Front Cardiovasc Med. 2022;9:885016.

Clustering of Unhealthy Lifestyle and the Risk of Adverse Events in Patients With Atrial Fibrillation.

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제1저자 이소령 · 교신저자 최의근

PMID 35859588 PMC9289142 DOI 10.3389/fcvm.2022.885016 IF 3 순환기내과

소속 (6)

Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Statistics and Actuarial Science, Soongsil University, Seoul, South Korea.
Liverpool Center for Cardiovascular Science, University of Liverpool and Liverpool Chest and Heart Hospital, Liverpool, United Kingdom.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

Abstract

BACKGROUND Little is known regarding the risk of clinical outcomes depending on the clustering of lifestyle behaviors after atrial fibrillation (AF) diagnosis. This study evaluated the association between a cluster of healthy lifestyle behaviors and the risk of adverse outcomes in patients with AF.

METHODS Using the Korean National Insurance Service database, patients who were newly diagnosed with AF between 2009 and 2016 were included. A healthy lifestyle behavior score (HLS) was calculated by assigning 1 point each for non-current smoking, for non-drinking, and for performing regular exercise from the self-reported questionnaire in health examinations. The primary outcome was defined as major adverse cardiovascular event (MACE), including ischemic stroke, myocardial infarction, and hospitalization for heart failure.

RESULTS A total of 208,662 patients were included; 7.1% in HLS 0, 22.7% in HLS 1, 58.6% in HLS 2, and 11.6% in HLS 3 groups. Patients with HLS 1, 2, and 3 were associated with a lower risk of MACE than those with HLS 0 (adjusted hazard ratio [95% confidence interval (CI)]: 0.788 [0.762-0.855], 0.654 [0.604-0.708], and 0.579 [0.527-0.636], respectively). After propensity score weighting, consistent results were observed. The risk reduction of healthy lifestyle combinations was consistently observed in various subgroups, regardless of the CHA₂DS₂-VASc score and oral anticoagulant use.

CONCLUSION Increased number of healthy lifestyle behaviors was significantly associated with lower MACE risk in patients with new-onset AF. These findings support the promotion of a healthy lifestyle to reduce the risk of adverse events in patients with AF.

Keywords

atrial fibrillationheart failurelifestylemyocardial infarctionstroke

Figures

**FIGURE 1** Study flow. AF, atrial fibrillation.

**FIGURE 2** The risk of primary and secondary outcomes according to healthy lifestyle behavior scores: a multivariable-adjusted Cox analysis. Model 3 was adjusted for age, sex, hypertension, diabetes mellitus, dyslipidemia, heart failure, prior ischemic stroke, prior myocardial infarction, peripheral artery disease, chronic obstructive pulmonary disease, cancer, chronic kidney disease, CHA₂DS₂-VASc score, use of oral anticoagulant, antiplatelet agent, and statin, BMI, and low income. Major adverse cardiovascular events was defined as the composite outcomes of ischemic stroke, myocardial infarction, and hospitalization for heart failure. BMI, body mass index; CI, confidence interval; HR, hazard ratio.

**FIGURE 3** Weighted Kaplan–Meier curves for major adverse cardiovascular events.

**FIGURE 4** The risk or primary and secondary outcomes according to healthy lifestyle behavior scores: an IPTW analysis. Major adverse cardiovascular events was defined as the composite outcomes of ischemic stroke, myocardial infarction, and hospitalization for heart failure. CI, confidence interval; HR, hazard ratio; IPTW, inverse probability of treatment weighting; IR, incidence rate; PY, person-years.

그림 출처: PubMed Central 공개 논문 (PMC9289142)

Conflict of interest statement

E-KC: research grants or speaking fees from Bayer, BMS/Pfizer, Biosense Webster, Chong Kun Dang, Daiichi-Sankyo, Dreamtech Co., Ltd., Medtronic, Samjinpharm, Sanofi-Aventis, Seers Technology, Skylabs, and Yuhan. GL: consultant and speaker for BMS/Pfizer, Boehringer Ingelheim and Daiichi-Sankyo, but no fees are received personally; no other relationships or activities that could appear to have influenced the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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