Atrial fibrillation incidence increased over three decades in a Dutch population, with age and sex-adjusted rates rising from 36 per 1,000 person-years in the 1990s to 52 in the 2010s, and men consistently showing higher rates than women. Hypertension accounted for the largest proportion of new cases in all groups.
Researchers examined participants from the Rotterdam Study across three periods: 1989 to 1993, 1997 to 2001, and 2009 to 2014. Each participant was followed for 5 years. Mean age was approximately 70 years across all periods. Men had incidence rates of 45, 35, and 66 per 1,000 person-years compared with 31, 23, and 44 for women in the three periods. The study was published in Heart.
Hypertension was the most consistent contributor, accounting for 36% of Atrial fibrillation (AF) cases in the 1990s, 35% in the 2000s, and 43% in the 2010s. Among women, hypertension explained nearly 60% of new AF cases in the 2010s.
Other comorbidities showed varied associations. Coronary heart disease was linked to AF risk in the 1990s and 2000s but not the 2010s. Heart failure showed significant association only in the 1990s, and stroke was associated with AF in the 2000s. Dyslipidemia showed an inverse relationship in the 2000s and 2010s. Obesity prevalence increased steadily, while diabetes prevalence also rose. Kidney dysfunction declined in later decades.
“Women are more likely to experience vascular stiffness and left ventricular diastolic dysfunction, which may increase susceptibility to develop AF. Additionally, women may be more prone to hypertension-induced atrial remodelling, such as exacerbating fibrotic changes in atrial tissue, left atrial enlargement or fibrosis,” wrote lead author Shuyue Yang, MD, Department of Epidemiology, Erasmus MC University Medical Center Rotterdam.
The Rotterdam Study is an ongoing population-based cohort in Ommoord, Rotterdam that began in 1989 with residents aged 55 years and older, with expansions in 2000 and 2006. AF was identified through electrocardiograms at baseline and follow-up visits, as well as continuous monitoring of general practice and hospital records. AF events during the dying process, following myocardial infarction, or after cardiac surgery were excluded.
Baseline comorbidities—including hypertension, dyslipidemia, diabetes, obesity, kidney dysfunction, coronary heart disease, heart failure, and stroke—were assessed using standardized definitions and measurements. These conditions were not updated during follow-up.
The researchers noted limitations. Comorbidities were measured only at baseline, which may underestimate their role over time. Excluding AF following myocardial infarction or cardiac surgery may omit relevant cases. Diagnostic sensitivity for AF may have changed across decades. Residual confounding cannot be excluded.
The researchers reported no competing interests. Study funders had no role in the design, conduct, or reporting of the research.
Source: Heart