Combined impact of healthy lifestyle factors on risk of atrial fibrillation: Prospective study in men and women

Background: The combined impact of multiple lifestyle factors on risk of atrial fibrillation (AF) remains unclear. We investigated the joint association of four modifiable lifestyle factors on incidence of AF in a prospective study of men and women. Methods: The study cohort comprised 39 300 men in the Cohort of Swedish Men and 33 090 women in the Swedish Mammography Cohort who were 45-83 years of age and free from atrial fibrillation at baseline. Healthy lifestyle was defined as body mass index <25 kg/m(2), regular exercise for >= 20 min/day, no or light-to-moderate alcohol consumption (<= 2 drinks/day for men and <= 1 drink/day for women), and not smoking. Incident AF cases were identified through linkage with the Swedish National Inpatient Register. Results: During a mean follow-up of 10.9 years, AF occurred in 4028 men and 2539 women. Compared with men and women with no healthy lifestyle factors, the multivariable relative risks (95% confidence interval) of AF were 0.83 (0.65-1.07) for one, 0.74 (0.58-0.94) for two, 0.62 (0.49-0.79) for three, and 0.50 (0.39-0.64) for four healthy lifestyle factors (P for trend <0.0001). The inverse association was similar in men and women. Conclusions: Four healthy lifestyle factors combined were associated with a halving of the risk of AF. (C) 2015 Elsevier Ireland Ltd. All rights reserved.