Current Knowledge and Future Directions in Epidemiology and Genomics
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Atrial fibrillation (AF) is of public health importance and profoundly increases morbidity, mortality, and health-related expenditures. Morbidities include the increased risks of cardiovascular outcomes such as heart failure and stroke and the deleterious effects on quality of life (QOL), functional status, and cognition. The clinical epidemiology of AF, its risk factors, and its outcomes have been investigated extensively. Genetic advances over the last decade have facilitated the identification of mutations and common polymorphisms associated with AF. Metabolomics, proteomics, and other “omics” technologies have only recently been applied to the study of AF, and have not yet been systematically investigated. Systems biology approaches, although still in their infancy, offer the promise of providing novel insights into pathways influencing AF risk. In the present review, we address the current state of the epidemiology and genomics of AF. We seek to emphasize how epidemiology and omic advances will contribute to a systems biology approach that will help to unravel the pathogenesis, risk stratification, and novel targets for AF therapies. Our purpose is to articulate questions and challenges that hinge on integrating novel scientific advances in the epidemiology and genomics of AF. As a reference, we have provided a glossary in the online-only Data Supplement.
AF: Increasing Burden and Burgeoning Costs
In the United States and Western Europe, the aging of the population and the accompanying rise in the prevalence of AF have magnified its toll on morbidity and healthcare costs. The estimated US prevalence of 2.7 to 6.1 million is expected to increase to 5.6 to 12.1 million by the middle of this century (Figure 1).1,2 Cumulative lifetime risk estimates demonstrate that AF is largely a disease of aging. In US and European community-based cohort studies, the lifetime risk of AF is 22% to …