Refining the Risk for Atrial Fibrillation

You can’t prevent what you can’t predictu003e u003e –K.M. Mac AulayAtrial fibrillation (AF) is a global public health problem characterized by dramatically increasing prevalence, significantly associated morbidity and mortality, and ominously spiraling healthcare costs. Thus, the lifetime risk for AF in individuals over the age of 40 in the United States is ≈1 in 4 and the risk of stroke, heart failure, and death is increased in affected individuals.1–5 Although currently estimated to be present in ≈2 million persons, it is expected that as many as 12 million people will have AF by 2050.6 Not surprisingly, AF is responsible for significant US healthcare costs, which are estimated to exceed 6 billion dollars annually.7 Accordingly, identifying the risk factors for the development of AF and strategies to reduce risk and, thereby prevent AF is a high priority of the American Heart Association.8See Article by Russo et al The established modifiable risk factors for AF include hypertension, diabetes mellitus, previous cardiovascular disease, obesity, and cigarette smoking.9 However, after considering these risk factors, considerable residual risk remains. In the Framingham cohort, hypertension, prevalent heart disease, diabetes mellitus, and cigarette smoking accounted for 44% of the risk in men and 58% of the risk in women.10 In the Atherosclerosis Risk in Communities (ARIC) study, 57% of incident AF cases during a 17-year follow-up could be explained by having at least 1 borderline or elevated risk factor (hypertension, obesity, diabetes mellitus, cigarette smoking, and previous heart disease); the most important contributor was hypertension, which accounted for approximately a quarter of the AF burden.11A heritable component undoubtedly accounts for some of the residual risk. …