title: Physical Activity and the Risk of Incident Atrial Fibrillation in Women Socioeconomic Status and the Incidence of Atrial Fibrillation in Whites and Blacks: The Atherosclerosis Risk in Communities (ARIC) Study Paradoxical Association of Lipoprotein Measures With Incident Atrial Fibrillation Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people Obesity, Physical Activity, and Their Interaction in Incident Atrial Fibrillation in Postmenopausal Women Physical Activity and Incidence of Atrial Fibrillation in Older Adults: The Cardiovascular Health Study Heavy alcohol consumption and risk of atrial fibrillation. The Circulatory Risk in Communities Study (CIRCS). 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association Atrial fibrillation in the Malmö diet and cancer study: a study of occurrence, risk factors and diagnostic validity Physical Activity, Obesity, Weight Change, and Risk of Atrial Fibrillation: The Atherosclerosis Risk in Communities Study Pulse pressure and risk of new-onset atrial fibrillation. Atrial fibrillation incidence and risk factors in relation to race-ethnicity and the population attributable fraction of atrial fibrillation risk factors: the Multi-Ethnic Study of Atherosclerosis. Risk factors for atrial fibrillation and their population burden in postmenopausal women: the Women's Health Initiative Observational Study Psoriasis and risk of atrial fibrillation and ischaemic stroke: a Danish Nationwide Cohort Study. Interaction of Blood Pressure and Body Mass Index With Risk of Incident Atrial Fibrillation in a Japanese Urban Cohort: The Suita Study. Rising Rates of Hospital Admissions for Atrial Fibrillation Palpitations are predictive of future atrial fibrillation. An 11-year follow-up of 22,815 men and women: the Tromsø Study Orthostatic hypotension and long-term incidence of atrial fibrillation: the Malmö Preventive Project. Cigarette smoking and risk of atrial fibrillation: the Rotterdam Study. Big men and atrial fibrillation: effects of body size and weight gain on risk of atrial fibrillation in men. Body fat, body fat distribution, lean body mass and atrial fibrillation and flutter. A Danish cohort study. Work related physical activity and risk of a hospital discharge diagnosis of atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study A multimarker approach to assess the influence of inflammation on the incidence of atrial fibrillation in women. The long- and short-term impact of elevated body mass index on the risk of new atrial fibrillation the WHS (women's health study). Close bidirectional relationship between chronic kidney disease and atrial fibrillation: the Niigata preventive medicine study. A clinical risk score for atrial fibrillation in a biracial prospective cohort (from the Atherosclerosis Risk in Communities [ARIC] study). Overweight and obesity as risk factors for atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study. Normal Thyroid Function and the Risk of Atrial Fibrillation: the Rotterdam Study. Relation of renal function to risk for incident atrial fibrillation in women. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Fibrinogen and albumin levels and risk of atrial fibrillation in men and women (the Copenhagen City Heart Study). Influence of Systolic and Diastolic Blood Pressure on the Risk of Incident Atrial Fibrillation in Women Alcohol consumption and risk of incident atrial fibrillation in women. Anemia and reduced kidney function as risk factors for new onset of atrial fibrillation (from the Ibaraki prefectural health study).
abstract: Background — Physical activity ( PA ) is well known to reduce the risk of cardiovascular disease . We hypothesized that regular PA , possibly acting through reductions in blood pressure and body mass index ( BMI ) , would reduce the risk of incident atrial fibrillation ( AF ) in women . Methods and Results — We prospect ively followed 34 759 women who reported their leisure-time PA levels for the occurrence of AF . We estimated energy expenditure in metabolic equivalent (MET)-h/wk and vali date d self-reported AF with medical records . The mean ( SD ) age of the 34 759 participants was 54.6 ( 7.0 ) years , the mean BMI was 26.0 ( 5.0 ) kg/m2 , 26.5 % had hypertension , and the median ( IQR ) PA was 8.4 ( 2.8 , 20.4 ) MET-h/wk . After a median of 14.4 years of observation , 968 women had development of AF . In age- , cholesterol- , smoking- , alcohol- , diabetes- , and race-adjusted models , increasing quintiles of PA were associated with reduced risks of AF ( hazard ratio for extreme quintiles , 0.82 ; 0.66 to 1.01 ; P trend=0.007 over quintiles ) . Although this association was not substantially different after adjusting for hypertension ( 0.87 ; 0.70 to 1.07 ; P trend 0.02 ) , it was attenuated after adjustment for BMI ( 0.99 ; 0.80 to 1.23 ; P trend=0.22 ) . Women who achieved the federal government 's recommendation of 7.5 MET-h/wk of PA were at reduced risk of AF compared with those who did not ( 0.86 ; 0.75 to 0.98 ; P=0.03 ) . This association was also attenuated by BMI ( 0.96 ; 0.84 to 1.10 ; P=0.57 ) . Conclusions — In middle-aged women , physical activity was associated with a modestly reduced risk of AF . However , this relationship was no longer significant after controlling for body mass index Background No previous studies have examined the interplay among socioeconomic status , sex , and race with the risk of atrial fibrillation ( AF ) .  Methods and Results We prospect ively followed 14 352 persons ( 25 % black , 75 % white , 55 % women , mean age 54 years ) who were free of AF and participating in the Atherosclerosis Risk in Communities ( ARIC ) study .  Socioeconomic status was assessed at baseline ( 1987–1989 ) through educational level and total family income . Incident AF through 2009 was ascertained from electrocardiograms , hospitalizations , and death certificates . Cox regression was used to estimate hazard ratios and 95 % CIs of AF for education and family income . Interactions were tested between socioeconomic status and age , race , or sex . Over a median follow‐up of 20.6 years , 1794 AF cases occurred . Lower family income was associated with higher AF risk ( hazard ratio 1.45 , 95 % CI 1.27 to 1.67 in those with income less than $ 25 000 per year compared with those with $ 50 000 or more per year ) . The association between education and AF risk varied by sex ( P=0.01 ) , with the lowest education group associated with higher AF risk in women ( hazard ratio 1.88 , 95 % CI 1.55 to 2.28 ) but not in men ( hazard ratio 1.15 , 95 % CI 0.97 to 1.36 ) compared with the highest education group . Adjustment for cardiovascular risk factors attenuated the associations . There were no interactions with race or age . Blacks had lower AF risk  than whites in all income and education groups . Conclusions Lower family income was associated with a higher AF risk overall , whereas the impact of education on AF risk was present only in women . Differences in socioeconomic status do not explain the lower risk of AF in blacks compared with whites Background —Low-density lipoprotein ( LDL ) cholesterol is a strong risk factor for atherosclerosis but has an inverse association with atrial fibrillation ( AF ) . We aim ed to provide insight into the paradoxical association of LDL cholesterol with AF by evaluating the relationship of various lipoprotein measures and incident AF . Methods and Results —We prospect ively evaluated lipoprotein measures among 23 738 healthy middle-aged and older women ( median follow-up 16.4 years ; N=795 incident AF events ) .  Baseline LDL cholesterol was directly measured , lipoprotein particle concentrations and size were measured by nuclear magnetic resonance spectroscopy , and apolipoproteins were measured by immunoassay . Cox regression models were adjusted for age , AF risk factors , inflammatory , and dysglycemic biomarkers . After multivariable adjustment , inverse associations with AF were observed ( hazard ratio , 95 % confidence interval for top versus bottom quintile , P value ) for LDL cholesterol ( 0.72 , 0.56–0.92 , P=0.009 ) , the total number of LDL particles ( 0.77 , 0.60–0.99 , P=0.045 ) , and very-low-density lipoprotein particles ( 0.78 , 0.61–0.99 , P=0.04 ) , which was driven by the number of cholesterol-poor small LDL ( 0.78 , 0.61–1.00 , P=0.05 ) and small very-low-density lipoprotein particles ( 0.78 , 0.62–0.99 , P=0.04 ) . By contrast , the larger cholesterol-rich LDL particles and all high-density lipoprotein measures were not associated with AF in multivariable models . Adjustment for inflammatory and dysglycemic biomarkers had minimal impact on these associations . Conclusions —In this prospect i ve study , the inverse association between LDL cholesterol and AF extended to several other atherogenic lipoproteins , and these associations are unlikely to be mediated by direct cholesterol effects . Clinical Trial Registration — Clinical Trials.gov ; Unique Identifier : NCT00000479 Summary Background The associations of blood pressure with the different manifestations of incident cardiovascular disease in a contemporary population have not been compared . In this study , we aim ed to analyse the associations of blood pressure with 12 different presentations of cardiovascular disease . Methods We used  linked electronic health records from 1997 to 2010 in the CALIBER ( CArdiovascular research using LInked Bespoke studies and Electronic health Records ) programme to assemble a cohort of 1·25 million patients , 30 years of age or older and initially free from cardiovascular disease , a fifth of whom received blood pressure-lowering treatments . We studied the heterogeneity in the age-specific associations of clinical ly measured blood pressure with 12 acute and chronic cardiovascular diseases , and estimated the lifetime risks ( up to 95 years of age ) and cardiovascular disease-free life-years lost adjusted for other risk factors at index ages 30 , 60 , and 80 years . This study is registered at Clinical Trials.gov , number NCT01164371 . Findings During 5·2 years median follow-up , we recorded 83 098 initial cardiovascular disease presentations . In each age group , the lowest risk for cardiovascular disease was in people with systolic blood pressure of 90–114 mm Hg and diastolic blood pressure of 60–74 mm Hg , with no evidence of a J-shaped increased risk at lower blood pressures . The effect of high blood pressure varied by cardiovascular disease endpoint , from strongly positive to no effect . Associations with high systolic blood pressure were strongest for intracerebral haemorrhage ( hazard ratio 1·44 [ 95 % CI 1·32–1·58 ] ) , subarachnoid haemorrhage ( 1·43 [ 1·25–1·63 ] ) , and stable angina ( 1·41 [ 1·36–1·46 ] ) , and weakest for abdominal aortic aneurysm ( 1·08 [ 1·00–1·17 ] ) . Compared with diastolic blood pressure , raised systolic blood pressure had a greater effect on angina , myocardial infa rct ion , and peripheral arterial disease , whereas raised diastolic blood pressure had a greater effect on abdominal aortic aneurysm than did raised systolic pressure . Pulse pressure associations were inverse for abdominal aortic aneurysm ( HR per 10 mm Hg 0·91 [ 95 % CI 0·86–0·98 ] ) and strongest for peripheral arterial disease ( 1·23 [ 1·20–1·27 ] ) . People with  hypertension ( blood pressure ≥140/90 mm Hg or those receiving blood pressure-lowering drugs ) had a lifetime risk of overall cardiovascular disease at 30 years of age of 63·3 % ( 95 % CI 62·9–63·8 ) compared with 46·1 % ( 45·5–46·8 ) for those with normal blood pressure , and developed cardiovascular disease 5·0 years earlier ( 95 % CI 4·8–5·2 ) . Stable and unstable angina accounted for most ( 43 % ) of the cardiovascular disease-free years of life lost associated with hypertension from index age 30 years , whereas heart failure and stable angina accounted for the largest proportion ( 19 % each ) of years of life lost from index age 80 years . Interpretation The widely held assumptions that blood pressure has strong associations with the occurrence of all cardiovascular diseases across a wide age range , and that diastolic and systolic associations are concordant , are not supported by the findings of this high-resolution study . Despite modern treatments , the lifetime burden of hypertension is substantial . These findings emphasise the need for new  blood pressure-lowering strategies , and will help to inform the design of r and omised trials to assess them . Funding Medical Research Council , National Institute for Health Research , and Wellcome Trust 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 prospect i ve 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 cl aims . 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 Background — Vigorous exertion and endurance training have been reported to increase  atrial fibrillation ( AF ) .  Associations of habitual light or moderate activity with AF incidence have not been evaluated . Methods and Results — We prospect ively investigated associations of leisure-time activity , exercise intensity , and walking habits , assessed at baseline and up date d during follow-up visits , with incident AF , diagnosed by annual 12-lead ECGs and hospital discharge records , from 1989 to 2001 among 5446 adults ≥65 years of age in the Cardiovascular Health Study . During 47 280 person-years of follow-up , 1061 new AF cases occurred ( incidence 22.4/1000 person-years ) . In multivariable-adjusted analyses , leisure-time activity was associated with lower AF incidence in a grade d manner , with 25 % ( hazard ratio [ HR ] 0.75 , 95 % confidence interval [ CI ] 0.61 to 0.90 ) , 22 % ( HR 0.78 , 95 % CI 0.65 to 0.95 ) , and 36 % ( HR 0.64 , 95 % CI 0.52 to 0.79 ) lower risk in quintiles 3 , 4 , and 5 versus quintile 1 ( P for trend < 0.001 ) . Exercise intensity had a U-shaped relationship with AF ( quadratic P=0.02 ) : Versus no exercise , AF incidence was lower with moderate-intensity exercise ( HR 0.72 , 95 % CI 0.58 to 0.89 ) but not with high-intensity exercise ( HR 0.87 , 95 % CI 0.64 to 1.19 ) . Walking distance and pace were each associated with lower AF risk in a grade d manner ( P for trend < 0.001 ) ; when we assessed the combined effects of distance and pace , individuals in quartiles 2 , 3 , and 4 had 25 % ( HR 0.75 , 95 % CI 0.56 to 0.99 ) , 32 % ( HR 0.68 , 95 % CI 0.50 to 0.92 ) , and 44 % ( HR 0.56 , 95 % CI 0.38 to 0.82 ) lower AF incidence than individuals in quartile 1 . Findings appeared unrelated to confounding by comorbidity or indication . After evaluation of cut points of moderate leisure-time activity ( ≈600 kcal/week ) , walking distance ( 12 blocks per week ) , and pace ( 2 mph ) , 26 % of all new AF cases ( 95 % CI 7 % to 43 % ) appeared attributable to absence of these activities . Conclusions — Light to moderate physical activities , particularly leisure-time activity and walking , are associated with significantly lower AF incidence in older adults BACKGROUND Evidence regarding the relationship between different levels of alcohol consumption and the risk of atrial fibrillation ( AF )  is currently limited in Asian population s. METHODS AND RESULTS Between 1991 and 1995 , a total of 8,602 Japanese men and women aged 30 - 80 years took part in the first examination of the Circulatory Risk in Communities Study ( CIRCS ) , a population -based cohort study in Japanese communities .  An interviewer obtained detailed information on weekly alcohol intake . During the follow-up period , the incidence of AF was ascertained from annual ECG records , the subject 's medical history of AF , and cardiovascular disease surveillance . The hazard ratios ( HRs ) of incident AF and the 95 % confidence intervals ( CIs ) relative to the never-drinking group were calculated with adjustment for potential confounding factors by using the Cox proportional hazard model . During a median follow-up period of 6.4 years , 296 incidents of AF occurred . A higher incidence of AF was observed among participants with an ethanol intake > 69g/day , compared with never-drinkers . Compared with the never-drinkers , the multivariable-adjusted HRs ( CIs ) of past , light ( < 23g/day ) , light-moderate ( 23 - 46g/day ) , moderate ( 46 - 69g/day ) , and heavy ( > 69g/day ) drinkers were 1.30 ( 0.68 - 2.49 ) , 0.89 ( 0.60 - 1.32 ) , 1.19 ( 0.73 - 1.95 ) , 1.36 ( 0.79 - 2.35 ) , and 2.90 ( 1.61 - 5.23 ) , respectively . CONCLUSIONS Heavy alcohol consumption is associated with a higher risk of AF Purpose — The aim of this guideline is to provide a focused up date of the current recommendations for the  endovascular  treatment of  acute ischemic stroke . When there is overlap , the recommendations made here supersede those of previous guidelines . Methods — This focused up date analyzes results from 8 r and omized , clinical trials of endovascular treatment and other relevant data published since 2013 . It is not intended to be a complete literature review from the date of the previous guideline publication but rather to include pivotal new evidence that justifies changes in current recommendations . Members of the writing committee were appointed by the American Heart Association/American Stroke Association Stroke Council ’s Scientific Statement Oversight Committee and the American Heart Association/American Stroke Association Manuscript Oversight Committee . Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process . Recommendations follow the American Heart Association/American Stroke Association methods of classifying the level of certainty of the treatment effect and the class of evidence . Prerelease review of the draft guideline was performed by 6 expert peer review ers and by the members of the Stroke Council Scientific Statement Oversight Committee and Stroke Council Leadership Committee . Results — Evidence -based guidelines are presented for the selection of patients with acute ischemic stroke for endovascular treatment , for the endovascular procedure , and for systems of care to facilitate endovascular treatment . Conclusions — Certain endovascular procedures have been demonstrated to provide clinical benefit in selected patients with acute ischemic stroke . Systems of care should be organized to facilitate the delivery of this care The validity of atrial fibrillation ( AF ) diagnoses in national registers for use as endpoints in prospect i ve studies has not been evaluated . We studied the validity of AF diagnoses in Swedish national hospital discharge and cause of death registers and the occurrence of and risk factors for AF in a middle-aged Swedish population using these registers . Our study included the 30,447 individuals ( age 44–73 ) who attended baseline visits in 1991–1996 of the Malmö Diet and Cancer study . Individuals with a first AF diagnosis were identified by record linkage with national registers . A subset of cases was r and omly selected for validation by examination of electrocardiograms and patient records . Electrocardiograms were available in 98 % of the validation sample ( 95 % definitive AF , 3 % no AF ) . The 2 % with ECGs unavailable had probable AF . Baseline AF prevalence was 1.3 % , higher in men and increased with age . During 11.2 years of follow-up 1430 first AF diagnoses occurred . Risk factors were age , hypertension , BMI , diabetes , history of heart failure , history of myocardial infa rct ion and , in men but not women , current smoking . The strongest risk factors were history of heart failure ( hazard ratio men 4.5 , women 8.7 ) and myocardial infa rct ion ( hazard ratio men 2.0 , women 1.8 ) . The largest population attributable risks were observed for hypertension ( men 38 % , women 34 % ) and obesity ( men 11 % , women 10 % ) . In conclusion , case misclassification of AF in national registers is small , indicating feasibility of use in prospect i ve studies . Hypertension and obesity account for large portions of population risk in middle-aged individuals with low prevalence of manifest cardiac disease Background —Physical activity ( PA ) has previously been suggested to attenuate the risk of atrial fibrillation ( AF ) conferred by excess body weight and weight gain . We prospect ively examined the relationship between body size , weight change , and level of PA in a biracial cohort of middle-aged men and women . Methods and Results —Baseline characteristics on risk factor levels were obtained on 14 219 participants from the Atherosclerosis Risk in Communities Study . AF incidence was ascertained from 1987 to 2009 . Adjusted Cox proportional hazards models were used to estimate the associations between body mass index , waist circumference , relative weight change , and PA level with incident AF . During follow-up , there were 1775 cases of incident AF . Body mass index and waist circumference were positively associated with AF as was weight loss/gain of > 5 % initial body weight . An ideal level of PA had a small protective effect on AF risk and partially attenuated the risk of AF associated with excess weight in men but not women : compared with men with a normal body mass index , the risk of AF in obese men with an ideal , intermediate , and poor level of PA at baseline was increased by 37 % , 129 % , and 156 % ( Pinteraction=0.04 ) . During follow-up , PA did not modify the association between weight gain and risk of AF . Conclusions —Obesity and extreme weight change are risk factors for incident AF , whereas being physically active is associated with a small reduction in risk . In men only , being physically active offset some , but not all , of the risk incurred with excess body weight CONTEXT  Atrial fibrillation ( AF )  is responsible for considerable morbidity and mortality , making identification of modifiable risk factors a priority . Increased pulse pressure , a reflection of aortic stiffness , increases cardiac load and may increase AF risk . OBJECTIVE To examine relations between pulse pressure and incident AF . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve , community-based observational cohort in Framingham , Mass , including 5331 Framingham Heart Study participants aged 35 years and older and initially free from AF ( median age , 57 years ; 55 % women ) . MAIN OUTCOME MEASURES Incident AF . RESULTS  AF  developed in 698 participants ( 13.1 % ) a median of 12 years after pulse pressure assessment . Cumulative 20-year AF incidence rates were 5.6 % for pulse pressure of 40 mm Hg or less ( 25th percentile ) and 23.3 % for pulse pressure greater than 61 mm Hg ( 75th percentile ) . In models adjusted for age , sex , baseline and time-dependent change in mean arterial pressure , and clinical risk factors for AF ( body mass index , smoking , valvular disease , diabetes , electrocardiographic left ventricular hypertrophy , hypertension treatment , and prevalent myocardial infa rct ion or heart failure ) , pulse pressure was associated with increased risk for AF ( adjusted hazard ratio [ HR ] , 1.26 per 20-mm Hg increment ; 95 % confidence interval [ CI ] , 1.12 - 1.43 ; P<.001 ) . In contrast , mean arterial pressure was unrelated to incident AF ( adjusted HR , 0.96 per 10-mm Hg increment ; 95 % CI , 0.88 - 1.05 ; P = .39 ) . Systolic pressure was related to AF ( HR , 1.14 per 20-mm Hg increment ; 95 % CI , 1.04 - 1.25 ; P = .006 ) ; however , if diastolic pressure was added , model fit improved and the diastolic relation was inverse ( adjusted HR , 0.87 per 10-mm Hg increment ; 95 % CI , 0.78 - 0.96 ; P = .01 ) , consistent with a pulse pressure effect . Among patients with interpretable echocardiographic images , the association between pulse pressure and AF persisted in models that adjusted for baseline left atrial dimension , left ventricular mass , and left ventricular fractional shortening ( adjusted HR , 1.23 ; 95 % CI , 1.09 - 1.39 ; P = .001 ) . CONCLUSION Pulse pressure is an important risk factor for incident AF in a community-based sample . Further research is needed to determine whether interventions that reduce pulse pressure will limit the growing incidence of AF PURPOSE We studied incident atrial fibrillation ( AF ) in the prospect i ve community-based Multi-Ethnic Study of Atherosclerosis ( MESA ) . Reportedly , non-Hispanic blacks ( NHBs ) have a lower AF burden compared with their non-Hispanic white ( NHW ) counterparts . Information on the epidemiology of AF in Hispanic and Asian population s is much more limited . METHODS We excluded participants with a history of AF at enrollment . A total of 6721 MESA participants were monitored for the first AF event ascertained according to hospital discharge International Classification of Diseases , Ninth Revision , codes . Age- and sex-adjusted incidence rates ( IRs ) of AF were calculated per 1000 person-years of observation . IR ratios were calculated using NHWs as the reference group . Age- and sex-adjusted population attributable fractions ( PAFs ) of established modifiable AF risk factors were ascertained . RESULTS In the MESA cohort , 47.2 % was male ; at baseline , 25.7 % had hypertension ; 12.5 % had diabetes . Three hundred five incident hospitalized AF events occurred over a mean follow-up of 7.3 years . Age- and sex-adjusted IRs and IR ratios showed that overall AF incidence was significantly lower among Hispanics , NHBs and Chinese compared with NHWs ( all P < .001 ) . Among participants 65 years of age or greater , Hispanics , Chinese , and blacks had significantly lower AF incidence than NHWs ( all P ≤ .01 ) , but IRs were similar among participants under age 65 years . The PAF for smoking was 27 % among NHBs but lower among other race-ethnic groups . Among NHWs , the PAF for hypertension was 22.2 % , but this was higher among NHBs ( 33.1 % ) , Chinese ( 46.3 % ) , and Hispanics ( 43.9 % ) . CONCLUSIONS Overall , the incidence of hospitalized AF was significantly lower in Hispanics , NHBs , and Chinese than in NHWs . A larger proportion of AF events appear to be attributable to hypertension among nonwhite population s compared with NHWs Objective Atrial fibrillation ( AF ) is the most common arrhythmia in women . Large studies evaluating key AF risk factors in older women are lacking . We aim ed to identify risk factors for AF  in postmenopausal women and measure population burden of modifiable risk factors . Design Prospect i ve observational study . Setting The Women 's Health Initiative ( WHI ) Observational Study . Patients 93 676 postmenopausal women were followed for an average of 9.8 years for cardiovascular outcomes . After exclusion of women with prevalent AF or incomplete data , 8252 of the remaining 81 892 women developed incident AF . Main outcome measures Incident AF was identified by WHI-ascertained hospitalisation records and diagnosis codes from Medicare cl aims . Multivariate Cox hazard regression analysis identified independent risk factors for incident AF . Results Age , hypertension , obesity , diabetes , myocardial infa rct ion and heart failure were independently associated with incident AF . Hypertension and overweight status accounted for 28.3 % and 12.1 % , respectively , of the population attributable risk . Hispanic and African – American participants had lower rates of incident AF ( HR 0.58 , 95 % CI 0.47 to 0.70 and HR 0.59 , 95 % CI 0.53 to 0.65 , respectively ) than Caucasians . Conclusions Caucasian ethnicity , traditional cardiovascular risk factors and peripheral arterial disease were independently associated with higher rates of incident AF  in postmenopausal women . Hypertension and overweight status accounted for a large proportion of population attributable risk . Measuring burden of modifiable AF risk factors in older women may help target interventions AIMS Psoriasis is a chronic inflammatory disease and inflammation contributes to the pathogenesis of  atrial fibrillation ( AF ) and ischaemic stroke . We therefore investigated the risk of these endpoints in patients with psoriasis . METHODS AND RESULTS Cohort study of the entire Danish population followed from 1997 to 2006 by individual-level-linkage of nationwide prospect ively recorded registers . Multivariable Poisson 's regression and sensitivity analyses were used to assess the psoriasis-related risk of AF and ischaemic stroke .  A total of 36 765 patients with mild psoriasis and 2793 with severe psoriasis were compared with 4 478 926 individuals , i.e. , the reference population . In patients with mild psoriasis , the adjusted rate ratios ( RRs ) for AF were 1.50 ( 1.21 - 1.86 ) and 1.16 ( 1.08 - 1.24 ) in patients aged < 50 and ≥50 years , respectively . Patients with severe psoriasis had a higher risk of AF with RRs 2.98 ( 1.80 - 4.92 ) in patients aged < 50 years and 1.29 ( 1.01 - 1.65 ) in patients aged ≥50 years . Patients with psoriasis also demonstrated a disease severity-dependent increased risk of ischaemic stroke , i.e. RRs 1.97 ( 1.66 - 2.34 ) and 2.80 ( 1.81 - 4.34 ) in patients aged < 50 years with mild and severe psoriasis , and RRs 1.13 ( 1.04 - 1.21 ) and 1.34 ( 1.04 - 1.71 ) in patients aged ≥50 years with mild and severe psoriasis , respectively . A range of sensitivity analyses yielded comparable results . CONCLUSION Psoriasis is associated with increased risk of AF and ischaemic stroke . These novel results add to a growing body of evidence , suggesting that patients with psoriasis could be considered at increased cardiovascular risk BACKGROUND AND PURPOSE To prevent stroke , strategies for atrial fibrillation ( AF ) prevention and an early detection of AF by electrocardiogram are essential . However , only a limited prospect i ve studies have examined the risk factors for AF , even in blood pressure ( BP ) and body mass index ( BMI ) , which are not clear among general population s. We investigated the impacts of BP and BMI on the risk of incident AF in a general population . METHODS A total of 6,906 participants ( 30 - 84 years ) in the Suita Study were prospect ively followed up for incident AF . Participants were diagnosed with AF if  AF or atrial flutter  was present on an electrocardiogram  from a routine health examination  ( every 2 years ) or if AF was indicated as a present illness from health examinations and /or medical records during follow-up . Adjusted Cox proportional hazard ratios ( HRs ) were calculated . RESULTS During the 12.8-year follow-up , 253 incident AF events occurred . Compared with the systolic BP ( SBP ) < 120 mm Hg and normal-weight , the adjusted HRs ( 95 % confidence intervals ; CIs ) of incident AF in the systolic hypertension and the overweight ( BMI ≥ 25kg/m(2 ) ) groups were 1.74 ( 1.22 - 2.49 ) and 1.35 ( 1.01 - 1.80 ) , respectively . Compared with SBP < 120 mm Hg and normal weight , the adjusted HRs ( 95 % CIs ) of incident AF in the SBP = 120 - 139 mm Hg with overweight and the systolic hypertension with normal or overweight were 1.72 ( 1.01 - 2.91 ) , 1.66 ( 1.10 - 2.50 ) , and 2.31 ( 1.47 - 3.65 ) , respectively ( P for interaction = 0.04 ) . CONCLUSIONS Systolic prehypertension and overweight are associated with incident AF  in Japanese population . The association between SBP and AF may be evident by overweight Background : Atrial fibrillation is a common arrhythmia associated with excess morbidity and mortality . We studied temporal changes in hospital admission rates for atrial fibrillation using data from a prospect i ve population -based cohort study spanning 2 decades ( the Copenhagen City Heart Study ) . Methods : The study included baseline data collected in 1981 through 1983 on 10,955 persons age 40 to 79 years and baseline data collected in 1991 through 1994 on 7212 persons age 40 to 79 years . We used hospital diagnosis data from the Danish National Hospital Discharge Register to determine the rate of first hospital admission for atrial fibrillation during 7 years following each of the 2 baseline data collecting periods . Changes in admission rates were analyzed using Cox proportional hazard models . Results : During the 2 7-year periods , 379 subjects were admitted with a hospital diagnosis of atrial fibrillation . The rate of hospital admissions for atrial fibrillation increased among both men and women from the first to the second period ( relative risk = 1.6 ; 95 % confidence interval = 1.3–1.9 [ adjusted for age , sex , prior myocardial infa rct ion , arterial hypertension , diabetes mellitus , electrocardiographic left ventricular hypertrophy , decreased lung function , smoking , height , and weight ] ) . Conclusion : During the latest 10 to 20 years , there has been a 60 % increase in hospital admissions for atrial fibrillation independent of changes in known risk factors . This increase could result from changes in admission threshold or coding practice s , or it could reflect a genuine increase in the population incidence of atrial fibrillation Background : Atrial fibrillation ( AF ) is a common cardiac arrhythmia which increases morbidity and mortality . Identification of risk factors is therefore important . We examined the impact of palpitations and cardiovascular risk factors in prediction of AF ( all types ) and lone AF in a large population -based cohort . Design : We carried out a prospect i ve population -based cohort study . Methods : A total of 22,815 participants from a population survey in 1994–1995 were followed-up for a mean of 11.1 years . Mean age at baseline was 46 years . Measurements of height , weight , blood pressure , heart rate , total cholesterol and high-density lipoprotein (HDL)-cholesterol , and information on palpitations , diabetes , angina , myocardial infa rct ion , and antihypertensive treatment were obtained at baseline . The outcome measure was first-ever AF , documented on an electrocardiogram .  Cox proportional hazards regression model was used to estimate hazard ratios ( HRs ) for AF . Results : Palpitations were associated with increased risk of AF in both women ( HR 1.62 , 95 % confidence interval [ CI ] 1.29–2.02 ) and men ( HR 1.91 , 95 % CI 1.54–2.35 ) . For hypertension the HR for AF was 1.98 ( 1.46 - 2.69 ) in women and 1.40 ( 1.13 - 1.74 ) in men . The HR for 1 SD increase in body mass index ( BMI ) was 1.16 ( 1.06–1.27 ) in women and 1.47 ( 1.32–1.63 ) in men . Body height and BMI were associated with increased risk for lone AF in men . Conclusion : Palpitations , hypertension and BMI were predictive of future atrial fibrillation in both sexes OBJECTIVES Orthostatic hypotension ( OH ) , a common manifestation of autonomic dysfunction , has been identified as an independent risk factor for all-cause mortality and incident cardiovascular disease . However , the role of OH in the development of atrial fibrillation has not been studied . DESIGN We investigated the incidence of atrial fibrillation in relation to baseline presence of OH according to international consensus criteria in the Swedish population -based prospect i ve cohort of the Malmö Preventive Project . The study sample consisted of 33,346 individuals ( 67.3 % men ; mean age , 45.6 ± 7.4 years ; range , 26 - 61 years ) . The association between OH and incidence of atrial fibrillation during follow-up was assessed using the Kaplan-Meier method and multivariable Cox proportional hazard models , taking into account conventional risk factors for atrial fibrillation . RESULTS At baseline , 1987 participants ( 6.1 % ) met the diagnostic criteria for OH . Over a follow-up period of approximately 24 years , 2312 individuals ( 3.0 events/1000 person-years ) were diagnosed with new-onset atrial fibrillation . Of these , 196 had OH at baseline ( 4.6 events/1000 person-years amongst all OH-positive individuals ) . In a multivariable Cox regression analysis , OH predicted incidence of atrial fibrillation independently of other risk factors ( hazard ratio [ HR ] : 1.30 ; 95 % confidence interval [ CI ] : 1.05 - 1.61 ; P = 0.016 ) , and this association was significant in hypertensive ( HR : 1.44 ; 95%CI : 1.10 - 1.88 ; P = 0.008 ) , but not in normotensive participants ( HR : 1.10 ; 95%CI : 0.77 - 1.58 ; P = 0.60 ) . CONCLUSIONS The presence of OH predicts the incidence of atrial fibrillation in middle-aged hypertensive individuals , independently of conventional risk factors . Further studies of the association of autonomic dysfunction and OH with atrial fibrillation are needed BACKGROUND Cigarette smoking is an important risk factor for cardiovascular disease , but it is unknown whether it also contributes to the risk of atrial fibrillation . METHODS AND RESULTS The study is part of the Rotterdam Study , a population -based cohort study among subjects aged > or = 55 years . The association between cigarette smoking and the risk of atrial fibrillation was examined in 5,668 subjects without atrial fibrillation at baseline . During a median follow-up of 7.2 years , 371 cases of atrial fibrillation were identified . Relative risks ( RR ) were calculated with 95 % CIs using the Cox proportional hazards model , adjusted for age , gender , body mass index , hypertension , systolic blood pressure , serum cholesterol level , diabetes mellitus , left ventricular hypertrophy on the electrocardiogram , prevalent and incident myocardial infa rct ion , prevalent heart failure , and the use of pulmonary medication . After multivariate adjustment , current smokers and former smokers had increased risks of atrial fibrillation as compared to never smokers ( RR 1.51 , 95 % CI 1.07 - 2.12 ; and RR 1.49 , 95 % CI 1.14 - 1.97 , respectively ) . No differences were found between men and women . CONCLUSIONS The results of this prospect i ve , population -based study show that current and former smoking of cigarettes are associated with increased risk of atrial fibrillation AIMS Obesity is a recognized risk factor for  atrial fibrillation ( AF ) , partly because of the association between body mass index ( BMI ) and atrial volume . We aim ed to determine whether other factors relating to body size were related to AF . METHODS AND RESULTS Data were derived from a r and om population sample of 6903 men ( mean age 51.5 years ) who underwent a single midlife evaluation as part of the multifactor Swedish Primary Prevention Study . A total of 1253 men ( 18.2 % ) had a subsequent hospital discharge diagnosis ( principal or secondary ) of AF during a maximum follow-up of 34.3 years . Body surface area ( BSA ) at age 20 ( calculated from recalled weight and measured height ) was strongly related to subsequent AF ( P < 0.0001 ) , as were midlife BMI and weight gain from age 20 to midlife ( P < 0.0001 ) . In a Cox regression model which adjusted for midlife BMI , weight gain and other risk factors , hazard ratios ( HR ) [ 95 % confidence intervals ( CI ) ] for AF for the second , third , and fourth quartile of BSA at age 20 , compared with the lowest quartile , were 1.47 ( 95 % CI , 1.22 - 1.76 ) , 1.66 ( 95 % CI , 1.38 - 2.00 ) , and 2.22 ( 95 % CI , 1.82 - 2.70 ) ( P for trend < 0.0001 ) . CONCLUSION Large body size in youth , in an era when obesity was rare , as well as weight gain from age 20 to midlife , were both independently related to the development of AF . Given the current trends not only for obesity but also for height , a substantial increase in the incidence of AF is likely OBJECTIVE It is recognized that higher height and weight are associated with higher risk of atrial fibrillation or flutter ( AF )  but it is unclear whether risk of AF is related to body fat , body fat location , or lean body mass . METHODS This article reports the Danish population -based prospect i ve cohort Diet , Cancer and Health study conducted among 55,273 men and women 50 - 64 years of age at recruitment . The associations between bioelectrical impedance derived measures of body composition and combinations of anthropometric measures of body fat distribution and risk of an incident record of AF in the Danish Registry of Patients were investigated . RESULTS During follow-up ( median 13.5 years ) AF developed in 1,669 men and 912 women . Higher body fat at any measured location was associated with higher risk of AF . The adjusted hazard ratio ( HR ) per 1 sex-specific st and ard deviation ( SD ) increment in body fat mass was 1.29 ( 95 % confidence interval [ CI ] , 1.24 - 1.33 ) . Higher lean body mass was also associated with a higher risk of AF . The adjusted HR for 1 sex-specific SD increment was 1.40 ( 95 % CI , 1.35 - 1.45 ) . CONCLUSION Higher body fat and higher lean body mass were both associated with higher risk of AF Background and Aims : Excessive sporting activities have been associated with risk of  atrial fibrillation .  To study if work related physical activity also confers risk of atrial fibrillation or flutter , the association between work related physical strain and the risk of a hospital discharge diagnosis ( inpatient as well as outpatient ) of atrial fibrillation or flutter was examined . Methods : A population based prospect i ve cohort study was conducted from December 1993 to December 2001 among 19 593 men and 18 807 women with a mean age at baseline of 56 years ( range 50–65 years ) in the Danish Diet , Cancer , and Health Study . The physical strain during working hours was categorised as sedentary , light , or heavy , and analysed using proportional hazard models . Subjects were followed up in the Danish National Registry of Patients and in the Danish Civil Registration System . Results : During follow up ( mean 5.7 years ) a hospital discharge diagnosis of atrial fibrillation or flutter occurred in 305 men and 113 women . When using the risk of atrial fibrillation or flutter associated with sedentary work at a sitting position as a reference , no excess risk ( unadjusted as well as adjusted ) was found of atrial fibrillation or flutter associated with sedentary work in a st and ing position , light workload , or heavy workload in men or women . Conclusion : No evidence was found of an association between physical activities during working hours and risk of a hospital discharge diagnosis of atrial fibrillation or flutter for men and women in the age group of 50–65 years AIMS To assess the joint influence of inflammatory biomarkers on the risk of incident atrial fibrillation ( AF ) in women . METHODS AND RESULTS We performed a prospect i ve cohort study among women participating in the Women 's Health Study . All women were free of AF at study entry and provided a baseline blood sample assayed for high-sensitivity C-reactive protein , soluble intercellular adhesion molecule-1 , and fibrinogen . To evaluate the joint effect of these three biomarkers , an inflammation score was created that ranged from 0 to 3 and reflected the number of biomarkers in the highest tertile per individual . During a median follow-up of 14.4 years , 747 of 24,734 women ( 3.0 % ) experienced a first AF event . Assessed individually , all three biomarkers were associated with incident AF , even after adjustment for traditional risk factors . When combined into an inflammation score , a strong and independent relationship between inflammation and incident AF emerged . Across increasing inflammation score categories , there were 1.66 , 2.22 , 2.73 , and 3.25 AF events per 1000 person-years of follow-up . The corresponding hazard ratios ( 95 % confidence intervals ) across inflammation score categories were 1.0 , 1.22 ( 1.00 - 1.49 ) , 1.32 ( 1.06 - 1.65 ) , and 1.59 ( 1.22 - 2.06 ) ( P for linear trend 0.0006 ) after multivariable adjustment . CONCLUSION In this large-scale prospect i ve study among women without a history of cardiovascular disease , markers of systemic inflammation were significantly related to AF even after controlling for traditional risk factors OBJECTIVES The purpose of this study was to characterize the relationship between changes in  body mass index ( BMI ) and incident atrial fibrillation ( AF ) in a large cohort of women . BACKGROUND Obesity and AF are increasing public health problems . The importance of dynamic obesity-associated AF risk is uncertain , and mediators are not well characterized . METHODS Cases of AF were confirmed by medical record review in 34,309 participants in the Women 's Health Study . Baseline and up date d measures of  BMI  were obtained from periodic question naires . RESULTS During 12.9 + /- 1.9 years of follow-up , 834 AF events were confirmed . BMI was linearly associated with AF risk , with a 4.7 % ( 95 % confidence interval [ CI ] : 3.4 to 6.1 , p < 0.0001 ) increase in risk with each kilogram per square meter . Adjustment for inflammatory markers minimally attenuated this risk . When up date d measures of BMI were used to estimate dynamic risk , overweight ( hazard ratio [ HR ] : 1.22 ; 95 % CI : 1.02 to 1.45 , p = 0.03 ) , and obesity ( HR : 1.65 ; 95 % CI : 1.36 to 2.00 ; p < 0.0001 ) were associated with adjusted short-term increases in AF risk . Participants becoming obese during the first 60 months had a 41 % adjusted increase in risk of the development of AF ( p = 0.02 ) compared with those maintaining BMI < 30 kg/m(2 ) . The prevalence of overweight and obesity increased over time . The adjusted proportion of incident AF attributable to short-term elevations in BMI was substantial ( 18.3 % ) . CONCLUSIONS In this population of apparently healthy women , BMI was associated with short- and long-term increases in AF risk , accounting for a large proportion of incident AF independent of traditional risk factors . A strategy of weight control may reduce the increasing incidence of AF . ( Women 's Health Study [ WHS ] : A R and omized Trial of Low-Dose Aspirin and Vitamin E in the Primary Prevention of Cardiovascular Disease and Cancer ; NCT00000479 ) BACKGROUND Atrial fibrillation ( AF ) and chronic kidney disease share risk factors and pathophysiologic mechanisms , suggesting that two conditions have close relationships . METHODS This is a prospect i ve community-based observational cohort study including 235,818 subjects based upon a voluntary annual health check-up program in Japan . We studied the association of kidney dysfunction at entry with subsequent new-onset AF  and the association of AF at entry with the development of kidney disease . RESULTS During a follow-up of 5.9 + /- 2.4 years , AF developed in 2947 subjects ( 1.3 % ) .  Baseline serum creatinine and estimated glomerular filtration rate ( GFR ) were associated with risk of subsequent AF . The HRs ( 95 % CI ) for AF were 1.32 ( 1.08 - 1.62 ) and 1.57 ( 0.89 - 2.77 ) for GFR 30 to 59 and < 30 mL/min per 1.73 m(2 ) , respectively . The effect of kidney disease on risk of new-onset AF remained significant in subjects without treated hypertension or diabetes . During the follow-up , 7791 subjects ( 3.3 % ) developed kidney dysfunction ( GFR < 60 mL/min per 1.73 m(2 ) ) , and 11 307 subjects ( 4.9 % ) developed proteinuria .  Atrial fibrillation at entry was associated with development of kidney dysfunction ( HRs [ 95 % CI ] , 1.77 [ 1.50 - 2.10 ] ) and proteinuria ( HR [ 95 % CI ] , 2.20 [ 1.92 - 2.52 ] ) . The association persisted in subjects without treated hypertension or diabetes . CONCLUSIONS Kidney dysfunction increased the risk of new onset of AF , and AF increased the risk of development of kidney disease . This finding supports the concept that the two conditions share common abnormal molecular signaling pathways contributing to their pathogenesis A risk score for atrial fibrillation ( AF ) has been developed by the Framingham Heart Study ; however , the applicability of this risk score , derived using data from white patients , to predict new-onset AF in nonwhites is uncertain . Therefore , we developed a 10-year risk score for new-onset AF  from risk factors commonly measured in clinical practice using 14,546 subjects from the Atherosclerosis Risk In Communities ( ARIC ) study , a prospect i ve community-based cohort of blacks and whites in the United States . During 10 years of follow-up , 515 incident AF events occurred . The following variables were included in the AF risk  score  : age , race , height , smoking status , systolic blood pressure , hypertension medication use , precordial murmur , left ventricular hypertrophy , left atrial enlargement , diabetes , coronary heart disease , and heart failure . The area under the receiver operating characteristics curve ( AUC ) of a Cox regression model that included the previous variables was 0.78 , suggesting moderately good discrimination . The point-based score developed from the coefficients in the Cox model had an AUC of 0.76 . This clinical risk score for AF in the Atherosclerosis Risk In Communities cohort compared favorably with the Framingham Heart Study 's AF ( AUC 0.68 ) , coronary heart disease ( CHD ) ( AUC 0.63 ) , and hard CHD ( AUC 0.59 ) risk scores and the Atherosclerosis Risk In Communities CHD risk score ( AUC 0.58 ) . In conclusion , we have developed a risk score for AF and have shown that the different pathophysiologies of AF and CHD limit the usefulness of a CHD risk score in identifying subjects at greater risk of AF PURPOSE We examined the association between the body mass index analyzed as a continuous variable and by categorization according to World Health Organization criteria ( normal weight , overweight and obesity ) and the risk of a hospital ( inpatient as well as outpatient ) diagnosis of atrial fibrillation or flutter . METHODS Population -based prospect i ve cohort study conducted from December 1993 to December 2001 among 47589 participants ( 22482 men and 25107 women ) without preexisting cardiovascular or endocrine disease and with a mean age at baseline of 56 years ( range 50 - 64 years ) in the Danish Diet , Cancer , and Health Study . Subjects were followed up in the Danish National Registry of Patients and in the Danish Civil Registration System . RESULTS During follow-up ( mean , 5.7 years ) atrial fibrillation or flutter developed in 553 subjects ( 372 men and 181 women ) . The adjusted hazard ratio for atrial fibrillation or flutter per unit of increase in the body mass index was 1.08 ( 95 % confidence interval [ CI ] : 1.05 to 1.11 ) in men and 1.06 ( 95 % CI : 1.03 to 1.09 ) in women . When using normal weight as a reference , the adjusted hazard ratio for atrial fibrillation or flutter by overweight was 1.75 ( 95 % CI : 1.35 to 2.27 ) in men and 1.39 ( 95 % CI : 0.99 to 1.94 ) in women . The adjusted hazard ratio by obesity was 2.35 ( 95 % CI : 1.70 to 3.25 ) in men and 1.99 ( 95 % CI : 1.31 to 3.02 ) in women . CONCLUSION Overweight and obesity are associated with an increased risk of a diagnosis of atrial fibrillation or flutter CONTEXT Hyperthyroidism is an established risk factor for atrial fibrillation ( AF ) , but information concerning the association with variations within the normal range of thyroid function and subgroups at risk is lacking . OBJECTIVE This study aim ed to investigate the association between normal thyroid function and AF prospect ively and explore potential differential risk patterns . DESIGN , SETTING , AND PARTICIPANTS From the Rotterdam Study we included 9166 participants ≥ 45 y with TSH and /or free T4 ( FT4 ) measurements and AF assessment  ( 1997 - 2012 median followup , 6.8 y ) , with 399 prevalent and 403 incident AF cases . MAIN OUTCOME MEASURES Outcome measures were 3-fold : 1 ) hazard ratios ( HRs ) for the risk of incident AF by Cox proportional-hazards models , 2 ) 10-year absolute risks taking competing risk of death into account , and 3 ) discrimination ability of adding FT4 to the CHARGE-AF simple model , an established prediction model for AF . RESULTS Higher FT4 levels were associated with higher risks of AF ( HR 1.63 , 95 % confidence interval , 1.19 - 2.22 ) , when comparing those in the highest quartile to those in lowest quartile . Absolute 10-year risks increased with higher FT4 in participants ≤ 65 y from 1 - 9 % and from 6 - 12 % in subjects ≥ 65 y. Discrimination of the prediction model improved when adding FT4 to the simple model ( c-statistic , 0.722 vs 0.729 ; P = .039 ) . TSH levels were not associated with AF . CONCLUSIONS There is an increased risk of AF with higher FT4 levels within the normal range , especially in younger subjects . Adding FT4 to the simple model slightly improved discrimination of risk prediction Few prospect i ve studies have explored the association between renal function and risk for  incident atrial fibrillation ( AF ) in apparently healthy population s. A total of 24,746 women participating in the Women 's Health Study who were free of cardiovascular disease and AF and provided blood sample s at baseline were prospect ively followed for incident AF from 1993 to 2010 . AF events were confirmed by medical chart review . Estimated glomerular filtration rate ( eGFR ) was calculated from baseline creatinine using the Chronic Kidney Disease Epidemiology ( CKD-EPI ) equation . Cox models were used to estimate hazard ratios and 95 % confidence intervals ( CIs ) for incident AF across eGFR categories controlling for AF risk factors . During a median of 15.4 years of follow-up , 786 incident AF events occurred . The multivariate-adjusted hazard ratios for incident AF across eGFR categories ( < 60 , 60 to 74.9 , 75 to 89 , and ≥90 ml/min/1.73 m(2 ) ) were 1.36 ( 95 % CI 1.00 to 1.84 ) , 0.90 ( 95 % CI 0.71 to 1.14 ) , 0.99 ( 95 % CI 0.84 to 1.18 ) and 1.00 , respectively , without evidence of a linear association ( P for trend = 0.48 ) . Similarly , there was no significant curvilinear association ( quadratic p = 0.10 ) in multivariate analysis across categories . Compared to women with eGFRs ≥60 ml/min/1.73 m(2 ) , the 1,008 women with eGFRs < 60 ml/min/1.73 m(2 ) had a multivariate-adjusted hazard ratio for AF of 1.39 ( 95 % CI 1.04 to 1.86 , p = 0.03 ) . In conclusion , no significant linear or curvilinear relation was observed between incident AF and less severe impairment of renal function in this large prospect i ve cohort of women . However , a significant elevation in AF risk was observed at a threshold eGFR of < 60 ml/min/1.73 m(2 ) AIMS Since atrial fibrillation ( AF ) is associated with increased risks of cardiovascular and cerebrovascular complications , estimations on the number of individuals with AF are relevant to healthcare planning . We aim ed to project the number of individuals with AF in the Netherl and s and in the European Union from 2000 to 2060 . METHODS AND RESULTS Age- and sex-specific AF prevalence estimates were obtained from the prospect i ve community-based Rotterdam Study . Population projections for the Netherl and s and the European Union were obtained from the European Union 's statistics office . In the age stratum of 55 - 59 years , the prevalence of AF was 1.3 % in men ( 95 % CI : 0.4 - 3.6 % ) and 1.7 % in women ( 95 % CI : 0.7 - 4.0 % ) . The prevalence of AF increased to 24.2 % in men ( 95 % CI : 18.5 - 30.7 % ) , and 16.1 % in women ( 95 % CI : 13.1 - 19.4 % ) , for those > 85 years of age . This age- and sex-specific prevalence remained stable during the years of follow-up . Furthermore , we estimate that in the European Union , 8.8 million adults over 55 years had AF in 2010 ( 95 % CI : 6.5 - 12.3 million ) . We project that this number will double by 2060 to 17.9 million ( 95 % CI : 13.6 - 23.7 million ) if the age- and sex-specific prevalence remains stable . CONCLUSION We estimate that from 2010 to 2060 , the number of adults 55 years and over with AF in the European Union will more than double . As AF is associated with significant morbidities and mortality , this increasing number of individuals with AF may have major public health implication Cross-sectional and limited prospect i ve evidence has suggested that inflammatory markers may predict for the risk of  atrial fibrillation ( AF ) .  In a prospect i ve cohort study , we studied the risk of incident AF among 8,870 women and men free of cardiovascular disease enrolled in the Copenhagen City Heart Study . We measured plasma fibrinogen and serum albumin levels  at a study visit from 1991 to 1994 . We identified 286 subsequent cases of AF during a mean of 7.5 years of follow-up by a vali date d nationwide registry of all hospitalizations . The fibrinogen levels at baseline were associated with a higher risk of AF , with a multivariate-adjusted hazard ratio for the highest versus lowest quartiles of 1.98 ( 95 % confidence interval [ CI ] 0.94 to 4.17 ) among men and 2.14 ( 95 % CI 1.15 to 3.96 ) among women . The albumin levels were inversely associated with the risk of AF among women ( hazard ratio 0.47 , 95 % CI 0.28 to 0.77 ) but not among men ( hazard ratio 1.01 , 95 % CI 0.56 to 1.84 ) . Additional adjustment for cases of coronary heart disease , congestive heart failure , and stroke that occurred during follow-up did not attenuate these associations . In conclusion , higher levels of fibrinogen and lower levels of albumin were prospect ively associated with a higher risk of AF , even accounting for their relation with the risk of cardiovascular disease . These findings support the hypothesis that inflammation contributes to the etiology of AF Background — The influence of systolic and diastolic blood pressure ( BP ) on  incident atrial fibrillation ( AF )  is not well studied among initially healthy , middle-aged women . Methods and Results — A total of 34 221 women participating in the Women 's Health Study were prospect ively followed up for incident AF . The risk of AF across categories of systolic and diastolic BP was compared by use of Cox proportional-hazards models . During 12.4 years of follow-up , 644 incident AF events occurred . Using  BP measurements at baseline , we discovered that the long-term risk of AF was significantly increased across categories of systolic and diastolic BP . Multivariable-adjusted hazard ratios for systolic BP categories ( < 120 , 120 to 129 , 130 to 139 , 140 to 159 , and ≥160 mm Hg ) were 1.0 , 1.00 ( 95 % CI , 0.78 to 1.28 ) , 1.28 ( 95 % CI , 1.00 to 1.63 ) , 1.56 ( 95 % CI , 1.22 to 2.01 ) , and 2.74 ( 95 % CI , 1.77 to 4.22 ) ( P for trend < 0.0001 ) . Adjusted hazard ratios across baseline diastolic BP categories ( < 65 , 65 to 74 , 75 to 84 , 85 to 89 , 90 to 94 , and ≥95 mm Hg ) were 1.0 , 1.17 ( 95 % CI , 0.81 to 1.69 ) , 1.18 ( 95 % CI , 0.84 to 1.65 ) , 1.53 ( 95 % CI , 1.05 to 2.23 ) , 1.35 ( 95 % CI , 0.82 to 2.22 ) , and 2.15 ( 95 % CI , 1.21 to 3.84 ) ( P for trend=0.004 ) . When BP changes over time were accounted for in up date d models , multivariable-adjusted hazard ratios were 1.0 , 1.14 ( 95 % CI , 0.89 to 1.46 ) , 1.37 ( 95 % CI , 1.07 to 1.76 ) , 1.71 ( 95 % CI , 1.33 to 2.21 ) , and 2.21 ( 95 % CI , 1.45 to 3.36 ) ( P for trend < 0.0001 ) for systolic BP categories and 1.0 , 1.12 ( 95 % CI , 0.82 to 1.52 ) , 1.13 ( 95 % CI , 0.83 to 1.52 ) , 1.30 ( 95 % CI , 0.89 to 1.88 ) , 1.50 ( 95 % CI , 1.01 to 1.88 ) , and 1.54 ( 95 % CI , 0.75 to 3.14 ) ( P for trend=0.026 ) for diastolic BP categories . Conclusions — In this large cohort of initially healthy women , BP was strongly associated with incident AF , and systolic BP was a better predictor than diastolic BP . Systolic BP levels within the nonhypertensive range were independently associated with incident AF even after BP changes over time were taken into account CONTEXT Previous studies suggest that consuming moderate to high amounts of alcohol on a regular basis might increase the risk of developing  atrial fibrillation  in men but not in women . However , these studies were not powered to investigate the association of alcohol consumption and atrial fibrillation among women . OBJECTIVE To prospect ively assess the association between regular alcohol consumption  and incident atrial fibrillation among women . DESIGN , SETTING , AND PARTICIPANTS Participants were 34 715 initially healthy women participating in the Women 's Health Study , a completed r and omized controlled trial conducted in the United States . Participants were older than 45 years and free of atrial fibrillation at baseline and underwent prospect i ve follow-up from 1993 to October 31 , 2006 .  Alcohol consumption  was assessed via question naires at baseline and at 48 months of follow-up and was grouped into 4 categories ( 0 , > 0 and < 1 , > or = 1 and < 2 , and > or = 2 drinks per day ) . Atrial fibrillation was self-reported on the yearly question naires and subsequently confirmed by electrocardiogram and medical record review . MAIN OUTCOME MEASURE Time to first episode of atrial fibrillation . RESULTS Over a median follow-up of 12.4 years , 653 cases of incident atrial fibrillation were confirmed . Age-adjusted incidences among women consuming 0 ( n = 15,370 ) , more than 0 and less than 1 ( n = 15,758 ) , 1 or more and less than 2 ( n = 2228 ) , and 2 or more ( n = 1359 ) drinks per day were 1.59 , 1.55 , 1.27 , and 2.25 events/1000 person-years of follow-up . Thus , compared with nondrinking women , women consuming 2 or more drinks per day had an absolute risk increase of 0.66 events/1000 person-years . The corresponding multivariate-adjusted hazard ratios ( HRs ) for incident atrial fibrillation were 1 , 1.05 ( 95 % CI , 0.88 - 1.25 ) , 0.84 ( 95 % CI , 0.58 - 1.22 ) , and 1.60 ( 95 % CI , 1.13 - 2.25 ) , respectively . The increased hazard in the small group of women consuming 2 or more drinks per day persisted when alcohol intake was up date d at 48 months ( HR , 1.49 ; 95 % CI , 1.05 - 2.11 ) or when women were censored at their first cardiovascular event ( HR , 1.68 ; 95 % CI , 1.18 - 2.39 ) . CONCLUSIONS Among healthy middle-aged women , consumption of up to 2 alcoholic beverages per day was not associated with an increased risk of incident atrial fibrillation . Heavier consumption of 2 or more drinks per day , however , was associated with a small but statistically significant increased risk of atrial fibrillation Chronic kidney disease ( CKD ) is a potential independent risk factor for  atrial fibrillation ( AF ) .  It remains unclear whether anemia is synergistically associated with increased risk of AF onset  in subjects with CKD . We evaluated the association of kidney function , hemoglobin ( Hb ) , and their combination with new-onset AF in a population -based cohort study . We conducted a 15-year prospect i ve cohort study of 132,250 Japanese subjects aged 40 to 79 years who participated in annual health checkups from 1993 .  Kaplan-Meier survival analysis was used to compare freedom from new-onset AF between groups classified by estimated glomerular filtration rate grade , Hb grade , and their combination . Cox proportional hazard model analysis was used to estimate hazard ratios ( HRs ) for new-onset AF . During a 13.8-year mean follow-up period , 1,232 ( 0.93 % ) subjects with  new-onset AF were identified . Lower estimated glomerular filtration rate and lower Hb grade s were significantly associated with a higher incidence of new-onset AF . Multivariate HRs and 95 % confidence intervals ( CIs ) of new-onset AF were 1.38 ( 1.21 to 1.56 ) for mild CKD group , 2.56 ( 2.09 to 3.13 ) for CKD group , and 1.50 ( 1.24 to 1.83 ) for anemia group . Borderline Hb level was not significantly associated with increased risk for new-onset AF ( HR 1.07 , CI 0.91 to 1.25 , p = 0.4284 ) . In the model with interaction term between CKD and anemia , the risk was significantly higher ( p = 0.0343 for the interaction ) than that predicted by each factor independently . In conclusion , decreased kidney function and lower Hb level are associated with increased risk for new-onset AF , especially when both are present
target: A systematic evaluation of the available evidence suggests similarities as well as important differences in the risk factors for incidence of AF as compared with other cardiovascular diseases , which has implication s for the primary prevention strategies for atrial fibrillation
background: Established primary prevention strategies of cardiovascular diseases are based on underst and ing of risk factors , but whether the same risk factors are associated with  atrial fibrillation ( AF )  remains unclear .