Association between baseline adherence to a healthy lifestyle with ischemic and major cardiovascular events in patients with atrial fibrillation

Abstract Aims Managing modifiable risk factors and adherence to a healthy lifestyle are key in the holistic integrated care management of atrial fibrillation (AF). This study examines the relationship between a baseline healthy lifestyle and adverse clinical outcomes in AF patients. Methods We included AF patients starting oral anticoagulation (OAC) between January 2016 and November 2021. Adherence to a healthy lifestyle was assessed at baseline using five modifiable lifestyle factors and patients were categorized into three groups based on points of adherence to modifiable factors: poor (0-8 points); moderate (9-12 points); high (13-17 points). The primary outcome was a composite of ischemic events, over a 2-years follow-up. Results 3,266 AF patients were included (median age 77 [IQR 70-83] years), 52.8% female), and of these, 906 (27.7%) had high adherence. Incidence rate ratios were significantly lower in both the moderate adherence group (0.61; 95% CI 0.46-0.80) and the high adherence group (0.59; 95% CI 0.42-0.81) compared to the poor adherence group. Cox regression analyses adjusted for OAC type showed that high adherence to a healthy lifestyle significantly reduced the risk of composite ischemic events (aHR 0.58; 95% CI 0.42-0.79; p<0.001). After adjusting for additional risk factors, high adherence remained associated with lower risk of ischemic events (aHR 0.59; 95% CI 0.42-0.81; p=0.001). Similar results were observed for the secondary endpoints of MACE and ischemic stroke/TIA/systemic embolism; and in competing risk regression analyses. Conclusion High baseline adherence to a healthy lifestyle reduced the risk of ischemic and major cardiovascular events in AF patients.