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Original research
Association of cardiovascular health and incident atrial fibrillation in elderly population
  1. Jae-Hyuk Lee1,
  2. Pil-Sung Yang2,
  3. Hee Tae Yu1,
  4. Tae-Hoon Kim1,
  5. Eunsun Jang1,
  6. Jae-Sun Uhm1,
  7. Hui-Nam Pak1,
  8. Moon-Hyoung Lee1,
  9. Boyoung Joung1
  1. 1Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
  2. 2Department of Cardiology, Bundang CHA Medical Center, Seongnam, Gyeonggi-do, Korea (the Republic of)
  1. Correspondence to Professor Boyoung Joung, Cardiology, Severance Cardiovascular Hospital, Seodaemun-gu, Seoul 03722, Korea (the Republic of); cby6908{at}


Objective To evaluate whether baseline and changes in cardiovascular health (CVH) were related to incident atrial fibrillation (AF) risk in the elderly population.

Methods From the Korea National Health Insurance Service-Senior cohort, we included 208 598 participants without prior AF (median age: 70 (IQR 66–74) years; 90 916 (43.6%) men) who underwent national health check-ups between 1 January 2005 and 31 December 2012. Using the six metrics of the American Heart Association, participants were categorised as having low, moderate and high CVH.

Results Over a median follow-up of 7.2 years, 7818 cases of incident AF occurred. In multivariable analysis, moderate (HR: 0.90; 95% CI: 0.86 to 0.94) and high (HR: 0.81; 95% CI: 0.73 to 0.91) CVH status at baseline were associated with a lower risk of incident AF. However, in 109 695 participants with changes in CVH between the first and second check-ups, the direction of change in CVH scores showed no consistent association with future AF incidence. In newly diagnosed participants with AF, the incidence of the composite outcome (stroke, major bleeding and all-cause death) decreased with every 1-point increase in the baseline CVH score (HR: 0.94; 95% CI: 0.89 to 0.99).

Conclusions In the general elderly population, better baseline CVH metrics were associated with lower incident AF risk. In participants with newly diagnosed AF, better CVH was also associated with lower incidence of future composite outcomes. However, the direction of change in CVH status within 2 years showed an inconsistent influence on incident AF risk.

  • atrial fibrillation
  • risk factors

Data availability statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Data availability statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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  • J-HL and P-SY contributed equally.

  • Contributors J-HL, P-SY and BJ participated in designing the work and statistical analysis, and drafted the manuscript. EJ and P-SY contributed to data collection. All authors were involved in interpretation of the results and revision for reviewer’s comment. All authors read and approved the manuscript before its submission.

  • Funding This study was supported by a research grant from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare (HI15C1200, HC19C0130), and a CMB-Yuhan research grant of Yonsei University College of Medicine (6-2019-0124).

  • Competing interests BJ—speaker for Bayer, BMS/Pfizer, Medtronic and Daiichi-Sankyo, and research funds from Medtronic and Abbott. No fees are directly received personally.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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