INTERVIEW
New Connections
Between AF and Other
Risk Factors
Isabelle C. Van Gelder, MD, PhD
In recent years,
there have been important improvements in
managing patients with
atrial fibrillation (AF).
Because of changing
lifestyles and an aging
population, however, we
may not know as much
about the incidence and
risk factors for AF as we thought. CardioSource
WorldNews spoke to Isabelle C. Van Gelder, MD,
PhD, about the community-based study from The
Netherlands that studied these incidences and
their relation to cardiovascular events, heart failure, and mortality.
CSWN: First, give us a sense of why you
did this study. Our understanding on this
issue has changed—is that what you were
looking for?
Isabelle C. Van Gelder, MD, PhD: Yes, our understanding of AF incidences has changed. What
we know now comes especially from American epidemiological studies and the Framingham Heart
Study—but these are rather old studies. So we had
the opportunity to examine it; this study was started by our nephrology department—with whom we
had wo rked before—and, because they have EKGs,
we had the possibility and the opportunity to look
at the incidence of AF. More than 8,000 people
were included in the trial back in 1997, and we
now have a follow-up of almost 10 years with
this analysis. We saw the study participants—not
patients at that moment—every 3 years at our department and other hospitals nearby. The review
was performed only in The Northern Netherlands;
those people who live there do not usually move,
so we had a very good follow-up.
So we thought we understood the risk factors
from the dated data. What are we learning now?
Important risk factors for AF are advanced age, being male, prior myocardial infarction, prior stroke,
and hypertension, of course. So that’s already
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well-known. What we now learn is that obesity
is a very important risk factor. Five points in BMI
elevation means a 50% increase in the risk of AF.
So if you go from 25 to 30 BMI points, then your
risk is increased by 45%. We also considered the
well-known work from Prashanthan Sanders,
MBBS, PhD, who shows that if you reduce weight
and you perform a little bit of physical activity
then the AF burden reduces.
learn: the incidence of HFpEF will increase, and
the link between AF and HFpEF is important.
And last year we also published another paper;
we wrote it with other AF researchers like Robert
George Weiss, MD, of Johns Hopkins. We showed
that AF almost never comes alone, that lone AF
doesn’t exist. So obesity is an important risk factor, but probably working with other things we do
not yet know. And genetics also plays a role. So,
in the next community-based study
on the incidence of AF, we’ll learn
even more.
We can’t prevent it but we
can try. Through lifestyle and
risk-factor management we
can reduce the AF burden and
also reduce the cost for AF.
So, for example, in The Netherlands, we bike.
The Netherlands is very small, and I only live 10
km from my hospital, so I have the opportunity
to bike. And a lot of people in the Netherlands
do bike, but we all know that our lifestyles have
changed, and it is very difficult to not become
obese. In my outpatient clinic, a lot of people who
are sitting in front of me because of AF are obese.
Did you find any other connections that you
thought there might be?
Well, actually after multi-variant analysis, B-type
natriuretic peptide (BNP) was a predictor. We
also have learned more that HF is a preserved
ejection fraction (HFpEF). All the data are about
HF with a reduced ejection fraction (HFrEF), and
even in our population the incidence of reduced
ejection fraction was higher than HFpEF. This is
because making the diagnosis of HFpEF is very
difficult. But everybody knows that the patients
with AF who deteriorate once they have an episode of AF are typical HFpEF patients. And that’s
also something in the future that we have to
So you found that obesity has
become a major risk factor for
AF and the incidence of AF
doubles the cardiovascular event
risk, all-cause mortality risk, and
HF risk fivefold. If you can prevent one of them, it can help you
prevent other factors, too.
Yes, fivefold, and I think that’s important. When AF occurs, then the risk for stroke,
for HF, and for mortality significantly increases.
We can’t prevent it but we can try. Through
lifestyle and risk-factor management, we can
reduce the AF burden and also reduce the cost
for AF. ■
Editor’s Note: This interview was edited from transcript.
REFERENCE
Vermond RA, Geelhoed B, Verweij N, et al.
J Am Coll Cardiol. 2015;66(9):1000-7.
To watch the interview with Dr. Van
Gelder, visit the CSWN YouTube channel or scan the QR code. Interview
conducted by Rick McGuire.
January 2016