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Height is associated with incident atrial fibrillation in a large Asian cohort

https://doi.org/10.1016/j.ijcard.2020.01.017Get rights and content

Highlights

  • It is unclear whether metabolic conditions affect higher AF risk in tall people.

  • This large Asian cohort study confirmed the association between stature and AF risk.

  • High AF risk in tall people was not influenced by metabolic conditions.

Abstract

Background

Although increased height is associated with a risk of atrial fibrillation (AF), the mechanism is not well understood. We aimed to explore whether this association varies with metabolic conditions.

Methods and results

We used the database from the 14-year Korea National Health Insurance Service–National Sample Cohort. The data of 368,206 adults older than 20 years who received a health check-up were analyzed to explore the association of height and AF risk. Cox proportional hazards regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of height with the risk of AF.

During the median follow up duration of 8.46 years, 2641 (0.72%) patients were diagnosed with AF at 3,070,724 person-years. Overall, greater height was significantly associated with AF risk (HR per 5 cm, 1.22; 95% CI, 1.03–1.05). The association did not vary with age, sex, obesity, hypertension, and diabetes.

Conclusion

Metabolic conditions do not affect the higher risk of AF in tall people.

Introduction

Atrial fibrillation (AF) amplifies the risk of major adverse cardiovascular events including stroke, heart failure, ischemic heart disease, sudden cardiac death, and all-cause mortality [1]. The prevalence of AF is projected to increase, primarily due to the aging population [2]. However, many cases of AF still occur among younger adults, leading researchers to explore other risk factors.

The increase in AF may, at least in part, be attributable to the increasing body size of the population. Prior studies have established that diverse adiposity measures are associated with the risk of AF [3]. In addition, the association between increased height and AF has been observed in a wide range of Western cohorts [[4], [5], [6], [7]]. Because a critical mass of atrial tissue necessary for AF to occur, the most plausible hypothesis is that increased heart size is associated with a higher risk of AF [7].

The pathophysiology of AF is heterogeneous and influenced by structural (e.g., left atrial size per se), hemodynamic (e.g., left atrial stretch), electrical, and neural factors [8]. Frequent AF in obese patients has been explained by several conditions causing atrial stretch, such as left ventricular hypertrophy, increased total blood volume, and metabolic clusters [9]. By contrast, it is unclear whether the elevated AF risk in tall people is simply due to the large left atrium or whether it is influenced by other metabolic disorders such as obesity, hypertension, and diabetes. The present study aimed to determine the interactive effects of these risk factors on AF in a large, population-based cohort.

Section snippets

Database and study population

The Korean National Health Insurance Service–National Sample Cohort (NHIS–NSC) 2002–2015 database was used for this population-based cohort study [10]. The NHIS–NSC is compiled by the NHIS with a systematic sampling method and comprises approximately 1 million nationally representative randomly selected subjects. It is mandatory that all Koreans join the NHIS, and the NHIS database includes the national records of health care utilization and prescriptions for the entire Korean population. In

Results

Mean age was 43.2 ± 13.6 years for men and 45.2 ± 14.1 years for women. Mean height was 170.1 ± 6.4 for men and 156.8 ± 6.1 years for women. Among the 368,206 individuals in this cohort, 2641 were diagnosed with AF at 3,070,724 person-years of follow up (mean, 8.46 years). Factors associated with AF in the current cohort were presented in Table 1. Table 2 shows the risk of AF in the overall study population and by subgroup in 5-cm increments of height. Overall, the AF risk increased 1.22 times

Discussion

Currently, height is well-recognized as a definite risk factor for AF. In this large national cohort study, we found that tall people are at high risk for AF and that this association is not affected by metabolic risk factors, such as obesity or diabetes. Our results would explain, at least in part, the variation in AF epidemiology, suggesting that high AF incidence in tall people is attributable to height itself. The high prevalence of AF is noted among men and in Western countries [2], and

Study limitations

One potential flaw with this study is the residual confounding factors inherent in any observational study. We were not able to obtain the clinical data such as echocardiographic findings, which might be helpful to interpret our results. Lifestyles, particularly for physical activity [17], were also not considered but are highly variable over time. Another limitation of our study is healthy user bias. We may have overestimated the risk of AF associated with increasing height because tall people

Conclusion

In summary, a robust association between tall stature and AF was found in this large Asian cohort, with no interaction of age, sex, obesity, and metabolic comorbidities. These findings suggest the important role of absolute heart size on the development of AF. Regardless of clinical factors, tall people may be a high-risk subgroup for incident AF. Further basic or genetic studies are needed to fully understand the role of height in the development of AF.

CRediT authorship contribution statement

Young Min Park:Conceptualization, Writing - original draft.Jeonggeun Moon:Conceptualization, Supervision, Writing - review & editing.In Cheol Hwang:Conceptualization, Methodology, Supervision, Writing - review & editing.Hyunsun Lim:Methodology, Data curation, Formal analysis.Bokeum Cho:Methodology, Data curation, Formal analysis.

Declaration of competing interest

There are no potential conflicts of interest.

Acknowledgements

Drs. Park and Moon contributed equally to this work. We received no financial support for the research, authorship and/or publication of this article.

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