[Skip to Content]
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
Purchase Options:
[Skip to Content Landing]
March 16, 1994

Independent Risk Factors for Atrial Fibrillation in a Population-Based Cohort: The Framingham Heart Study

Author Affiliations

From The Framingham (Mass) Heart Study (Drs Benjamin, Levy, Vaziri, D'Agostino, and Wolf and Mr Belanger); the Cardiology Section, Boston (Mass) City Hospital, Boston University School of Medicine (Dr Benjamin); National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Levy); Department of Mathematics, Boston University (Dr D'Agostino and Mr Belanger); Departments of Preventive Medicine (Drs Benjamin, Levy, and Wolf) and Neurology (Dr Wolf), Boston University School of Medicine; and Divisions of Cardiology and Clinical Epidemiology, Beth Israel Hospital, Boston (Dr Levy).

JAMA. 1994;271(11):840-844. doi:10.1001/jama.1994.03510350050036

Objective.  —To determine the independent risk factors for atrial fibrillation.

Design.  —Cohort study.

Setting.  —The Framingham Heart Study.

Subjects.  —A total of 2090 men and 2641 women members of the original cohort, free of a history of atrial fibrillation, between the ages of 55 and 94 years.

Main Outcome Measures.  —Sex-specific multiple logistic regression models to identify independent risk factors for atrial fibrillation, including age, smoking, diabetes, electrocardiographic left ventricular hypertrophy, hypertension, myocardial infarction, congestive heart failure, and valve disease.

Results.  —During up to 38 years of follow-up, 264 men and 298 women developed atrial fibrillation. After adjusting for age and other risk factors for atrial fibrillation, men had a 1.5 times greater risk of developing atrial fibrillation than women. In the full multivariable model, the odds ratio (OR) of atrial fibrillation for each decade of advancing age was 2.1 for men and 2.2 for women (P<.0001). In addition, after multivariable adjustment, diabetes (OR, 1.4 for men and 1.6 for women), hypertension (OR, 1.5 for men and 1.4 for women), congestive heart failure (OR, 4.5 for men and 5.9 for women), and valve disease (OR, 1.8 for men and 3.4 for women) were significantly associated with risk for atrial fibrillation in both sexes. Myocardial infarction (OR, 1.4) was significantly associated with the development of atrial fibrillation in men. Women were significantly more likely than men to have valvular heart disease as a risk factor for atrial fibrillation. The multivariable models were largely unchanged after eliminating subjects with valvular heart disease.

Conclusion.  —In addition to intrinsic cardiac causes such as valve disease and congestive heart failure, risk factors for cardiovascular disease also predispose to atrial fibrillation. Modification of risk factors for cardiovascular disease may have the added benefit of diminishing the incidence of atrial fibrillation.(JAMA. 1994;271:840-844)

Kannel WB, Abbott RD, Savage DD, McNamara PM.  Coronary heart disease and atrial fibrillation: The Framingham Study.  Am Heart J . 1983;106: 389-396.Crossref
Wolf PA, Abbott RD, Kannel WB.  Atrial fibrillation as an independent risk factor for stroke: The Framingham Study.  Stroke . 1991;22:983-988.Crossref
Gajewski J, Singer RB.  Mortality in an insured population with atrial fibrillation.  JAMA . 1981;245: 1540-1544.Crossref
Kannel WB, Abbott RD, Savage DD, McNamara PM.  Epidemiologic features of chronic atrial fibrillation: the Framingham Study.  N Engl J Med . 1982; 306:1018-1022.Crossref
Aberg H.  Atrial fibrillation: a review of 463 cases from Philadelphia General Hospital from 1955 to 1965.  Acta Med Scand . 1968;184:425-431.Crossref
Davidson E, Weinberger I, Rotenberg Z, Fuchs J, Agmon J.  Atrial fibrillation: cause and time of onset.  Arch Intern Med . 1989;149:457-459.Crossref
Godtfredsen J.  Atrial fibrillation: course and prognosis—a follow-up study of 1212 cases.  In: Kulbertus HE, Olsson SB, Schlepper M, eds.  Atrial Fibrillation . Mölndal, Sweden: AB Hassle; 1982:134-145.
McEachern D, Baker BM.  Auricular fibrillation: its etiology, age incidence and production by digitalis therapy.  Am J Med Sci . 1932;183:35-48.Crossref
Stroud WD, Laplace LB, Reisinger JA.  The etiology, prognosis and treatment of auricular fibrillation.  Am J Med Sci . 1932;183:48-60.Crossref
Sawyer CG, Bolin LB, Stevens EL, Daniel LB, O'Neil NC, Hayes DM.  Atrial fibrillation: its etiology, treatment and association with embolization.  South Med J . 1958;51:84-93.Crossref
Önundarson PT, Thorgeirsson G, Jonmundsson E, Sigfusson N, Hardarson T.  Chronic atrial fibrillation—epidemiologic features and 14-year follow-up: a case control study.  Eur Heart J . 1987;8:521-527.
Lake FR, Cullen KJ, de Klerk NH, McCall MG, Rosman DL.  Atrial fibrillation and mortality in an elderly population.  Aust N Z J Med . 1989;19:321-326.Crossref
Dawber TR, Meadors GF, Moore FE.  Epidemiological approaches to heart disease: the Framingham Study.  Am J Public Health . 1951;41:279-286.Crossref
Shurtleff D.  Some characteristics related to the incidence of cardiovascular disease and death: Framingham Study, 18-year follow-up.  In: Kannel WB, Gordon T, eds.  The Framingham Study: An Epidemiological Investigation of Cardiovascular Disease . Washington, DC: Dept of Health, Education, and Welfare; 1974: section 30. DHEW publication NIH 74-599.
Kannel WB, Gordon T, Offutt D.  Left ventricular hypertrophy by electrocardiogram: prevalence, incidence, and mortality in the Framingham Study.  Ann Intern Med . 1969;71:89-105.Crossref
Cupples LA, D'Agostino RB, Anderson K, Kannel WB.  Comparison of baseline and repeated measure covariate techniques in the Framingham Heart Study.  Stat Med . 1988;7:205-218.Crossref
D'Agostino RB, Lee ML, Belanger AJ, Cupples LA, Anderson K, Kannel WB.  Relation of pooled logistic regression to time dependent Cox regression analysis: the Framingham Study.  Stat Med . 1990;9:1501-1515.Crossref
Walker SD.  The estimation and interpretation of attributable risk in health research.  Biometrics . 1976;32:829-849.Crossref
Sherman DG, Goldman L, Whiting RB, Jurgensen K, Kaste M, Easton D.  Thromboembolism in patients with atrial fibrillation.  Arch Neurol . 1984;41:708-710.Crossref
Cameron A, Schwartz MJ, Kronmal RA, Kosinski AS.  Prevalence and significance of atrial fibrillation in coronary artery disease (CASS Registry).  Am J Cardiol . 1988;61:714-717.Crossref
Wood P.  An appreciation of mitral stenosis, part I: clinical features.  BMJ . 1954;1:1051-1063.Crossref
Robinson K, Frenneaux MP, Stockins B, Karatasakis G, Poloniecki JD, McKenna WJ.  Atrial fibrillation in hypertrophic cardiomyopathy: a longitudinal study.  J Am Coll Cardiol . 1990;15:1279-1285.Crossref
Vaziri SM, Larson MG, Benjamin EJ, Levy D.  Echocardiographic predictors of nonrheumatic atrial fibrillation: Framingham Heart Study.  Circulation . 1994;89:724-730.Crossref
Ettinger PO, Wu CF, De la Cruz C, Weisse AB, Ahmed SS, Rega TJ.  Arrhythmias and the 'holiday heart': alcohol associated cardiac rhythm disorders.  Am Heart J . 1978;95:555-562.Crossref
Petersen P, Godtfredsen J, Boysen G, Andersen ED, Andersen B.  Placebo-controlled, randomized trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation: the Copenhagen AFASAK Study.  Lancet . 1989;1:175-179.Crossref
The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators.  The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation.  N Engl J Med . 1990; 323:1505-1511.Crossref
Stroke Prevention in Atrial Fibrillation Investigators.  Stroke Prevention in Atrial Fibrillation Study: final results.  Circulation . 1991;84:527-539.Crossref
Ezekowitz MD, Bridgers SL, James KE, et al, for the Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators.  Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation.  N Engl J Med . 1992; 327:1406-1412.Crossref
Coplen SE, Antman EM, Berlin JA, Hewitt P, Chalmers TC.  Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion: a meta-analysis of randomized control trials.  Circulation . 1990;82:1106-1116.Crossref
Albers GW, Sherman DG, Gress DR, Paulseth JE, Petersen P.  Stroke prevention in nonvalvular atrial fibrillation: a review of prospective randomized trials.  Ann Neurol . 1991;30:511-518.Crossref
Fihn SD, McDonell M, Martin D, et al, for the Warfarin Optimized Outpatient Follow-up Study Group.  Risk factors for complications of chronic aticoagulation: a multicenter study.  Ann Intern Ned . 1993;118:511-520.Crossref