B, et al. Sex differences in atrial fibrillation risk: The VITAL Rhythm study. JAMA Cardiol 2022; 7(10):1027–1035. doi:10.1001/jamacardio.2022.2825

Mao J, Middeldorp M, Moorthy M, et al. Predictors of new onset asymptomatic atrial fibrillation: A vital rhythm study. J Am Coll Cardiol 2023; 81(8 Suppl 7):124. https://doi.org/ 10.1016/S0735-1097(23)00568-5

Disclosures

Jessica Mao: Nothing to disclose

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