title: Combined impact of healthy lifestyle factors on risk of atrial fibrillation: Prospective study in men and women.
abstract: BACKGROUND
  The combined impact of multiple lifestyle factors on risk of atrial fibrillation (AF) remains unclear. We investigated the joint association of four modifiable lifestyle factors on incidence of AF in a prospective study of men and women.
  
  
  METHODS
  The study cohort comprised 39 300 men in the Cohort of Swedish Men and 33 090 women in the Swedish Mammography Cohort who were 45-83 years of age and free from atrial fibrillation at baseline. Healthy lifestyle was defined as body mass index <25 kg/m(2), regular exercise for ≥ 20 min/day, no or light-to-moderate alcohol consumption (≤ 2 drinks/day for men and ≤ 1 drink/day for women), and not smoking. Incident AF cases were identified through linkage with the Swedish National Inpatient Register.
  
  
  RESULTS
  During a mean follow-up of 10.9 years, AF occurred in 4028 men and 2539 women. Compared with men and women with no healthy lifestyle factors, the multivariable relative risks (95% confidence interval) of AF were 0.83 (0.65-1.07) for one, 0.74 (0.58-0.94) for two, 0.62 (0.49-0.79) for three, and 0.50 (0.39-0.64) for four healthy lifestyle factors (P for trend <0.0001). The inverse association was similar in men and women.
  
  
  CONCLUSIONS
  Four healthy lifestyle factors combined were associated with a halving of the risk of AF.
authors.affiliation: Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: susanna.larsson@ki.se.
authors.forename: Susanna C
authors.initials: SC
authors.lastname: Larsson
authors.affiliation: Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Nikola
authors.initials: N
authors.lastname: Drca
authors.affiliation: Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Jensen-Urstad
authors.affiliation: Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Alicja
authors.initials: A
authors.lastname: Wolk
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology; D015992:Body Mass Index; D015444:Exercise; D005260:Female; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
keywords: Alcohol; Atrial fibrillation; Body mass index; Lifestyle; Physical activity; Smoking