Article Text

Original research
Risk of atrial fibrillation and stroke among older men exposed to prolonged endurance sport practice: a 10-year follow-up. The Birkebeiner Ageing Study and the Tromsø Study
  1. Kristoffer Robin Johansen1,2,
  2. Anette Hylen Ranhoff3,4,
  3. Eivind Sørensen4,5,
  4. Bjarne M Nes6,
  5. Kim Arne Heitmann1,
  6. Turid Apelland5,
  7. Silvana Bucher Sandbakk7,
  8. Tom Wilsgaard8,
  9. Maja-Lisa Løchen8,9,
  10. Dag S Thelle10,11,
  11. Bente Morseth1,2 and
  12. Marius Myrstad5,12
  13. On behalf of the NEXAF initiative
    1. 1School of Sport Sciences, UiT The Arctic University of Norway, Tromso, Norway
    2. 2Centre for Research and Education, University Hospital of North Norway, Tromso, Norway
    3. 3Department of Clinical Science, University of Bergen, Bergen, Norway
    4. 4Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
    5. 5Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, N-1346 Gjettum, Norway
    6. 6Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
    7. 7Department for Teacher Education, Norwegian University of Science and Technology, Trondheim, Norway
    8. 8Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Norway
    9. 9Department of Cardiology, University Hospital of North Norway, Tromso, Norway
    10. 10Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
    11. 11School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
    12. 12Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, N-1346 Gjettum, Norway
    1. Correspondence to Kristoffer Robin Johansen; kristoffer.r.johansen{at}uit.no

    Abstract

    Aims Endurance sport practice is associated with a high prevalence of atrial fibrillation (AF), which increases the risk of stroke in the general population. However, stroke risk in endurance athletes with AF is sparsely investigated. Most studies have been limited by design and are largely restricted to younger and middle-aged populations. Thus, we aimed to investigate AF and stroke risk in older athletes exposed to prolonged endurance training.

    Method During a 10-year period, 505 male athletes aged ≥65 years frequently participating in a long-distance ski race were compared with 1867 men of the same age from the general population. The main exposure was endurance sport practice with self-reported AF and stroke as outcomes. Stroke risk was further examined by joint modelling of AF and endurance practice. Statistical analysis was conducted with a modified Poisson model.

    Results Athletes (median age: 68, range: 65–90) participated in a long-distance ski race over a median of 14 years (range: 1–53). Prevalence (28.5% vs 17.8%) and adjusted risk of AF (risk ratio (RR): 1.88, 95% CI: 1.49 to 2.37) were higher in athletes compared with non-athletes, whereas the prevalence (5.4% vs 9.7%) and risk of stroke were lower (RR: 0.60, 95% CI: 0.37 to 0.95). Compared with athletes without AF, risk of stroke was twofold in athletes (RR: 2.38, 95% CI: 1.08 to 5.24) and nearly fourfold in non-athletes (RR: 3.87, 95% CI: 1.98 to 7.57) with AF.

    Conclusion Although older male endurance athletes experienced an increased risk of AF, the long-term risk of stroke was substantially reduced compared with non-athletes.

    • epidemiology
    • atrial fibrillation
    • stroke

    Data availability statement

    Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. The data underlying this article cannot be shared publicly due to GDPR regulations but is available on request. The legal restrictions on data availability are set by the Tromsø Study Data and Publication Committee in order to control for data sharing, including publication of datasets with the potential of reverse identification of de-identified sensitive participant information. The data can however be made available on application to the Tromsø Study Data and Publication Committee. Contact information: The Tromsø Study, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway; e-mail: tromsous@uit.no. The datasets generated in BiAS are not publicly available as the study is not yet completed but may be available on reasonable request. The Stata code used for the main analysis is available on reasonable request.

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    Data availability statement

    Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. The data underlying this article cannot be shared publicly due to GDPR regulations but is available on request. The legal restrictions on data availability are set by the Tromsø Study Data and Publication Committee in order to control for data sharing, including publication of datasets with the potential of reverse identification of de-identified sensitive participant information. The data can however be made available on application to the Tromsø Study Data and Publication Committee. Contact information: The Tromsø Study, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway; e-mail: tromsous@uit.no. The datasets generated in BiAS are not publicly available as the study is not yet completed but may be available on reasonable request. The Stata code used for the main analysis is available on reasonable request.

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    Footnotes

    • Twitter @KristofferRJ89, @KimAHeitmann, @MorsethBente, @MariusMyrstad

    • Collaborators This work has been done within the framework of the Norwegian Exercise and Atrial Fibrillation Initiative (NEXAF) project (https://nexaf.no), which is a collaborative research initiative aiming to increase knowledge about physical activity and exercise in relation to atrial fibrillation. The NEXAF initiative: Bente Morseth1,2, Marius Myrstad3,4, Bjarne Martens Nes5, Jan Pål Loennechen5,6, Maja-Lisa Løchen7, Arnljot Tveit4,8, Turid Apelland4, Kristine Folkenborg4, Kristoffer Robin Johansen1,2, Kristin Espolin Johnson5, Jon Magne Letnes5,6, Vegard Malmo5,6, Andreas Berg Sellevold5,6, Eivind Sørensen3,4, Rune Byrkjeland3,4, Steve Enger4, Hilde Larhammer3,4, Sophia Onarheim4, Vigdis Bache-Semb4. Affiliations: 1School of Sport Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway. 2Centre for Research and Education, University Hospital of North Norway, Tromsø, Norway. 3Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, N-1346 Gjettum, Norway. 4Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, N-1346 Gjettum, Norway. 5Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway. 6Department of Cardiology, St. Olavs Hospital, Trondheim, Norway. 7Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway. 8Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway.

    • Contributors KRJ drafted the manuscript and performed all statistical analyses. KRJ, AHR, BM and MM came up with the idea and design of the study. M-LL, AHR, ES and MM contributed to acquisition and interpretation of the data. TW provided expert advice and supervision of the statistical analyses. All authors contributed to conception of the work and made critical revision of the manuscript for key intellectual content. KRJ is responsible for the overall content as the guarantor.

    • Funding KRJ was funded by the Northern Norway Regional Health Authority (grant number HNF1568-21). The Birkebeiner Ageing Study has been funded by the Kavli Research Centre for Ageing and Dementia and the Norwegian Extra Foundation.

    • Competing interests M-LL has received lecture fees from Bayer, Sanofi and BMS/Pfizer not related to this study. MM has received lecture fees from Bayer, Boehringer-Ingelheim, Bristol Myers Squibb, mSD and Pfizer not related to this work.

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

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