Prevalence of atrial fibrillation and cardiovascular risk factors in a 63-65 years old general population cohort: the Akershus Cardiac Examination (ACE) 1950 Study

Abstract

Objectives: To investigate the sex-specific prevalence of atrial fibrillation (AF), including subclinical AF found by screening in a general population aged 63-65 years. The prevalence of cardiovascular risk factors and their association with AF will also be investigated.

Design: Cross-sectional analysis of an observational, prospective, longitudinal, population-based cohort study.

Setting: General population in Akershus county, Norway.

Participants: Women and men born in 1950. We included 3706 of 5827 eligible individuals (63.6%); 48.8% were women.

Methods: All participants underwent extensive cardiovascular examinations, including 12-lead ECG. History of AF and other cardiovascular diseases were self-reported. Subsequent validation of all reported or detected AF diagnoses was performed.

Results: Mean age was 63.9±0.7 years. Prevalence of ECG-verified AF was 4.5% (women 2.4%, men 6.4%; p<0.001), including screen-detected AF in 0.3% (women 0.1%, men 0.6%; p<0.01). Hypertension was found in 62.0% (women 57.8%, men 66.0%; p<0.001). Overweight or obesity was found in 67.6% (women 59.8%, men 74.9%; p<0.001). By multivariate logistic regression, risk factors associated with AF were height (OR 1.67 per 10 cm; 95% CI 1.26 to 2.22; p<0.001), weight (OR 1.15 per 10 kg; 95% CI 1.01 to 1.30; p=0.03), hypertension (OR 2.49; 95% CI 1.61 to 3.86; p<0.001), heart failure (OR 3.51; 95% CI 1.71 to 7.24; p=0.001), reduced estimated glomerular filtration rate (OR 2.56; 95% CI 1.42 to 4.60; p<0.01) and at least one first-degree relative with AF (OR 2.32; 95% CI 1.63 to 3.31; p<0.001), whereas male sex was not significantly associated (OR 1.00; 95% CI 0.59 to 1.68; p=0.99).

Conclusion: In this cohort from the general population aged 63-65 years, we found a higher prevalence of known AF than previously reported below the age of 65 years. The additional yield of single time point screening for AF was low. Body size and comorbidity may explain most of the sex difference in AF prevalence at this age.

Trial registration number: NCT01555411; Results.

Keywords: atrial fibrillation; cardiac epidemiology; cardiovascular risk; obesity; prevalence; screening.

Conflict of interest statement

Competing interests: TB has (outside this work) received honoraria from Boehringer-Ingelheim, Bayer and Pfizer/Bristol-Myers Squibb. TO has (outside this work) received honoraria or research support from Abbott, AstraZeneca, Bayer, Novartis, Roche, Singulex and Thermo Fisher. HR has (outside this work) received honoraria or research support from Novartis, CardiNor AS and SpinChip Diagnostics. TO and HR are partners in a patent filed by the University of Oslo regarding the use of secretoneurin as a biomarker in patients with cardiovascular disease and patients with critical illness.

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

Flow chart of Akershus Cardiac Examination (ACE) 1950 study population and atrial fibrillation (AF) prevalence.