title: P wave indices, obesity, and the metabolic syndrome: the atherosclerosis risk in communities study.
abstract: Atrial fibrillation and obesity are increasing in prevalence and are interrelated epidemics. There has been limited assessment of how obesity and the metabolic syndrome impact P wave indices, established electrocardiographic predictors of atrial fibrillation. We conducted a cross-sectional analysis to determine the association of obesity and the components of the metabolic syndrome with P wave indices in the population-based Atherosclerosis Risk in Communities (ARIC) study. Analyses were adjusted for demographic, anthropometric and clinical variables, and cardiovascular diseases and risk factors. Following relevant exclusions, 14,433 subjects were included (55% women and 24.7% black). In multivariable analyses, we identified significant, progressive increases in PR interval, P wave maximum duration, and P wave terminal force with BMI 25-30 kg/m(2) and BMI ≥30 kg/m(2) compared to the reference group <25 kg/m(2) (P < 0.0001 for trend for all P wave indices). These effects were present in both blacks and whites. Presence of metabolic syndrome was also associated with longer P wave indices. When components of the metabolic syndrome were examined separately, hypertension resulted in significant (P < 0.001) augmentation of the three P wave indices. Similarly, waist circumference was associated with greater P wave maximum duration in both races (P < 0.001). We concluded that P wave indices are significantly associated with obesity and particularly with hypertension and waist circumference. P wave indices may comprise intermediate markers, independent of age and cardiovascular risk, of the pathway linking obesity and with the risk of atrial fibrillation (AF).
authors.affiliation: Department of Medicine, Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts, USA. jmagnani@bu.edu
authors.forename: Jared W
authors.initials: JW
authors.lastname: Magnani
authors.forename: Faye L
authors.initials: FL
authors.lastname: Lopez
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.forename: Richard F
authors.initials: RF
authors.lastname: Maclehose
authors.forename: Richard S
authors.initials: RS
authors.lastname: Crow
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
mesh_terms: D050197:Atherosclerosis / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000453:epidemiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology