title: Association of Smoking, Alcohol, and Obesity with Cardiovascular Death and Ischemic Stroke in Atrial Fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study and Cardiovascular Health Study (CHS).
abstract: Atrial fibrillation (AF) is associated with an increased risk of ischemic stroke and cardiovascular (CV) death. Whether modifiable lifestyle risk factors are associated with these CV outcomes in AF is unknown. Among Atherosclerosis Risk in Communities (ARIC) study and Cardiovascular Health Study (CHS) participants with incident AF, we estimated the risk of composite endpoint of ischemic stroke or CV death associated with candidate modifiable risk factor (smoking, heavy alcohol consumption, or high body mass index [BMI]), and computed the C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) of incorporating each factor into the CHA2DS2-VASc. Among 1222 ARIC (mean age: 63.4) and 756 CHS (mean age: 79.1) participants with incident AF, during mean follow-up of 6.9 years and 5.7 years, there were 332 and 335 composite events respectively. Compared with never smokers, current smokers had a higher incidence of the composite endpoint in ARIC [HR: 1.65 (1.21-2.26)] but not in CHS [HR: 1.05 (0.69-1.61)]. In ARIC, the addition of current smoking did not improve risk prediction over and above the CHA2DS2-VASc. No significant associations were observed with alcohol consumption or BMI with CVD outcomes in AF patients from either cohort. Smoking is associated with an increased risk of ischemic stroke or CV death in ARIC, which comprised mostly middle-aged to young-old (65-74 years), but not in CHS, which comprised mostly middle-old or oldest-old (≥75 years) adults with AF. However, addition of smoking to the CHA2DS2-VASc score did not improve risk prediction of these outcomes.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America.
authors.forename: Younghoon
authors.initials: Y
authors.lastname: Kwon
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America.
authors.forename: Faye L
authors.initials: FL
authors.lastname: Norby
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington, United States of America.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Jensen
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Agarwal
authors.affiliation: Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, and Department of Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.|Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington, United States of America.|Department of Neurology, University of Washington, Seattle, Washington, United States of America.
authors.forename: W T
authors.initials: WT
authors.lastname: Longstreth
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington, United States of America.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America.
authors.forename: Lin Y
authors.initials: LY
authors.lastname: Chen
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D012907:Smoking / Q000009:adverse effects*; D020521:Stroke / Q000453:epidemiology / Q000401:mortality*