Obesity, physical activity, and their interaction in incident atrial fibrillation in postmenopausal women

Farnaz Azarbal, Marcia L. Stefanick, Elena Salmoirago-Blotcher, Jo Ann E Manson, Christine M. Albert, Michael J. LaMonte, Joseph C. Larson, Wenjun Li, Lisa W. Martin, Rami Nassir, Lorena Garcia, Themistocles L. Assimes, Katie M. Tharp, Mark A. Hlatky, Marco V. Perez

Research output: Contribution to journalArticle

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Abstract

Background-Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased risk of stroke and death. Obesity is an independent risk factor for AF, but modifiers of this risk are not well known. We studied the roles of obesity, physical activity, and their interaction in conferring risk of incident AF. Methods and Results-The Women's Health Initiative (WHI) Observational Study was a prospective observational study of 93 676 postmenopausal women followed for an average of 11.5 years. Incident AF was identified using WHI-ascertained hospitalization records and diagnostic codes from Medicare claims. A multivariate Cox's hazard regression model adjusted for demographic and clinical risk factors was used to evaluate the interaction between obesity and physical activity and its association with incident AF. After exclusion of women with prevalent AF, incomplete data, or underweight body mass index (BMI), 9792 of the remaining 81 317 women developed AF. Women were, on average, 63.4 years old, 7.8% were African American, and 3.6% were Hispanic. Increased BMI (hazard ratio [HR], 1.12 per 5-kg/m2 increase; 95% confidence interval [CI], 1.10 to 1.14) and reduced physical activity (>9 vs. 0 metabolic equivalent task hours per week; HR, 0.90; 95% CI, 0.85 to 0.96) were independently associated with higher rates of AF after multivariate adjustment. Higher levels of physical activity reduced the AF risk conferred by obesity (interaction P=0.033). Conclusions-Greater physical activity is associated with lower rates of incident AF and modifies the association between obesity and incident AF.

Original languageEnglish (US)
Article numbere001127
JournalJournal of the American Heart Association
Volume3
Issue number4
DOIs
StatePublished - 2014

Fingerprint

Atrial Fibrillation
Obesity
Exercise
Women's Health
Observational Studies
Body Mass Index
Metabolic Equivalent
Confidence Intervals
Thinness
Medicare
Hispanic Americans
Proportional Hazards Models
African Americans
Cardiac Arrhythmias
Hospitalization
Stroke
Demography
Prospective Studies

Keywords

  • Atrial fibrillation
  • Electrophysiology
  • Epidemiology
  • Exercise
  • Obesity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Azarbal, F., Stefanick, M. L., Salmoirago-Blotcher, E., Manson, J. A. E., Albert, C. M., LaMonte, M. J., ... Perez, M. V. (2014). Obesity, physical activity, and their interaction in incident atrial fibrillation in postmenopausal women. Journal of the American Heart Association, 3(4), [e001127]. https://doi.org/10.1161/JAHA.114.001127

Obesity, physical activity, and their interaction in incident atrial fibrillation in postmenopausal women. / Azarbal, Farnaz; Stefanick, Marcia L.; Salmoirago-Blotcher, Elena; Manson, Jo Ann E; Albert, Christine M.; LaMonte, Michael J.; Larson, Joseph C.; Li, Wenjun; Martin, Lisa W.; Nassir, Rami; Garcia, Lorena; Assimes, Themistocles L.; Tharp, Katie M.; Hlatky, Mark A.; Perez, Marco V.

In: Journal of the American Heart Association, Vol. 3, No. 4, e001127, 2014.

Research output: Contribution to journalArticle

Azarbal, F, Stefanick, ML, Salmoirago-Blotcher, E, Manson, JAE, Albert, CM, LaMonte, MJ, Larson, JC, Li, W, Martin, LW, Nassir, R, Garcia, L, Assimes, TL, Tharp, KM, Hlatky, MA & Perez, MV 2014, 'Obesity, physical activity, and their interaction in incident atrial fibrillation in postmenopausal women', Journal of the American Heart Association, vol. 3, no. 4, e001127. https://doi.org/10.1161/JAHA.114.001127
Azarbal, Farnaz ; Stefanick, Marcia L. ; Salmoirago-Blotcher, Elena ; Manson, Jo Ann E ; Albert, Christine M. ; LaMonte, Michael J. ; Larson, Joseph C. ; Li, Wenjun ; Martin, Lisa W. ; Nassir, Rami ; Garcia, Lorena ; Assimes, Themistocles L. ; Tharp, Katie M. ; Hlatky, Mark A. ; Perez, Marco V. / Obesity, physical activity, and their interaction in incident atrial fibrillation in postmenopausal women. In: Journal of the American Heart Association. 2014 ; Vol. 3, No. 4.
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abstract = "Background-Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased risk of stroke and death. Obesity is an independent risk factor for AF, but modifiers of this risk are not well known. We studied the roles of obesity, physical activity, and their interaction in conferring risk of incident AF. Methods and Results-The Women's Health Initiative (WHI) Observational Study was a prospective observational study of 93 676 postmenopausal women followed for an average of 11.5 years. Incident AF was identified using WHI-ascertained hospitalization records and diagnostic codes from Medicare claims. A multivariate Cox's hazard regression model adjusted for demographic and clinical risk factors was used to evaluate the interaction between obesity and physical activity and its association with incident AF. After exclusion of women with prevalent AF, incomplete data, or underweight body mass index (BMI), 9792 of the remaining 81 317 women developed AF. Women were, on average, 63.4 years old, 7.8{\%} were African American, and 3.6{\%} were Hispanic. Increased BMI (hazard ratio [HR], 1.12 per 5-kg/m2 increase; 95{\%} confidence interval [CI], 1.10 to 1.14) and reduced physical activity (>9 vs. 0 metabolic equivalent task hours per week; HR, 0.90; 95{\%} CI, 0.85 to 0.96) were independently associated with higher rates of AF after multivariate adjustment. Higher levels of physical activity reduced the AF risk conferred by obesity (interaction P=0.033). Conclusions-Greater physical activity is associated with lower rates of incident AF and modifies the association between obesity and incident AF.",
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T1 - Obesity, physical activity, and their interaction in incident atrial fibrillation in postmenopausal women

AU - Azarbal, Farnaz

AU - Stefanick, Marcia L.

AU - Salmoirago-Blotcher, Elena

AU - Manson, Jo Ann E

AU - Albert, Christine M.

AU - LaMonte, Michael J.

AU - Larson, Joseph C.

AU - Li, Wenjun

AU - Martin, Lisa W.

AU - Nassir, Rami

AU - Garcia, Lorena

AU - Assimes, Themistocles L.

AU - Tharp, Katie M.

AU - Hlatky, Mark A.

AU - Perez, Marco V.

PY - 2014

Y1 - 2014

N2 - Background-Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased risk of stroke and death. Obesity is an independent risk factor for AF, but modifiers of this risk are not well known. We studied the roles of obesity, physical activity, and their interaction in conferring risk of incident AF. Methods and Results-The Women's Health Initiative (WHI) Observational Study was a prospective observational study of 93 676 postmenopausal women followed for an average of 11.5 years. Incident AF was identified using WHI-ascertained hospitalization records and diagnostic codes from Medicare claims. A multivariate Cox's hazard regression model adjusted for demographic and clinical risk factors was used to evaluate the interaction between obesity and physical activity and its association with incident AF. After exclusion of women with prevalent AF, incomplete data, or underweight body mass index (BMI), 9792 of the remaining 81 317 women developed AF. Women were, on average, 63.4 years old, 7.8% were African American, and 3.6% were Hispanic. Increased BMI (hazard ratio [HR], 1.12 per 5-kg/m2 increase; 95% confidence interval [CI], 1.10 to 1.14) and reduced physical activity (>9 vs. 0 metabolic equivalent task hours per week; HR, 0.90; 95% CI, 0.85 to 0.96) were independently associated with higher rates of AF after multivariate adjustment. Higher levels of physical activity reduced the AF risk conferred by obesity (interaction P=0.033). Conclusions-Greater physical activity is associated with lower rates of incident AF and modifies the association between obesity and incident AF.

AB - Background-Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased risk of stroke and death. Obesity is an independent risk factor for AF, but modifiers of this risk are not well known. We studied the roles of obesity, physical activity, and their interaction in conferring risk of incident AF. Methods and Results-The Women's Health Initiative (WHI) Observational Study was a prospective observational study of 93 676 postmenopausal women followed for an average of 11.5 years. Incident AF was identified using WHI-ascertained hospitalization records and diagnostic codes from Medicare claims. A multivariate Cox's hazard regression model adjusted for demographic and clinical risk factors was used to evaluate the interaction between obesity and physical activity and its association with incident AF. After exclusion of women with prevalent AF, incomplete data, or underweight body mass index (BMI), 9792 of the remaining 81 317 women developed AF. Women were, on average, 63.4 years old, 7.8% were African American, and 3.6% were Hispanic. Increased BMI (hazard ratio [HR], 1.12 per 5-kg/m2 increase; 95% confidence interval [CI], 1.10 to 1.14) and reduced physical activity (>9 vs. 0 metabolic equivalent task hours per week; HR, 0.90; 95% CI, 0.85 to 0.96) were independently associated with higher rates of AF after multivariate adjustment. Higher levels of physical activity reduced the AF risk conferred by obesity (interaction P=0.033). Conclusions-Greater physical activity is associated with lower rates of incident AF and modifies the association between obesity and incident AF.

KW - Atrial fibrillation

KW - Electrophysiology

KW - Epidemiology

KW - Exercise

KW - Obesity

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