Published Online
on February 19, 2008

A more recent version of this article appeared on March 11, 2008

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Submitted on October 29, 2007
Accepted on December 11, 2007

Metabolic Syndrome and Risk of Development of Atrial Fibrillation. The Niigata Preventive Medicine Study

Hiroshi Watanabe MD, PhD^*, Naohito Tanabe MD, PhD, Toru Watanabe MD, PhD, Dawood Darbar MD, PhD, Dan M. Roden MD, Shigeru Sasaki MD, PhD, and Yoshifusa Aizawa MD, PhD

From the Division of Cardiology (H.W., Y.A.) and Department of Public Health (N.T.), Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; Niigata Association for Comprehensive Health Promotion and Research, Niigata, Japan (T.W., S.S.); and Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn (H.W., D.D., D.M.R.).

^* To whom correspondence should be addressed. E-mail: hiroshi7{at}med.niigata-u.ac.jp.

Background—The metabolic syndrome consists of a cluster of atherosclerotic risk factors, many of which also have been implicated in the genesis of atrial fibrillation (AF). However, the precise role of the metabolic syndrome in the development of AF is unknown.

Methods and Results—This prospective, community-based, observational cohort study was based on an annual health check-up program in Japan. We studied 28 449 participants without baseline AF. We used 2 different criteria for the metabolic syndrome—the guidelines of the National Cholesterol Education Program Third Adult Treatment Panel (NCEP-ATP III) and those of the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI)—to study the risk of development of new-onset AF. The metabolic syndrome was present in 3716 subjects (13%) and 4544 subjects (16%) using the NCEP-ATP III and AHA/NHLBI definitions, respectively. During a mean follow-up of 4.5 years, AF developed in 265 subjects (105 women). Among the metabolic syndrome components, obesity (age- and sex-adjusted hazard ratio [HR], 1.64), elevated blood pressure (HR, 1.69), low high-density lipoprotein cholesterol (HR, 1.52), and impaired insulin tolerance (HR, 1.44 [NCEP-ATP III] and 1.35 [AHA/NHLBI]) showed an increased risk for AF. The association between the metabolic syndrome and AF remained significant in subjects without treated hypertension or diabetes by the NCEP-ATP III definition (HR, 1.78) but not by the AHA/NHLBI definition (HR, 1.28).

Conclusions—The metabolic syndrome was associated with increased risk of AF. The metabolic derangements of the syndrome may be important in the pathogenesis of AF.

Key words: arrhythmia • diabetes mellitus • hypercholesterolemia • hypertension • metabolic syndrome X • risk factors • obesity

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