title: Dietary Fat Intake Is Differentially Associated with Risk of Paroxysmal Compared with Sustained Atrial Fibrillation in Women.
abstract: BACKGROUND
  Dietary fats have effects on biological pathways that may influence the development and maintenance of atrial fibrillation (AF). However, associations between n-3 (ω-3) polyunsaturated fatty acids and AF are inconsistent, and data on other dietary fats and AF risk are sparse.
  
  
  OBJECTIVE
  We examined the association between dietary fatty acid (FA) subclasses and risk of incident AF and explored whether these associations differed for sustained and paroxysmal AF.
  
  
  METHODS
  We conducted a prospective cohort study in 33,665 women ≥45 y old without cardiovascular disease (CVD) and AF at baseline in 1993. Fat intake was estimated from food frequency questionnaires at baseline and in 2004. Incident AF was confirmed by medical records through October 2013. AF patterns were classified according to the most sustained form of AF within 2 y of diagnosis. Cox proportional hazards models with the use of a competing risk model approach estimated the RR.
  
  
  RESULTS
  Over 19.2 y, 1441 cases of incident AF (929 paroxysmal and 467 persistent/chronic) were confirmed. Intakes of total fat and FA subclasses were not associated with risk of AF. Saturated fatty acids (SFAs) and monounsaturated fatty acids (MUFAs) were differentially associated with AF patterns. The RR for a 5% increment of energy from SFAs was 1.47 (95% CI: 1.04, 2.09) for persistent/chronic and 0.85 (95% CI: 0.66, 1.08) for paroxysmal AF (P-difference = 0.01). For MUFAs, the RR for a 5% increment was 0.67 (95% CI: 0.46, 0.98) for persistent/chronic and 1.03 (95% CI: 0.78, 1.34) for paroxysmal AF, although the difference between patterns was not significant (P-difference = 0.07).
  
  
  CONCLUSIONS
  Dietary fat was not associated with risk of incident AF in women without established CVD or AF. High SFA and low MUFA intakes were associated with greater risk of persistent or chronic, but not paroxysmal, AF. Improving dietary fat quality may play a role in the prevention of sustained forms of AF. The Women's Health Study was registered at clinicaltrials.gov as NCT00000479.
authors.affiliation: Center for Arrhythmia Prevention, Division of Preventive Medicine, and Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; and schiuve@hsph.harvard.edu.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Chiuve
authors.affiliation: Division of Preventive Medicine, and Division of Cardiology, University of Alberta, Edmonton, Canada.
authors.forename: Roopinder K
authors.initials: RK
authors.lastname: Sandhu
authors.affiliation: Division of Preventive Medicine, and.
authors.forename: M Vinayaga
authors.initials: MV
authors.lastname: Moorthy
authors.affiliation: Division of Preventive Medicine, and.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Glynn
authors.affiliation: Center for Arrhythmia Prevention, Division of Preventive Medicine, and Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA;
authors.forename: Christine M
authors.initials: CM
authors.lastname: Albert
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D001281:Atrial Fibrillation / Q000145:classification / Q000453:epidemiology; D004041:Dietary Fats / Q000008:administration & dosage; D005227:Fatty Acids / Q000008:administration & dosage; D005229:Fatty Acids, Monounsaturated / Q000008:administration & dosage; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D043371:Fatty Acids, Omega-6 / Q000008:administration & dosage; D005500:Follow-Up Studies; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016032:Randomized Controlled Trials as Topic
chemical_list: D004041:Dietary Fats; D005227:Fatty Acids; D005229:Fatty Acids, Monounsaturated; D015525:Fatty Acids, Omega-3; D043371:Fatty Acids, Omega-6
keywords: atrial fibrillation; epidemiology; monounsaturated fatty acids; saturated fatty acids; women