Abstract
BACKGROUND: There is limited evidence regarding the significance of the combination or cumulative burden of waist circumference (WC) with body mass index (BMI) to predict future atrial fibrillation (AF) risks. OBJECTIVES: The authors investigated the impact of the cumulative burden of BMI and WC and their combination on the incident AF risk. METHODS: We included subjects 20 years of age and older who underwent 4 consecutive national health check-ups annually (between 2009 and 2013), excluding those with previous AF. The 4-year cumulative burden of BMI and WC was categorized as a burden-score, derived from the sum of the BMI and WC scores from yearly check-ups. Incident nonvalvular AFs were identified using claims data from the Korean National Health Insurance Service (median 5.2 years of follow-up). RESULTS: A total of 3,726,172 subjects (age 44.5 ± 11.1 years, men 69.5% [n = 2,590,986 of 3,726,172]) were analyzed. Compared to a zero burden score, maximum burden score of BMI increased AF risk with an incidence rate of 1.56 of 1,000 person-years (adjusted HR: 1.32; 95% CI: 1.27-1.37). The risk of AF was markedly increased for those with the highest WC burden-score (incidence rate: 2.26/1,000 person-years; adjusted HR = 1.52; 95% CI: 1.46-1.58). Different BMI burdens within the same WC burden group did not affect the risk of AF, whereas increasing WC burden within each BMI burden group significantly elevated the AF risk. AF risk was particularly high in individuals with a moderate BMI burden with a high WC burden. CONCLUSIONS: The cumulative burden of WC was a more potent indicator of AF risk than either a single BMI measurement or the overall BMI burden.