Burden of cardiometabolic disorders and lifetime risk of new-onset atrial fibrillation among men and women: the Rotterdam Study

Aims To examine the association between the burden of cardiometabolic disorders with new-onset atrial fibrillation (AF) and lifetime risk of AF incidence among men and women. Methods Four thousand one hundred and one men and 5421 women free of AF at baseline (1996–2008) from the population-based and results Rotterdam Study were included. Sex-specific Cox proportional-hazards regression models were used to assess the association between the burden of cardiometabolic disorders and risk of new-onset AF. The remaining lifetime risk for AF was estimated at index ages of 55, 65, and 75 years up to age 108. Mean age at baseline was 65.5 ± 9.4 years. Median followup time was 12.8 years. In the fully adjusted model, a stronger association was found between a larger burden of cardiometabolic disorders and incident AF among women [hazard ratio (HR): 1.33% and 95% conference interval (CI): 1.22–1.46], compared to men [1.18 (1.08–1.29)] (P for sex-interaction <0.05). The lifetime risk for AF significantly increased with the number of cardiometabolic disorders among both sexes. At an index age of 55 years, the lifetime risks (95% CIs) for AF were 27.1% (20.8–33.4), 26.5% (22.8–30.5), 29.9% (26.7–33.2), 30.8% (25.7–35.8), and 33.3% (23.1–43.6) among men, for 0, 1, 2, 3, and ≥4 comorbid cardiometabolic disorders. Corresponding risks were 15.8% (10.5–21.2), 23.0% (19.8–26.2), 29.7% (26.8–32.6), 26.2% (20.8–31.6), and 34.2% (17.3–51.1) among women. Conclusion We observed a significant combined impact of cardiometabolic disorders on AF risk, in particular among women. Participants with cardiometabolic multimorbidity had a significantly higher lifetime risk of AF, especially at a young index age. Lay summary The present study examined the association between the burden of cardiometabolic disorders with new-onset atrial fibrillation (AF) and lifetime risk of AF incidence among 4101 men and 5421 women from the Rotterdam Study cohort. We observed a significant combined impact of cardiometabolic disorders on AF risk, in particular among women. Participants with cardiometabolic multimorbidity had a significantly higher lifetime risk of AF, especially at a young index age. _• A stronger association was found between a larger burden of cardiometabolic disorders and incident AF among women [hazard ratio: 1.33% and 95% conference interval: 1.22–1.46], compared to men [1.18 (1.08–1.29)] (P for sex-interaction <0.05). _• Among participants aged 55 years or older, the lifetime risk of AF was 25.2% among healthy men and 16.3% among healthy women. Individuals with cardiometabolic multimorbidity exhibited a markedly escalated lifetime risk of AF, particularly evident at a younger age.