Abstract
BACKGROUND: Atrial fibrillation and flutter (AF/AFL) are increasingly recognized as obesity-related cardiovascular conditions. However, the global burden of AF/AFL attributable to high body-mass index (BMI) has not been comprehensively quantified. METHODS: Using data from the Global Burden of Disease Study 2021, we assessed trends in high BMI-attributable AF/AFL burden from 1990 to 2021 across 26 global regions. We analyzed age-standardized disability-adjusted life years (DALYs) and deaths by sex, region, and Socio-demographic Index (SDI). Joinpoint regression and decomposition methods were applied to assess trend inflections and component contributions, while ARIMA models forecasted burden through 2040. RESULTS: From 1990 to 2021, global age-standardized DALY and death rates attributable to high BMI rose by 67.7% and 66.7%, with EAPCs of 1.64 (95% CI: 1.60-1.69) and 1.65 (95% CI: 1.59-1.70), respectively. In 2021, high BMI contributed to 333,778 DALYs and 1,034 deaths globally. East Asia and South Asia exhibited the fastest growth in burden, with death-related AAPCs of 7.76% and 7.72%, respectively. Decomposition analysis indicated that population aging and growth were the main drivers of burden increases. Forecasts project DALYs to reach 64.5 million and deaths 2,036 by 2040. CONCLUSIONS: The AF/AFL burden attributable to high BMI has escalated globally, particularly in low- and middle-SDI regions. Without targeted strategies to reduce obesity, this upward trend is likely to continue, underscoring the need for integrated arrhythmia prevention within global obesity control frameworks.