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  • Age-specific atrial fibrillation incidence, attributable risk factors and risk of stroke and mortality: results from the MORGAM Consortium

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Arrhythmias and sudden death
Original research
Age-specific atrial fibrillation incidence, attributable risk factors and risk of stroke and mortality: results from the MORGAM Consortium
  1. Bente Morseth1,
  2. Bastiaan Geelhoed2,
  3. Allan Linneberg3,4,
  4. Lars Johansson5,
  5. Kari Kuulasmaa6,
  6. Veikko Salomaa6,
  7. Licia Iacoviello7,8,
  8. Simona Costanzo8,
  9. Stefan Söderberg5,
  10. Teemu J Niiranen6,9,
  11. Julie K K Vishram-Nielsen3,10,
  12. Inger Njølstad11,
  13. Tom Wilsgaard11,
  14. Ellisiv B Mathiesen12,13,
  15. Maja-Lisa Løchen11,
  16. Tanja Zeller2,14,
  17. Stefan Blankenberg2,14,
  18. Francisco M Ojeda2 and
  19. Renate B Schnabel2,14
  20. On behalf of the MORGAM consortium
  1. 1School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
  2. 2Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
  3. 3Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
  4. 4Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
  5. 5Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
  6. 6Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
  7. 7Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy
  8. 8Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli (IS), Italy
  9. 9Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland
  10. 10Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  11. 11Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
  12. 12Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
  13. 13Department of Neurology, University Hospital of North Norway, Tromsø, Norway
  14. 14German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
  1. Correspondence to Dr Bente Morseth; bente.morseth{at}uit.no

Abstract

Background The main aim was to examine age-specific risk factor associations with incident atrial fibrillation (AF) and their attributable fraction in a large European cohort. Additionally, we aimed to examine risk of stroke and mortality in relation to new-onset AF across age.

Methods We used individual-level data (n=66 951, 49.1% men, age range 40–98 years at baseline) from five European cohorts of the MOnica Risk, Genetics, Archiving and Monograph Consortium. The participants were followed for incident AF for up to 10 years and the association with modifiable risk factors from the baseline examinations (body mass index (BMI), hypertension, diabetes, daily smoking, alcohol consumption and history of stroke and myocardial infarction (MI)) was examined. Additionally, the participants were followed up for incident stroke and all-cause mortality after new-onset AF.

Results AF incidence increased from 0.9 per 1000 person-years at baseline age 40–49 years, to 17.7 at baseline age ≥70 years. Multivariable-adjusted Cox models showed that higher BMI, hypertension, high alcohol consumption and a history of stroke or MI were associated with increased risk of AF across age groups (p<0.05). Between 30% and 40% of the AF risk could be attributed to BMI, hypertension and a history of stroke or MI. New-onset AF was associated with a twofold increase in risk of stroke and death at ages≥70 years (p≤0.001).

Conclusion In this large European cohort aged 40 years and above, risk of AF was largely attributed to BMI, high alcohol consumption and a history MI or stroke from middle age. Thus, preventive measures for AF should target risk factors such as obesity and hypertension from early age and continue throughout life.

  • atrial fibrillation
  • risk factors
  • stroke
  • epidemiology

Data availability statement

The data are not available in a public repository. Access to the data is restricted by the ethical approvals and the legislation of the European Union and the countries of each MORGAM study. Approval by the Principal Investigator of each cohort study and the MORGAM/BiomarCaRE Steering Group will be required for release of the data. The MORGAM Manual at https://www.thl.fi/publications/morgam/manual/contents.htm gives more information on access to the data.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/openhrt-2021-001624

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    Data availability statement

    The data are not available in a public repository. Access to the data is restricted by the ethical approvals and the legislation of the European Union and the countries of each MORGAM study. Approval by the Principal Investigator of each cohort study and the MORGAM/BiomarCaRE Steering Group will be required for release of the data. The MORGAM Manual at https://www.thl.fi/publications/morgam/manual/contents.htm gives more information on access to the data.

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    Footnotes

    • Twitter @MorsethBente

    • Contributors RBS, BM, BG and M-LL contributed to the conception and the design of the work. M-LL, BG, BM, RBS, KK, VS, TJN, LI, SC, JKKV, IN, EBM, AL, TW, SS and LJ contributed to the acquisition, analysis or interpretation of data for the work. BM, RBS, BG and M-LL drafted the manuscript. All authors critically revised the manuscript. All gave final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy.

    • Funding The MORGAM Project has received funding from EU projects MORGAM (Biomed, BMH4-CT98-3183), GenomEUtwin (FP5, QLG2-CT-2002-01254), ENGAGE (FP7, HEALTH-F4-2007-201413), CHANCES (FP7, HEALTH-F3-2010-242244), BiomarCaRE (FP7, HEALTH-F2-2011-278913), euCanSHare (Horizon 2020, No. 825903) and AFFECT-EU (Horizon 2020, No. 847770); and Medical Research Council, London (G0601463, No. 80983: Biomarkers in the MORGAM Populations). This has supported central coordination, workshops and part of the activities of the MORGAM Data Centre, the MORGAM Laboratories and the MORGAM Participating Centres. TJN was supported by the Emil Aaltonen Foundation, Paavo Nurmi Foundation, Finnish Medical Foundation, and Academy of Finland (grant number 321351). RBS has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme under the grant agreement No 648131, from the European Union’s Horizon 2020 research and innovation programme under the grant agreement No 847770 (AFFECT-EU) and German Center for Cardiovascular Research (DZHK e.V.) (81Z1710103); German Ministry of Research and Education (BMBF 01ZX1408A) and ERACoSysMed3 (031L0239).

    • Competing interests RBS has received lecture fees and advisory board fees from BMS/Pfizer outside this work.

    • Provenance and peer review Not commissioned; externally peer reviewed.