Personalized Care Approach Focusing on Lifestyle Factors may Reduce AFib Risk for Individuals
Atrial fibrillation, a widespread type of arrhythmia, affects over a global population. This irregular heart rhythm is a crucial risk factor for stroke. While age, sex, and genetics are non-modifiable factors, physical activity, diabetes, obesity, smoking, and managing comorbid conditions are significant modifiable risk factors.
Besides lifestyle factors, chronic conditions, such as those affecting the cardiovascular, respiratory, metabolic, and mental health systems, are connected to an augmented risk of atrial fibrillation. A recent review compiled evidence on the various lifestyle factors, comorbidities, and socioeconomic aspects that could potentially influence atrial fibrillation incidence and morbidity.
The review emphasized the necessity of a multidisciplinary, patient-centered approach to manage atrial fibrillation and decrease the risks of death and other health complications.
Dr. Stephen Tang, a board-certified cardiac electrophysiologist at Providence Saint John's Health Center in Santa Monica, CA, not associated with the research, elucidated to Medical News Today that appropriate management of atrial fibrillation extends beyond oral anticoagulation for stroke prevention or rate or rhythm control with medication or ablation. "This complex disease is driven by numerous risk factors and comorbidities," he said. He added that identifying and optimizing these risk factors is essential for managing atrial fibrillation effectively long-term.
Atrial fibrillation, often shortened to "AFib," involves an abnormal heart rhythm caused by the irregular beating of the left upper heart chamber or atrium. This irregular heart rhythm may lead to the formation of a blood clot in the atrium, which could dislodge and travel to the brain, blocking blood flow and causing a stroke.
Dr. Tang pointed out that genetic factors, sex, and age are non-modifiable risk factors for atrial fibrillation. Other risk factors for atrial fibrillation include lifestyle factors, comorbid conditions, and socioeconomic factors.
Lifestyle adjustments and medications can aid in managing this cardiovascular condition. Blood thinners, also known as anticoagulants, can decrease the risk of blood clot formation and stroke. Drugs that target vitamin K, such as warfarin, have been conventionally used as oral anticoagulants. In recent times, nonvitamin K antagonist oral anticoagulants (NOACs) that block other factors have become the first-line treatment for atrial fibrillation.
Other drugs, like beta-blockers and calcium channel blockers, are useful in controlling the heart rate. When lifestyle modifications and medications are insufficient for managing atrial fibrillation, individuals may require invasive procedures, such as catheter ablation, to restore a normal heart rhythm.
Physical activity is associated with a decreased risk of atrial fibrillation incidence, recurrence, morbidity, and mortality. Regular moderate-to-vigorous training and high-intensity interval training are effective in reducing morbidity and improving the quality of life in individuals with atrial fibrillation. Conversely, a sedentary lifestyle is linked to an increased risk of atrial fibrillation.
Obesity is a significant risk factor for the development of atrial fibrillation, as it can increase the likelihood of atrial fibrillation recurrence, complications during catheter ablation, stroke, and death. Weight loss can help decrease the risk of atrial fibrillation recurrence and morbidity.
Smoking and moderate to heavy alcohol consumption are risk factors for atrial fibrillation, particularly in a dose-dependent manner. In cases of moderate to heavy alcohol consumption, the relationship between alcohol intake and atrial fibrillation risk is less consistent.
In addition to being risk factors, chronic cardiovascular, respiratory, and mental health conditions can increase complications associated with atrial fibrillation. Obstructive sleep apnea, for instance, occurs in 21-74% of atrial fibrillation patients. These disruptions in breathing associated with obstructive sleep apnea increase the risk of blood clot formation and change the structural and electrical properties of the heart, contributing to atrial fibrillation. Using a continuous positive airway pressure (CPAP) machine for the management of sleep apnea can decrease the risk of atrial fibrillation incidence, recurrence, or progression.
Individuals with pre-existing cardiovascular conditions, such as coronary artery disease, hypertension, heart failure, and cardiomyopathies, are at an increased risk of atrial fibrillation. Hypertension is a well-known risk factor for atrial fibrillation patients and is associated with a 1.7-2.5 times higher risk of atrial fibrillation.
While the use of anticoagulants is essential for maintaining a regular heart rhythm, they must be used cautiously in patients undergoing minimally invasive surgery for coronary artery disease due to the risk of bleeding.
Diabetes is associated with an increased risk of atrial fibrillation incidence and complications. However, the relationship between blood glucose control and atrial fibrillation risk is inconsistent across studies. Achieving better control of blood glucose (sugar) levels and reducing weight can reduce the risk of atrial fibrillation.
Individuals with atrial fibrillation and kidney disease are more likely to experience complications during catheter ablation. Severe impairment of kidney function can interfere with the metabolism of anticoagulant drugs, increasing the risk of adverse effects.
The presence of multiple comorbid conditions in individuals with atrial fibrillation increases the risk of complications such as stroke and mortality. The use of multiple medications increases the risk of adverse events due to potential drug-drug interactions. polypharmacy, the use of five or more drugs, is associated with a higher risk of complications in individuals with atrial fibrillation.
Other risk factors for atrial fibrillation include sex, socioeconomic status, and ethnicity/race. Studies suggest that individuals of South Asian and African origin may be at a lower risk of atrial fibrillation compared to the white population, contrary to the higher risk of other cardiovascular conditions observed in individuals of South Asian origin. In terms of biological sex, atrial fibrillation is more common in men than women, but women are at a higher risk of complications, including stroke and mortality.
The complexities of atrial fibrillation demand a personalized, multidisciplinary approach to treatment, tailored to a patient's unique circumstances. Dr. Nikhil Warrier, a board-certified cardiac electrophysiologist and medical director of electrophysiology at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA, emphasized that the underlying risk factors can vary between patients. "For example, having a conversation that targets alcohol intake reduction and cessation in a patient for whom this is the primary trigger is different than someone who is sedentary, where starting an exercise program may be the conversation during the visit," he explained. "At the same time, management strategies for [AFib] differ based on the persistence of the arrhythmia along with age and other modifiable risk factors of the patient. In one patient, ablation may be a great first treatment option, while in another patient, that would be a poor option," Dr. Warrier added.
While the recognized risk factors for atrial fibrillation are important to consider, challenges persist in achieving optimal treatment outcomes. Dr. Tang pointed out that the same risk factors - obesity, lack of exercise, smoking, alcohol, hypertension, diabetes, high cholesterol, and sleep apnea - are common risk factors for cardiovascular disease. "The treatment goals of weight loss, heart-healthy eating, exercise, smoking and alcohol cessation, and treatment of sleep disorders are widely recommended by many doctors, but these are difficult to implement in many patients as it require a complete change in lifestyle and habits," he cautioned.
- Dr. Stephen Tang illustrated that appropriate management of atrial fibrillation, termed 'AFib', encompasses more than just oral anticoagulation for stroke prevention or rate or rhythm control through medication or ablation.
- He further stated that this complex disease is influenced by a multitude of risk factors and comorbidities, such as lifestyle factors, chronic health conditions, and socioeconomic factors.
- Lifestyle modifications, including regular physical activity, can help decrease the risk of atrial fibrillation incidence, recurrence, and morbidity.
- Obesity is a significant risk factor for the development of atrial fibrillation, with weight loss aiding in decreasing the risk of recurrence and associated morbidity.
- Smoking and heavy alcohol consumption are risk factors for atrial fibrillation, with smoking particularly having a dose-dependent relationship.
- Chronic cardiovascular, respiratory, and mental health conditions can increase complications associated with atrial fibrillation, such as obstructive sleep apnea, a common condition observed in 21-74% of atrial fibrillation patients.
- Diabetes is associated with an increased risk of atrial fibrillation incidence and complications, although the relationship between blood glucose control and atrial fibrillation risk is inconsistent across studies.
- The complexity of atrial fibrillation demands a personalized, multidisciplinary approach to treatment, taking into account a patient's unique circumstances and underlying risk factors. This approach may include lifestyle interventions, medications, and invasive procedures as necessary.
