Impact of air pollution and multimorbidity on the risk of incident atrial fibrillation

BACKGROUND: Emerging evidence suggests associations between air pollution, multimorbidity, and atrial fibrillation (AF), but their interplay remains unclear. We evaluated these relationships in a prospective cohort. METHODS: )) was conducted at the geocoded residential locations of each participant. Multimorbidity clusters were determined using latent class analysis using 35 long-term conditions (LTCsc. Three latent classes were identified: non-cardiovascular disease (non-CVD) multimorbidity, mental health multimorbidity and cardiometabolic multimorbidity. These were compared with no LTCs and singular LTCs. Cox models examined the effects of air pollution and multimorbidity status on AF incidence. Counterfactual analyses were performed to calculate the proportion of preventable AF. RESULTS: to the 10th percentile could prevent 26-52% of AF cases in multimorbidity subgroups, with the largest reductions in cardiometabolic (52%) clusters. CONCLUSION: Air pollution and multimorbidity were independently and synergistically associated with higher AF risk. Mitigation strategies targeting pollution may reduce AF burden, particularly in high-risk populations.