Less dementia in patients with newly diagnosed atrial fibrillation adhering with a clustering of healthy lifestyle behaviours: a nationwide population-based cohort study

Abstract Background Atrial fibrillation (AF) increases the risk of dementia. A new paradigm for AF management should include a new pillar targeting lifestyle modification. There are limited data on the clinical impact of healthy lifestyle behaviours on the risk of dementia in patients with newly diagnosed AF. Purpose To evaluate the association between the combination(s) of healthy lifestyle behaviours and the risk of incident dementia in patients with AF Methods Using the Korean National Health Insurance database between 2009 and 2016, we identified adult patients who were newly diagnosed as AF without dementia and underwent national health screening examination within 2-year after their AF diagnosis. Patients were categorized into 4 groups according to a healthy lifestyle-behavior score (HLS) 0, 1, 2, and 3 by assigning 1 point each for no current smoking, abstaining alcohol, and performing regular exercise. For the comparison, each group was balanced using the inverse probability of treatment weighting (IPTW). The primary outcome was incident dementia during follow-up. Results Among a total of 199,952 patients (mean age 63.2; 60.2% male) were included, the number of patients within the HLS 0, 1, 2, and 3 groups were 8709 (4.4%), 34839 (17.4%), 106796 (53.4%) and 49608 (24.8%), respectively. After IPTW, weighted incidence rates of dementia were 21.8, 16.8, 16.8, and 13.6 per 1000 person-years for HLS 0, 1, 2, and 3 groups, respectively. After multivariable adjustment of subjects edited by IPTW, HLS 1,2, and 3 groups were associated with a lower risk of dementia compared to HLS 0 group: Hazard Ratio [HR] 0.769, 95% confidence interval [CI] 0.704–0.842 for score 1; HR 0.770, 95% CI 0.709–0.836 for score 2; HR 0.622, 95% CI 0.569–0.679 for score 3. The effect of healthy lifestyle was similar for Alzheimer's dementia (HR 0.823, 95% CI 0.739–0.917 for score 1; HR 0.839, 95% CI 0.760–0.927 for score 2; HR 0.660, 95% CI 0.594–0.734 for score 3) and vascular dementia (HR 0.532, 95% CI 0.437–0.648 for score 1; HR 0.503 95% CI 0.422–0.600 for score 2; HR 0.458, 95% CI 0.378–0.554 for score 3). There was consistency in subgroup analyses stratified by age, sex, CHA2DS2-VASc score, oral anticoagulation use and prior stroke history. Conclusion A combination of a healthy lifestyle, including quitting smoking, abstaining from alcohol consumption, and performing regular physical activity, was associated with a significantly lower risk of dementia in both Alzheimer's dementia and vascular dementia in patients with new-onset AF. These findings support the promotion of a healthy lifestyle within an integrated care approach to AF patient management, which could reduce the risk of dementia. FUNDunding Acknowledgement Type of funding sources: None.