title: Associations of Epicardial, Abdominal, and Overall Adiposity With Atrial Fibrillation.
abstract: BACKGROUND
  Although adiposity is increasingly recognized as a risk factor for atrial fibrillation (AF), the importance of epicardial fat compared with other adipose tissue depots remains uncertain. We sought to characterize and compare the associations of AF with epicardial fat and measures of abdominal and overall adiposity.
  
  
  RESULTS
  We conducted a meta-analysis of 63 observational studies including 352 275 individuals, comparing AF risk for 1-SD increases in epicardial fat, waist circumference, waist/hip ratio, and body mass index. A 1-SD higher epicardial fat volume was associated with a 2.6-fold higher odds of AF (odds ratio, 2.61; 95% confidence interval [CI], 1.89-3.60), 2.1-fold higher odds of paroxysmal AF (odds ratio, 2.14; 95% CI, 1.45-3.16) and, 5.4-fold higher odds of persistent AF (odds ratio, 5.43; 95% CI, 3.24-9.12) compared with sinus rhythm. Likewise, a 1-SD higher epicardial fat volume was associated with 2.2-fold higher odds of persistent compared with paroxysmal AF (odds ratio, 2.19; 95% CI, 1.66-2.88). Similar associations existed for postablation, postoperative, and postcardioversion AF. In contrast, associations of abdominal and overall adiposity with AF were less extreme, with relative risks per 1-SD higher values of 1.32 (95% CI, 1.25-1.41) for waist circumference, 1.11 (95% CI, 1.08-1.14) for waist/hip ratio, and 1.22 (95% CI, 1.17-1.27) for body mass index.
  
  
  CONCLUSIONS
  Strong and graded associations were observed between increasing epicardial fat and AF. Moreover, the strength of associations of AF with epicardial fat is greater than for measures of abdominal or overall adiposity. Further studies are needed to assess the mechanisms and clinical relevance of epicardial fat.
authors.affiliation: From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia (R.M., D.H.L., R.K.P., P.S.); Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Health, Melbourne, Victoria, Australia (D.T.W.); and Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia (J.B.S.). christopher.wong@ctsu.ox.ac.uk.
authors.forename: Christopher X
authors.initials: CX
authors.lastname: Wong
authors.affiliation: From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia (R.M., D.H.L., R.K.P., P.S.); Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Health, Melbourne, Victoria, Australia (D.T.W.); and Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia (J.B.S.).
authors.forename: Michelle T
authors.initials: MT
authors.lastname: Sun
authors.affiliation: From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia (R.M., D.H.L., R.K.P., P.S.); Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Health, Melbourne, Victoria, Australia (D.T.W.); and Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia (J.B.S.).
authors.forename: Ayodele
authors.initials: A
authors.lastname: Odutayo
authors.affiliation: From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia (R.M., D.H.L., R.K.P., P.S.); Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Health, Melbourne, Victoria, Australia (D.T.W.); and Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia (J.B.S.).
authors.forename: Connor A
authors.initials: CA
authors.lastname: Emdin
authors.affiliation: From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia (R.M., D.H.L., R.K.P., P.S.); Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Health, Melbourne, Victoria, Australia (D.T.W.); and Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia (J.B.S.).
authors.forename: Rajiv
authors.initials: R
authors.lastname: Mahajan
authors.affiliation: From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia (R.M., D.H.L., R.K.P., P.S.); Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Health, Melbourne, Victoria, Australia (D.T.W.); and Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia (J.B.S.).
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Lau
authors.affiliation: From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia (R.M., D.H.L., R.K.P., P.S.); Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Health, Melbourne, Victoria, Australia (D.T.W.); and Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia (J.B.S.).
authors.forename: Rajeev K
authors.initials: RK
authors.lastname: Pathak
authors.affiliation: From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia (R.M., D.H.L., R.K.P., P.S.); Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Health, Melbourne, Victoria, Australia (D.T.W.); and Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia (J.B.S.).
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Wong
authors.affiliation: From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia (R.M., D.H.L., R.K.P., P.S.); Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Health, Melbourne, Victoria, Australia (D.T.W.); and Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia (J.B.S.).
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Selvanayagam
authors.affiliation: From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia (R.M., D.H.L., R.K.P., P.S.); Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Health, Melbourne, Victoria, Australia (D.T.W.); and Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia (J.B.S.).
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
authors.affiliation: From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia (R.M., D.H.L., R.K.P., P.S.); Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and Monash Health, Melbourne, Victoria, Australia (D.T.W.); and Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia (J.B.S.).
authors.forename: Robert
authors.initials: R
authors.lastname: Clarke
mesh_terms: D050153:Abdominal Fat / Q000503:physiopathology; D050154:Adiposity; D000886:Anthropometry; D001281:Atrial Fibrillation / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D010496:Pericardium / Q000503:physiopathology; D012307:Risk Factors
keywords: abdominal fat; adipose tissue; atrial fibrillation; meta-analysis; obesity