Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Focused 2012 update of the Canadian Cardiovascular Society atrial fibrillation guidelines: recommendations for stroke prevention and rate/rhythm control. Interaction of Blood Pressure and Body Mass Index With Risk of Incident Atrial Fibrillation in a Japanese Urban Cohort: The Suita Study. Obesity and outcomes among patients with established atrial fibrillation. Risk factors for atrial fibrillation and their population burden in postmenopausal women: the Women's Health Initiative Observational Study Risk factors for thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study. A randomised controlled trial and cost effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in the over 65s: (SAFE) [ISRCTN19633732] Atrial fibrillation in the Malmö diet and cancer study: a study of occurrence, risk factors and diagnostic validity Atrial fibrillation and mortality in an elderly population. Previously known and newly diagnosed atrial fibrillation: a major risk indicator after a myocardial infarction complicated by heart failure or left ventricular dysfunction. Development of a Basic Risk Score for Incident Atrial Fibrillation in a Japanese General Population　- The Suita Study. A clinical risk score for atrial fibrillation in a biracial prospective cohort (from the Atherosclerosis Risk in Communities [ARIC] study). EARLY: a pilot study on early diagnosis of atrial fibrillation in a primary healthcare centre. Atrial Fibrillation Is a Major Risk Factor for Stroke, Especially in Women: The Jichi Medical School Cohort Study Atrial fibrillation and the risk of myocardial infarction. Obesity, Physical Activity, and Their Interaction in Incident Atrial Fibrillation in Postmenopausal Women Atrial fibrillation incidence and risk factors in relation to race-ethnicity and the population attributable fraction of atrial fibrillation risk factors: the Multi-Ethnic Study of Atherosclerosis.
Atrial  fibrillation ( AF ) is a common arrhythmia in elderly persons and a common cause of embolic stroke . Most studies of the prevalence and correlates of AF have used selected , hospital-based population s. The Cardiovascular Health Study is a population -based , longitudinal study of risk factors for coronary artery disease and stroke in 5,201 men and women aged > or = 65 years .  AF  was diagnosed in 4.8 % of women and in 6.2 % of men at the baseline examination , and prevalence was strongly associated with advanced age in women . Prevalence of AF  was 9.1 % in men and women with clinical cardiovascular disease , 4.6 % in patients with evidence of sub clinical but no clinical cardiovascular disease , and only 1.6 % in subjects with neither clinical nor sub clinical cardiovascular disease . A history of congestive heart failure , valvular heart disease and stroke , echocardiographic evidence of enlarged left atrial dimension , abnormal mitral or aortic valve function , treated systemic hypertension , and advanced age were independently associated with the prevalence of AF .  The low prevalence of AF in the absence of clinical and sub clinical cardiovascular disease calls into question the existence and clinical usefulness of the concept of so-called " lone atrial fibrillation " in the elderly The Canadian Cardiovascular Society ( CCS ) published the complete set of 2010 Atrial Fibrillation ( AF ) Guidelines in the January , 2011 issue of the Canadian Journal of Cardiology . During its deliberations , the CCS Guidelines Committee engaged to a timely review of future evidence , with periodic composition of focused up date s to address clinical ly important advances . In 2011 , results were published from 3 pivotal AF trials : the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonist for Prevention of Stroke and Embolism Trial in Atrial Fibrillation ( ROCKET-AF ) , the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation ( ARISTOTLE ) study , and the Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of St and ard Therapy ( PALLAS ) , comparing dronedarone with placebo in patients with permanent AF and additional cardiovascular disease risk-factor burden . Each of these large r and omized trials provided clear results with major implication s for AF management . Other important evidence that has emerged since the 2010 Guidelines includes findings about prediction instruments for AF-associated stroke and bleeding risk , stroke risk in paroxysmal-AF patients , risk-benefit considerations related to oral anticoagulation in patients with chronic kidney disease , and risk/benefit considerations in the use of antiplatelet agents , alone and in combination with each other or with oral anticoagulants , in AF patients . The Guidelines Committee judged that this extensive and important new evidence required focused updating of the 2010 Guidelines with respect to stroke prevention and rate/rhythm control . This report presents the details of the new recommendations , along with the background and rationale BACKGROUND AND PURPOSE To prevent stroke , strategies for atrial fibrillation ( AF ) prevention and an early detection of AF by electrocardiogram are essential . However , only a limited prospect i ve studies have examined the risk factors for AF , even in blood pressure ( BP ) and body mass index ( BMI ) , which are not clear among general population s. We investigated the impacts of BP and BMI on the risk of incident AF in a general population . METHODS A total of 6,906 participants ( 30 - 84 years ) in the Suita Study were prospect ively followed up for incident AF . Participants were diagnosed with AF if  AF or atrial flutter  was present on an electrocardiogram  from a routine health examination  ( every 2 years ) or if AF was indicated as a present illness from health examinations and /or medical records during follow-up . Adjusted Cox proportional hazard ratios ( HRs ) were calculated . RESULTS During the 12.8-year follow-up , 253 incident AF events occurred . Compared with the systolic BP ( SBP ) < 120 mm Hg and normal-weight , the adjusted HRs ( 95 % confidence intervals ; CIs ) of incident AF in the systolic hypertension and the overweight ( BMI ≥ 25kg/m(2 ) ) groups were 1.74 ( 1.22 - 2.49 ) and 1.35 ( 1.01 - 1.80 ) , respectively . Compared with SBP < 120 mm Hg and normal weight , the adjusted HRs ( 95 % CIs ) of incident AF in the SBP = 120 - 139 mm Hg with overweight and the systolic hypertension with normal or overweight were 1.72 ( 1.01 - 2.91 ) , 1.66 ( 1.10 - 2.50 ) , and 2.31 ( 1.47 - 3.65 ) , respectively ( P for interaction = 0.04 ) . CONCLUSIONS Systolic prehypertension and overweight are associated with incident AF  in Japanese population . The association between SBP and AF may be evident by overweight Atrial fibrillation ( AF ) and obesity have reached epidemic proportions . The impact of obesity on clinical outcomes in patients with established AF is unknown . We analyzed 2,492 patients in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management ( AFFIRM ) study .  Body mass index ( BMI ) was evaluated as a categorical variable ( normal 18.5 to < 25 kg/m(2 ) , overweight 25 to < 30 kg/m(2 ) , obese > or=30 kg/m(2 ) ) . Rate of death from any cause was higher in the normal BMI group ( 5.8 per 100 patient-years ) than in the overweight and obese groups ( 3.9 and 3.7 , respectively ) . Cardiovascular death rate was highest in the normal BMI group ( 3.1 per 100 patient-years ) , lowest in the overweight group ( 1.5 per 100 patient-years ) , and intermediate in the obese group ( 2.1 per 100 patient-years ) . After adjustment for baseline factors , differences in risk of death from any cause were no longer significant . However , overweight remained associated with a lower risk of cardiovascular death ( hazard ratio 0.47 , p = 0.002 ) . Obese patients were more likely to have an uncontrolled heart rate at rest , but rhythm-control strategy success was similar across BMI categories . In each BMI category , risk of death from any cause was similar for patients r and omized to a rhythm- or rate-control strategy . In conclusion , in patients with established AF , overweight and obesity do not adversely affect overall survival . Obesity does not appear to affect the relative benefit of a rate- or rhythm-control strategy Objective Atrial fibrillation ( AF ) is the most common arrhythmia in women . Large studies evaluating key AF risk factors in older women are lacking . We aim ed to identify risk factors for AF  in postmenopausal women and measure population burden of modifiable risk factors . Design Prospect i ve observational study . Setting The Women 's Health Initiative ( WHI ) Observational Study . Patients 93 676 postmenopausal women were followed for an average of 9.8 years for cardiovascular outcomes . After exclusion of women with prevalent AF or incomplete data , 8252 of the remaining 81 892 women developed incident AF . Main outcome measures Incident AF was identified by WHI-ascertained hospitalisation records and diagnosis codes from Medicare cl aims . Multivariate Cox hazard regression analysis identified independent risk factors for incident AF . Results Age , hypertension , obesity , diabetes , myocardial infa rct ion and heart failure were independently associated with incident AF . Hypertension and overweight status accounted for 28.3 % and 12.1 % , respectively , of the population attributable risk . Hispanic and African – American participants had lower rates of incident AF ( HR 0.58 , 95 % CI 0.47 to 0.70 and HR 0.59 , 95 % CI 0.53 to 0.65 , respectively ) than Caucasians . Conclusions Caucasian ethnicity , traditional cardiovascular risk factors and peripheral arterial disease were independently associated with higher rates of incident AF  in postmenopausal women . Hypertension and overweight status accounted for a large proportion of population attributable risk . Measuring burden of modifiable AF risk factors in older women may help target interventions As previously reported , 1007 patients with chronic atrial fibrillation participated in the Copenhagen AFASAK study . Before inclusion to trial , they all had a physical examination , chest roentgenogram , and echocardiogram with determination of left atrial size . This study evaluated the importance of cardiovascular risk factors for development of thromboembolic complications . To exclude any treatment effects on occurrence of thromboembolic complications , we included only the 336 patients from the placebo group . Using Cox 's regression model , previous myocardial infa rct ion was a significant risk factor for development of thromboembolic complications . Age , gender , heart failure , chest pain , hypertensive heart disease , diabetes , systolic and diastolic blood pressure , smoking , relative heart volume , and left atrial size were all without statistical importance Background Atrial fibrillation ( AF ) has been recognised as an important independent risk factor for thromboembolic disease , particularly stroke for which it provides a five-fold increase in risk . This study aim ed to determine the baseline prevalence and the incidence of AF based on a variety of screening strategies and in doing so to evaluate the incremental cost-effectiveness of different screening strategies , including targeted or whole population screening , compared with routine clinical practice , for detection of AF in people aged 65 and over . The value of clinical assessment and echocardiography as additional methods of risk stratification for thromboembolic disease in patients with AF were also evaluated . Methods The study design was a multi-centre r and omised controlled trial with a study population of patients aged 65 and over from 50 General Practice s in the West Midl and s. These purpose fully selected general practice s were r and omly allocated to 25 intervention practice s and 25 control practice s. GPs and practice nurses within the intervention practice s received education on the importance of AF detection and ECG interpretation . Patients in the intervention practice s were r and omly allocated to systematic ( n = 5000 ) or opportunistic screening ( n = 5000 ) . Prospect i ve identification of pre-existing risk factors for AF within the screened population enabled comparison between high risk targeted screening and total population screening . AF detection rates in systematic ally screened and opportunistically screened population s in the intervention practice s were compared to AF detection rate in 5,000 patients in the control practice The validity of atrial fibrillation ( AF ) diagnoses in national registers for use as endpoints in prospect i ve studies has not been evaluated . We studied the validity of AF diagnoses in Swedish national hospital discharge and cause of death registers and the occurrence of and risk factors for AF in a middle-aged Swedish population using these registers . Our study included the 30,447 individuals ( age 44–73 ) who attended baseline visits in 1991–1996 of the Malmö Diet and Cancer study . Individuals with a first AF diagnosis were identified by record linkage with national registers . A subset of cases was r and omly selected for validation by examination of electrocardiograms and patient records . Electrocardiograms were available in 98 % of the validation sample ( 95 % definitive AF , 3 % no AF ) . The 2 % with ECGs unavailable had probable AF . Baseline AF prevalence was 1.3 % , higher in men and increased with age . During 11.2 years of follow-up 1430 first AF diagnoses occurred . Risk factors were age , hypertension , BMI , diabetes , history of heart failure , history of myocardial infa rct ion and , in men but not women , current smoking . The strongest risk factors were history of heart failure ( hazard ratio men 4.5 , women 8.7 ) and myocardial infa rct ion ( hazard ratio men 2.0 , women 1.8 ) . The largest population attributable risks were observed for hypertension ( men 38 % , women 34 % ) and obesity ( men 11 % , women 10 % ) . In conclusion , case misclassification of AF in national registers is small , indicating feasibility of use in prospect i ve studies . Hypertension and obesity account for large portions of population risk in middle-aged individuals with low prevalence of manifest cardiac disease Prospect i ve data from Busselton , Western Australia , collected during triennial surveys from 1966 - 81 with follow-up of subjects to 1983 , showed that atrial fibrillation ( AF ) was frequent in elderly people and associated with increased mortality . Of 1770 people aged over 60 years , 40 were in atrial fibrillation when first seen and a further 47 developed it during follow-up . Atrial fibrillation was positively associated with angina , history of a myocardial infa rct ion and left bundle branch block . Relative mortality in those with atrial fibrillation compared with those without it , was 1.92 for all causes , 1.82 for death from cardiovascular causes ( excluding stroke ) and 3.78 for deaths from stroke , after adjustment by proportional hazards regression for confounding effects of age , sex , history of a myocardial infa rct ion , an abnormal electrocardiogram , angina , cholesterol level systolic blood pressure and Quetelet 's Index ( weight/height2 ) . The excess relative mortality declined with increasing age for both women and men . This raised relative mortality remained constant with time from the first detection of AF for all causes and cardiovascular causes but appeared to increase with time from detection for stroke death . The risk of death from stroke was greatest in the younger women . The observed risk of death from stroke in patients with AF suggests that anticoagulant use should be considered in selected patients AIMS To characterize the relationship between known and newly diagnosed atrial fibrillation ( AF ) and the risk of death and major cardiovascular ( CV ) events in patients with acute myocardial infa rct ion ( MI ) complicated by heart failure ( HF ) and /or left ventricular systolic dysfunction ( LVSD ) . METHODS The VALIANT trial enrolled 14,703 individuals with acute MI complicated by HF and /or LVSD .  AF was assessed at presentation and at r and omization ( median 4.9 days after symptom onset ) . Primary outcomes were risk of death and major CV events 3 years following acute MI . RESULTS A total of 1812 with current AF ( AF between presentation and r and omization ) , 339 patients with prior AF ( history of AF without current AF ) , and 12,509 without AF were enrolled . Patients with AF were older ; had more prior HF , angina , and MI , and received beta-blockers and thrombolytics less often than those without AF . Three-year mortality estimates were 20 % in those without AF , 37 % with current AF , and 38 % with prior AF . Compared with patients without AF , the multivariable adjusted HR of death was 1.25 ( 1.03 - 1.52 ; p=0.03 ) for prior AF and 1.32 ( 1.20 - 1.45 ; p<0.0001 ) for current AF . HR for major CV events was 1.15 ( 0.98 - 1.35 ; p=0.08 ) and 1.21 ( 1.12 - 1.31 ; p<0.0001 ) . CONCLUSION AF is associated with greater long-term mortality and adverse CV events with acute MI complicated by HF or LVSD BACKGROUND An atrial fibrillation ( AF ) risk score for a non-Western general population has not been established . Methods and Results : A total of 6,898 participants ( 30 - 79 years old ) initially free of AF have been prospect ively followed for incident AF since 1989 . AF was diagnosed when AF or atrial flutter was present on ECG at a biannual health examination ; was indicated as a current illness ; or was in the medical records during follow-up . Cox proportional hazard ratios were analyzed after adjusting for cardiovascular risk factors at baseline . During the 95,180 person-years of follow-up , 311 incident AF events occurred . We developed a scoring system for each risk factor as follows : 0/-5 , 3/0 , 7/5 , and 9/9 points for men/women in their 30 s-40 s , 50 s , 60 s , and 70 s , respectively ; 2 points for systolic hypertension , overweight , excessive drinking , or coronary artery disease ; 1 point for current smoking ; -1 point for moderate non-high-density lipoprotein-cholesterol ; 4 points for arrhythmia ; and 8 , 6 , and 2 points for subjects with cardiac murmur in their 30 s-40 s , 50 s , and 60 s , respectively ( C-statistic 0.749 ; 95 % confidence interval , 0.724 - 0.774 ) . Individuals with score ≤2 , 10 - 11 , or ≥16 points had , respectively , ≤1 % , 9 % , and 27 % observed probability of developing AF in 10 years . CONCLUSIONS We developed a 10-year risk score for incident AF using traditional risk factors that are easily obtained in routine outpatient clinics/health examinations without ECG A risk score for atrial fibrillation ( AF ) has been developed by the Framingham Heart Study ; however , the applicability of this risk score , derived using data from white patients , to predict new-onset AF in nonwhites is uncertain . Therefore , we developed a 10-year risk score for new-onset AF  from risk factors commonly measured in clinical practice using 14,546 subjects from the Atherosclerosis Risk In Communities ( ARIC ) study , a prospect i ve community-based cohort of blacks and whites in the United States . During 10 years of follow-up , 515 incident AF events occurred . The following variables were included in the AF risk  score  : age , race , height , smoking status , systolic blood pressure , hypertension medication use , precordial murmur , left ventricular hypertrophy , left atrial enlargement , diabetes , coronary heart disease , and heart failure . The area under the receiver operating characteristics curve ( AUC ) of a Cox regression model that included the previous variables was 0.78 , suggesting moderately good discrimination . The point-based score developed from the coefficients in the Cox model had an AUC of 0.76 . This clinical risk score for AF in the Atherosclerosis Risk In Communities cohort compared favorably with the Framingham Heart Study 's AF ( AUC 0.68 ) , coronary heart disease ( CHD ) ( AUC 0.63 ) , and hard CHD ( AUC 0.59 ) risk scores and the Atherosclerosis Risk In Communities CHD risk score ( AUC 0.58 ) . In conclusion , we have developed a risk score for AF and have shown that the different pathophysiologies of AF and CHD limit the usefulness of a CHD risk score in identifying subjects at greater risk of AF AIM Atrial fibrillation ( AF ) is associated with high morbidity and mortality . Early diagnosis is likely to improve therapy and prognosis . The study objective was to evaluate the usefulness of a programme for early diagnosis of AF in patients from an urban primary care centre . METHODS AND RESULTS Participants were recruited from a r and omized sample of patients not diagnosed with AF but having relevant risk factors : age ≥ 65 years , ischaemic and /or valvular heart disease , congestive heart failure , hypertension , and /or diabetes . Patients were r and omly assigned to the intervention group ( IG ) or control group ( CG ) . The intervention included ( i ) initial visit with clinical history , electrocardiogram , and instruction about pulse palpation and warning signs and ( ii ) electrocardiogram every 6 months during a 2-year follow-up . The main endpoint of the study was the proportion of new cases diagnosed at 6 months . Secondary endpoints were number of new AF diagnoses and complications associated with the arrhythmia in both groups . A total of 928 patients were included ( 463 IG and 465 CG ) . At 6 months , AF was diagnosed in 8 IG patients and 1 CG patient ( 1.7 vs. 0.2 % , respectively , P = 0.018 ) . After 2 years of follow-up , 11 IG patients and 6 CG patients had newly diagnosed AF ( 2.5 vs. 1.3 % , respectively , P = 0.132 ) . Time to first diagnosis of AF was shorter in IG patients [ median ( inter-quartile range ) : 7 ( 192 ) days vs. 227 ( 188.5 ) days in CG , P = 0.029 ] . CONCLUSION The simple screening proposed could be useful for the early detection of AF in primary care Background Only a few population -based cohort studies have investigated the impact of  atrial fibrillation ( AF ) on stroke in Japan . Methods A total of 10 929 participants ( 4147 men and 6782 women ) were included in this population -based prospect i ve cohort study . Baseline data , including  electrocardiograms ( ECGs )  to ascertain AF status , were obtained from April 1992 through July 1995 in 12 areas in Japan . Cox proportional hazards models were used to analyze the association of AF with stroke . Results A total of 54 participants had AF ( 0.49 % ) . The mean follow-up period was 10.7 years , during which 405 strokes were identified ; 12 of these occurred in participants with AF . The crude incidence of stroke in participants with and without AF was 14.9 and 4.5 per 1000 person-years in men , respectively , and 39.3 and 2.7 per 1000 person-years in women . After adjusting for geographical area , sex , age , smoking status , drinking status , obesity , hypertension , dyslipidemia , and diabetes mellitus , the hazard ratios ( 95 % confidence interval ) of AF in all participants and in male and female participants were 4.11 ( 2.28–7.41 ) , 2.12 ( 0.77–5.84 ) , and 10.6 ( 5.01–22.4 ) , respectively . The population attributable fraction ( PAF ) of stroke caused by AF was 2.2 % ; the PAFs were 1.0 % and 3.6 % in men and women , respectively . Conclusions The present Japanese population -based prospect i ve cohort study showed that AF is a major risk factor for stroke , especially in women IMPORTANCE Myocardial infa rct ion ( MI ) is an established risk factor for  atrial fibrillation ( AF ) .  However , the extent to which AF is a risk factor for MI has not been investigated . OBJECTIVE To examine the risk of incident MI associated with AF . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve cohort of 23,928 participants residing in the continental United States and without coronary heart disease at baseline were enrolled from the Reasons for Geographic and Racial Differences in Stroke ( REGARDS ) cohort between 2003 and 2007 , with follow-up through December 2009 . MAIN OUTCOMES AND MEASURES Expert-adjudicated total MI events ( fatal and nonfatal ) . RESULTS Over 6.9 years of follow-up ( median 4.5 years ) , 648 incident MI events occurred . In a sociodemographic-adjusted model , AF was associated with about 2-fold increased risk of MI ( hazard ratio [ HR ] , 1.96 [ 95 % CI , 1.52 - 2.52 ] ) . This association remained significant ( HR , 1.70 [ 95 % CI , 1.26 - 2.30 ] ) after further adjustment for total cholesterol , high-density lipoprotein cholesterol , smoking status , systolic blood pressure , blood pressure-lowering drugs , body mass index , diabetes , warfarin use , aspirin use , statin use , history of stroke and vascular disease , estimated glomerular filtration rate , albumin to creatinine ratio , and C-reactive protein level . In subgroup analysis , the risk of MI associated with AF was significantly higher in women ( HR , 2.16 [ 95 % CI , 1.41 - 3.31 ] ) than in men ( HR , 1.39 [ 95 % CI , 0.91 - 2.10 ] ) and in blacks ( HR , 2.53 [ 95 % CI , 1.67 - 3.86 ] ) than in whites ( HR , 1.26 [ 95 % CI , 0.83 - 1.93 ] ) ; for interactions , P = .03 and P = .02 , respectively . On the other h and , there were no significant differences in the risk of MI associated with AF in older ( ≥75 years ) vs younger ( < 75 years ) participants ( HR , 2.00 [ 95 % CI , 1.16 - 3.35 ] and HR , 1.60 [ 95 % CI , 1.11 - 2.30 ] , respectively ) ; for interaction , P = .44 . CONCLUSIONS AND RELEVANCE AF is independently associated with an increased risk of incident MI , especially in women and blacks . These findings add to the growing concerns of the seriousness of AF as a public health burden : in addition to being a well-known risk factor for stroke , AF is also associated with increased risk of MI Background Atrial fibrillation ( AF ) is the most common cardiac arrhythmia and is associated with increased risk of stroke and death . Obesity is an independent risk factor for AF , but modifiers of this risk are not well known . We studied the roles of obesity , physical activity , and their interaction in conferring risk of incident AF . Methods and Results The Women 's Health Initiative ( WHI ) Observational Study was a prospect i ve observational study of 93 676 postmenopausal women followed for an average of 11.5 years .  Incident AF was identified using WHI‐ascertained hospitalization records and diagnostic codes from Medicare cl aims . A multivariate Cox 's hazard regression model adjusted for demographic and clinical risk factors was used to evaluate the interaction between obesity and  physical activity and its association with incident AF . After exclusion of women with prevalent AF , incomplete data , or underweight body mass index ( BMI ) , 9792 of the remaining 81 317 women developed AF . Women were , on average , 63.4 years old , 7.8 % were African American , and 3.6 % were Hispanic .  Increased BMI ( hazard ratio [ HR ] , 1.12 per 5‐kg/m2 increase ; 95 % confidence interval [ CI ] , 1.10 to 1.14 ) and  reduced physical activity  ( > 9 vs. 0 metabolic equivalent task hours per week ; HR , 0.90 ; 95 % CI , 0.85 to 0.96 ) were independently associated with higher rates of AF after multivariate adjustment . Higher  levels of physical activity reduced the AF risk conferred by obesity ( interaction P=0.033 ) . Conclusions  Greater physical activity is associated with lower rates of incident AF and modifies the association between obesity and incident AF PURPOSE We studied incident atrial fibrillation ( AF ) in the prospect i ve community-based Multi-Ethnic Study of Atherosclerosis ( MESA ) . Reportedly , non-Hispanic blacks ( NHBs ) have a lower AF burden compared with their non-Hispanic white ( NHW ) counterparts . Information on the epidemiology of AF in Hispanic and Asian population s is much more limited . METHODS We excluded participants with a history of AF at enrollment . A total of 6721 MESA participants were monitored for the first AF event ascertained according to hospital discharge International Classification of Diseases , Ninth Revision , codes . Age- and sex-adjusted incidence rates ( IRs ) of AF were calculated per 1000 person-years of observation . IR ratios were calculated using NHWs as the reference group . Age- and sex-adjusted population attributable fractions ( PAFs ) of established modifiable AF risk factors were ascertained . RESULTS In the MESA cohort , 47.2 % was male ; at baseline , 25.7 % had hypertension ; 12.5 % had diabetes . Three hundred five incident hospitalized AF events occurred over a mean follow-up of 7.3 years . Age- and sex-adjusted IRs and IR ratios showed that overall AF incidence was significantly lower among Hispanics , NHBs and Chinese compared with NHWs ( all P < .001 ) . Among participants 65 years of age or greater , Hispanics , Chinese , and blacks had significantly lower AF incidence than NHWs ( all P ≤ .01 ) , but IRs were similar among participants under age 65 years . The PAF for smoking was 27 % among NHBs but lower among other race-ethnic groups . Among NHWs , the PAF for hypertension was 22.2 % , but this was higher among NHBs ( 33.1 % ) , Chinese ( 46.3 % ) , and Hispanics ( 43.9 % ) . CONCLUSIONS Overall , the incidence of hospitalized AF was significantly lower in Hispanics , NHBs , and Chinese than in NHWs . A larger proportion of AF events appear to be attributable to hypertension among nonwhite population s compared with NHWs
A systematic evaluation of the available evidence suggests similarities as well as important differences in the risk factors for incidence of AF as compared with other cardiovascular diseases , which has implication s for the primary prevention strategies for atrial fibrillation
Established primary prevention strategies of cardiovascular diseases are based on underst and ing of risk factors , but whether the same risk factors are associated with  atrial fibrillation ( AF )  remains unclear .