Background
Methods
Study design and population
Follow-up and outcome ascertainment
Definition of risk factors burden and profiles
Risk factor and category | Definition |
---|---|
Smoking | |
Optimal | Never smoker |
Borderline | Former smoker |
Elevated | Current smoker |
Alcohol consumption | |
Optimal | Consumption of < 6 standard drinks/day for women or < 8 standard drinks/day for men |
Elevated | Consumption of ≥ 6 standard drinks/day for women or ≥ 8 standard drinks/day for men |
Body mass index | |
Optimal | < 25 |
Borderline | 25–29 |
Elevated | ≥ 30 |
Blood pressure | |
Optimal | Systolic blood pressure < 120 mm Hg and diastolic blood pressure < 80 mm Hg, and no treatment or history for hypertension |
Borderline | Systolic blood pressure 120-139 mm Hg or diastolic blood pressure 80-89 mm Hg, and no treatment or history for hypertension |
Elevated | Systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥ 90 mm Hg, and/or treatment or history for hypertension |
Diabetes mellitus (type 1 or 2) | |
Optimal | Glycated hemoglobin (HbA1c) < 6.5 and no treatment or history for diabetes |
Elevated | Glycated hemoglobin (HbA1c) ≥ 6.5 or treatment or history for diabetes |
History of heart failure or myocardial infarction | |
Optimal | No history of heart failure or myocardial infarction |
Elevated | History of heart failure or myocardial infarction |
Definition of genetic predisposition
Statistical analysis
Results
Characteristics at index ages 45, 55, and 65 years
Variables | 45 years (N = 84,206) | 55 years (N = 117,520) | 65 years (N = 147,178) | p value |
---|---|---|---|---|
Sex | <.0001 | |||
Female | 45,841 (54.4) | 66,283 (56.4) | 78,119 (53.1) | |
Male | 38,365 (45.6) | 51,237 (43.6) | 69,059 (46.9) | |
Ethnicity | <.0001 | |||
Non-White | 8320 (9.9) | 6783 (5.8) | 4564 (3.1) | |
White | 75,886 (90.1) | 110,737 (94.2) | 142,614 (96.9) | |
Smoking | <.0001 | |||
Optimal | 51,565 (61.2) | 66,321 (56.4) | 74,110 (50.4) | |
Borderline | 20,966 (24.9) | 38,239 (32.5) | 61,075 (41.5) | |
Elevated | 11,675 (13.9) | 12,960 (11.0) | 11,993 (8.1) | |
Alcohol consumption | <.0001 | |||
Optimal | 81,845 (97.2) | 114,010 (97.0) | 143,757 (97.7) | |
Elevated | 2361 (2.8) | 3510 (3.0) | 3421 (2.3) | |
BMI | <.0001 | |||
Optimal | 32,605 (38.7) | 39,883 (33.9) | 44,801 (30.4) | |
Borderline | 33,340 (39.6) | 48,407 (41.2) | 66,694 (45.3) | |
Elevated | 18,261 (21.7) | 29,230 (24.9) | 35,683 (24.2) | |
Blood pressure | <.0001 | |||
Optimal | 21,228 (25.2) | 16,632 (14.2) | 9135 (6.2) | |
Borderline | 34,490 (41.0) | 39,243 (33.4) | 33,749 (22.9) | |
Elevated | 28,488 (33.8) | 61,645 (52.5) | 104,294 (70.9) | |
Diabetes mellitus | <.0001 | |||
Optimal | 81,713 (97.0) | 111,303 (94.7) | 135,551 (92.1) | |
Elevated | 2493 (3.0) | 6217 (5.3) | 11,627 (7.9) | |
Heart history | <.0001 | |||
Optimal | 83,751 (99.5) | 115,620 (98.4) | 141,774 (96.3) | |
Elevated | 455 (0.5) | 1900 (1.6) | 5404 (3.7) | |
Polygenic risk score | <.0001 | |||
Low | 21,118 (25.0) | 29,380 (25.0) | 37,730 (25.6) | |
Intermediate | 41,910 (49.8) | 58,811 (50.1) | 74,193 (50.4) | |
High | 21,178 (25.2) | 29,329 (25.0) | 35,255 (24.0) |
Single risk factors, risk factor burden, and 10-year risk of atrial fibrillation
Study sample (index age) and risk factor burden | All | Low PRS | Intermediate PRS | High PRS | ||||
---|---|---|---|---|---|---|---|---|
No. of atrial fibrillation cases/total | 10-year risk (95% CI) | No. of atrial fibrillation cases/total | 10-year risk (95% CI) | No. of atrial fibrillation cases/total | 10-year risk (95% CI) | No. of atrial fibrillation cases/total | 10-year risk (95% CI) | |
45 years | ||||||||
Optimal | 30/7913 | 0.25 (0.13, 0.36) | 5/1974 | 0.26 (0.03, 0.50) | 10/3904 | 0.18 (0.03, 0.32) | 15/2035 | 0.37 (0.10, 0.64) |
Borderline | 237/32,184 | 0.44 (0.36, 0.51)* | 30/8109 | 0.27 (0.15, 0.38) | 94/16,056 | 0.35 (0.25, 0.44)* | 113/8019 | 0.79 (0.59, 0.99)* |
Elevated | 657/44,109 | 0.92 (0.83, 1.01)* | 90/11,035 | 0.54 (0.39, 0.68)* | 283/21,950 | 0.74 (0.63, 0.86)* | 284/11,124 | 1.65 (1.40, 1.90)* |
55 years | ||||||||
Optimal | 88/5719 | 1.13 (0.84, 1.41) | 9/1444 | 0.43 (0.09, 0.78) | 41/2828 | 0.98 (0.60, 1.35) | 38/1447 | 2.10 (1.34, 2.86) |
Borderline | 698/35,405 | 1.29 (1.17, 1.41) | 80/8865 | 0.61 (0.44, 0.78) | 294/17,778 | 1.02 (0.87, 1.18) | 324/8762 | 2.52 (2.17, 2.86) |
Elevated | 3097/76,396 | 2.47 (2.35, 2.58)* | 415/19,071 | 1.28 (1.11, 1.45)* | 1421/38,205 | 2.18 (2.03, 2.33)* | 1261/19,120 | 4.22 (3.92, 4.52)* |
65 years | ||||||||
Optimal | 111/2867 | 2.93 (2.29, 3.57) | 24/776 | 2.27 (1.16, 3.38) | 35/1380 | 1.71 (1.00, 2.42) | 52/711 | 6.02 (4.23, 7.81) |
Borderline | 1551/29,686 | 3.88 (3.65, 4.11)* | 253/7541 | 2.43 (2.07, 2.79) | 693/15,056 | 3.44 (3.14, 3.74)* | 605/7089 | 6.35 (5.76, 6.94) |
Elevated | 11262/11,4625 | 7.05 (6.90, 7.20)* | 1751/29,413 | 3.91 (3.68, 4.14)* | 5448/57,757 | 6.72 (6.51, 6.93)* | 4063/27,455 | 11.10 (10.72, 11.49)* |
Potential interactions between risk factor burden and PRS on the AF incidence
Study sample (index age) and risk factor burden | PRS levels (HR, 95% CI)a | RERI b | P for interactionc | |||
---|---|---|---|---|---|---|
Low | Intermediate | High | Intermediate | High | ||
45 years | ||||||
Optimal | 1.00 | 1.01 (0.35, 2.96) | 2.89 (1.05, 7.95)* | 0.63 | ||
Borderline | 1.14 (0.44, 2.93) | 1.81 (0.74, 4.46) | 4.45 (1.82, 10.88)* | 0.65 (−0.25, 1.55) | 1.15 (−0.55, 2.84) | |
Elevated | 2.28 (0.93, 5.62) | 3.65 (1.51, 8.84)* | 7.32 (3.02, 17.70)* | 1.43 (0.43, 2.42)* | 3.35 (0.61, 6.08)* | |
55 years | ||||||
Optimal | 1.00 | 2.37 (1.15, 4.86)* | 4.32 (2.09, 8.94)* | 0.08 | ||
Borderline | 1.24 (0.62, 2.47) | 2.28 (1.17, 4.42)* | 5.17 (2.66, 10.02)* | −0.35 (−1.56, 0.85) | 0.42 (−1.13, 1.97) | |
Elevated | 2.67 (1.38, 5.16)* | 4.61 (2.40, 8.89)* | 8.41 (4.37, 16.20)* | 0.63 (−0.21, 1.48) | 2.44 (0.69, 4.20)* | |
65 years | ||||||
Optimal | 1.00 | 0.83 (0.50, 1.40) | 2.40 (1.49, 3.89)* | 0.002 | ||
Borderline | 0.97 (0.64, 1.47) | 1.33 (0.89, 2.00) | 2.56 (1.70, 3.84)* | 0.53 (0.16, 0.90)* | 0.18 (−0.59, 0.95) | |
Elevated | 1.54 (1.03, 2.30)* | 2.51 (1.68, 3.73)* | 4.12 (2.76, 6.14)* | 1.13 (0.83, 1.43)* | 1.16 (0.49, 1.84)* |
Risk factor burden and 10-year risk of AF stratified by genetic predisposition
Risk factor profile borderline or multiple elevated risk factors and 10-year risk of AF
Risk factor profile and number of elevated/borderline risk factors | Index age 45 years | Index age 55 years | Index age 65 years | |||
---|---|---|---|---|---|---|
No. of atrial fibrillation cases/total | 10-year risk (95% CI) | No. of atrial fibrillation cases/total | 10-year risk (95% CI) | No. of atrial fibrillation cases/total | 10-year risk (95% CI) | |
Optimal | ||||||
0/0 | 30/7913 | 0.25 (0.13, 0.36) | 88/5719 | 1.13 (0.84, 1.41) | 111/2867 | 2.93 (2.29, 3.57) |
Borderline | ||||||
0/1 | 90/15,231 | 0.36 (0.26, 0.46) | 252/14,992 | 1.08 (0.91, 1.26) | 537/11,038 | 3.63 (3.27, 4.00) |
0/2 | 119/13,356 | 0.48 (0.35, 0.60) | 318/15,226 | 1.37 (1.18, 1.56) | 667/12,947 | 3.81 (3.47, 4.15) |
0/>=3 | 28/3597 | 0.60 (0.34, 0.86) | 128/5187 | 1.65 (1.29, 2.01) | 347/5701 | 4.53 (3.97, 5.08) |
Elevated | ||||||
1/any | 281/28,166 | 0.62 (0.52, 0.71) | 1302/45,475 | 1.76 (1.63, 1.88) | 5460/69,283 | 5.55 (5.38, 5.73) |
2/any | 255/12,689 | 1.27 (1.07, 1.48) | 1160/23,820 | 2.96 (2.73, 3.18) | 3997/34,484 | 8.38 (8.08, 8.69) |
>= 3/any | 121/3254 | 2.16 (1.64, 2.69) | 635/7101 | 5.36 (4.82, 5.91) | 1805/10,858 | 12.33 (11.69, 12.97) |