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Being Tall Joins Being Old as Risk Factor for Atrial
Fibrillation
Study
is first to show height as a potent risk of this heart problem
April 14, 2006 – Most senior citizens are aware
that the risk of atrial fibrillation increases with age but now there is
a new risk and it cannot be controlled either – being tall. A new
analysis of data from a registry of patients with left ventricular
dysfunction indicates that height is an independent risk factor for an
arrhythmia of the upper chambers of the heart, according to a new study
in the April 18, 2006, issue of the Journal of the American College of
Cardiology.
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"Tall stature is a potent risk for the development
of atrial fibrillation and is independent of other clinical risk
factors. Indeed, the male predominance of atrial fibrillation appears to
be explained by the difference in height between men and women," said
Jonathan J. Langberg, M.D. from Emory University in Atlanta, Georgia.
Atrial fibrillation is the most common sustained
cardiac arrhythmia. During an episode, the upper chambers of the heart
flutter instead of pumping blood effectively. The incidence increases as
people age, with a prevalence of more than 5 percent in senior citizens
over the age of 65 years.
The size of the left atrium of the heart is known
to be associated with atrial fibrillation, so the researchers wanted to
see if bigger people have a higher risk of atrial fibrillation.
"It is well known that small animals do not develop
atrial fibrillation, while those larger than humans, particularly
horses, seem to be quite susceptible. I also encountered a string of
very tall patients, most of whom were former basketball players, with
lone atrial fibrillation," Dr. Langberg said.
The researchers, including first author Ibrahim R.
Hanna, M.D., reviewed data on 25,268 enrolled in the ADVANCENT registry.
ADVANCENT is a prospective, longitudinal, multicenter, observational
registry designed to collect and report data on the histories,
diagnostics, therapies, and interventions for patients with left
ventricular dysfunction (ejection fraction ¡Ü 40 percent). They
separated the patients by height into four groups each for men and women
and then compared atrial fibrillation rates.
The patients in the tallest quartile group had an
atrial fibrillation prevalence that was 32 percent higher than those in
the shortest quartile. Extrapolating from this result indicates that
every 16 centimeters (about 6 inches) increase in height is associated
with a 50 percent increase in the chance of developing atrial
fibrillation.
"Tall patients may need more aggressive attempts to
attenuate risk factors. Controlled trials should evaluate stature in
treatment and control arms," Dr. Langberg said.
He noted that this study just used a snapshot of
the health information of the patients at a single point in time,
although the patients of course reached their adult height long before
they were likely to develop atrial fibrillation. And while all the
subjects in this study were patients with impaired left ventricular
function, Dr. Langberg speculates that the same results would be found
in other groups.
Professor Michael Feneley, M.D., F.R.A.C.P.,
F.A.C.C. from St Vincent's Hospital in Sydney, Australia, who was not
connected with this study, pointed out that height is not a modifiable
risk factor.
"Although the paper supports previous evidence of a
relationship between atrial size and atrial fibrillation, there is no
therapeutically applicable outcome from the study, because you can't
alter your height as a risk factor for atrial fibrillation!" Prof.
Feneley said.
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