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Atrial Fibrillation Prevention: A Three-legged Stool 

April 18, 2017

By Payal Kohli, MD

As the incidence of atrial fibrillation continues to increase with the aging population, physicians are increasingly turning their attention to prevention strategies (in addition to treatment) to try to target the causes of AF in an attempt to manage overall disease burden.

A recent comprehensive and thorough review in the Journal of the American College of Cardiology highlights and categorizes prevention strategies into three major approaches, summarized below.

Table 1. Targeting Modifiable Lifestyle Risk Factors 

AF Modifiable Lifestye Factor 

Relationship to AF

Clinician Intervention 

Alcohol

>50% of US adults consume regularly

>21 drinks/wk increased AF by 39%.

>35 drinks/wk increased AF by 45% -90%.

In women, ≥2 drinks/day increased AF by 60%.

1.5 drinks/day increased AF by 25-46%.

Each drink/day increased AF by ~8%.

Counsel on avoiding unhealthy drinking and how even light to moderate drinking can increase AF risk.

Physical activity and cardiorespiratory fitness

Mixed data about relationship between exercise and AF.

Overall, vigorous exercise may be associated with ↑ AF; moderate activity appears protective.

Avoid sedentary lifestyle

Psychosocial

Anger, tension, hostility increase AF by 10-30%.

Panic disorder increased AF by 73%.

Job strain increased AF by 23%.

Stress triggered 54% of AF episodes.

Happiness had protective effect (88% lower risk of AF after adjustment).

Encourage positive emotions; treat depression, anxiety, stress promptly.

Smoking

Current or former smoking increased AF by 51%; risk decreases after quitting smoking.

Secondhand smoke associated with higher risk.

Up to 12% AF cases avoided with quitting smoking.

Offer smoking cessation interventions.

Healthy diet

Obesity, DM, dyslipidemia (see Table 2) associated with  

Counsel on healthy food choices and maintenance of healthy weight.

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