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Circulation: Arrhythmia and Electrophysiology
Epicardial fat may have paracrine effects that contribute to cardiovascular pathophysiology. This meta-analysis of 352 275 individuals demonstrates a strong association of increasing epicardial fat with atrial fibrillation, more so than for measures of abnormal or overall adiposity. Studies to assess causality, mechanisms, and the impact of therapeutic strategies are warranted.
Associations of Epicardial, Abdominal, and Overall Adiposity with Atrial Fibrillation
Christopher X. Wong, MBBS, MSc, MPH, PhD, Michelle T. Sun, MBBS, Ayodele Odutayo, MD, MSc, Connor A. Emdin, HBSc, DPhil, Rajiv Mahajan, MBBS, PhD, Dennis H. Lau, MBBS, PhD, Rajeev K. Pathak, MBBS, PhD, Dennis T. Wong, BMed, PhD, Joseph B. Selvanayagam, MBBS, DPhil, Prashanthan Sanders, MBBS, PhD, Robert Clarke, MD, FRCP
Correspondence to: Christopher X. Wong, MBBS, MSc, MPH, PhD, Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Dr, Oxford, United Kingdom. E-mail firstname.lastname@example.org.
Background: Although adiposity is increasingly recognized as a risk factor for atrial fibrillation (AF), the importance of epicardial fat compared with other adipose tissue depots remains uncertain. We sought to characterize and compare the associations of AF with epicardial fat and measures of abdominal and overall adiposity.
Methods and Results: We conducted a meta-analysis of 63 observational studies including 352 275 individuals, comparing AF risk for 1-SD increases in epicardial fat, waist circumference, waist/hip ratio, and body mass index. A 1-SD higher epicardial fat volume was associated with a 2.6-fold higher odds of AF (odds ratio, 2.61; 95% confidence interval [CI], 1.89–3.60), 2.1-fold higher odds of paroxysmal AF (odds ratio, 2.14; 95% CI, 1.45–3.16) and, 5.4-fold higher odds of persistent AF (odds ratio, 5.43; 95% CI, 3.24–9.12) compared with sinus rhythm. Likewise, a 1-SD higher epicardial fat volume was associated with 2.2-fold higher odds of persistent compared with paroxysmal AF (odds ratio, 2.19; 95% CI, 1.66–2.88). Similar associations existed for postablation, postoperative, and postcardioversion AF. …