Abstract
BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia around the world with an increased risk of a broad spectrum of adverse comorbidities and death. Whether cardiovascular health (CVH) is associated with AF development remains unclear. METHODS: 238,420 participants without cardiovascular disease at baseline were selected from the UK Biobank study cohort from 2006 to 2010. CVH was defined based on "Life's Essential 8″ scores. Sex-specific multi-state Markov and flexible parametric survival models were used to estimate the hazard ratio (HR) and 95 % confidence intervals (95 % CI) for the associations of CVH with incident AF and its prognosis. RESULTS: In fully-adjusted models, CVH is significantly associated with a reduced risk of incident AF among both men and women, after accounting for the potential impact of death. Among AF patients without other evaluated diseases, a higher CVH score was generally linked with a reduced risk of death in both sexes. Among AF patients with incident prognostic diseases, only CVH associated with death following heart failure (0.78, 0.63-0.97) was observed among men, whereas CVH was significantly associated with death following coronary heart disease (0.80, 0.69-0.93), stroke (0.73, 0.61-0.89) and dementia (0.79, 0.71-1.03) among women. CONCLUSIONS: We found significant associations between CVH and the risk reduction of incident AF and its prognostic outcomes, with these associations being more pronounced among women. Findings suggest a potential of screening CVH for both primary prevention of new-onset AF and the secondary prevention to improve AF prognosis.