Atrial Fibrillation and Its Comorbidities: Simple Steps to Take Charge of Your Health

Atrial fibrillation (Afib) is often intertwined with other health conditions. Afib alone can coexist with conditions like high blood pressure, diabetes, and sleep apnea. Together, these comorbidities can increase the severity of symptoms and overall health risks, making effective management even more important. By understanding the interconnections between Afib and other conditions patients can better understand how to manage their own health.

Key points:

What is comorbidity?

Comorbidity refers to one or more additional health conditions occurring alongside a primary condition. When a person has comorbidities, it means they have multiple health issues at the same time, which can interact with each other and complicate diagnosis, treatment, and overall health management.

Common comorbidities of Afib

Studies show that Afib is frequently linked to other conditions that can shape health outcomes. Some of the most commonly seen comorbidities are:

• Hypertension
• Diabetes
• Obstructive sleep apnea
• Myocardial infarction
• Coronary artery disease

Let’s take a closer look at these connected health determinants.

Hypertension is a risk factor and a comorbidity

Hypertension, also known as high blood pressure, is the most commonly seen comorbidity of Afib. Hypertension is found in over 70% of patients with atrial fibrillation, and additionally, patients with hypertension have up to a 73% higher risk of developing Afib. So hypertension is a common risk factor as well.

If left untreated, hypertension can lead to kidney damage and left ventricular hypertrophy, both of which further elevate the risk of atrial fibrillation and related complications. Uncontrolled hypertension is the most important contributor to Afib development and its severity. A randomized clinical trial found that hypertension in Afib patients caused a high risk of stroke (greater than 7% risk per year). So hypertension plays a key role in atrial fibrillation and its management.

Diabetes in Afib patients is associated with poorer health outcomes

A study across 27 European countries, assessed the impact of diabetes on Afib management and outcomes. Among 11,028 Afib patients, 23% had diabetes. Over a 2 year observation period, diabetic patients showed worse health outcomes, including reduced quality of life and increased anxiety. Diabetes in Afib patients was linked to greater healthcare utilization, with longer hospital stays and more frequent visits to cardiologists, GPs, and emergency rooms. Additionally, diabetes independently increases risks for major adverse cardiovascular events.

Development of obstructive sleep apnea (OSA) in Afib patients

OSA is prevalent in Afib patients (21–74%) and contributes to Afib through mechanisms like intermittent low oxygen levels at night, inflammation, and pressure changes in the chest. These promote blood clotting, scarring of the heart tissue, and changes in the heart’s electrical system.

In addition, OSA has been shown to lower the success of antiarrhythmic drugs, electrical cardioversion, and catheter ablation in Afib. A study with 324 patients found that after a single ablation procedure, 63% of patients without OSA and 41% with OSA were free from recurrent AF without antiarrhythmic drug therapy.

Using continuous positive airway pressure (CPAP) treatment to prevent obstructive breathing events can help prevent Afib recurrence. A study found that CPAP therapy significantly improved atrial fibrillation, with 71.9% of CPAP users remaining Afib-free compared to 36.7% of non-users.

Coronary artery disease is prevalent in Afib patients

Coronary artery disease (CAD) is a condition in which the blood vessels supplying oxygen and nutrients to the heart muscle become narrowed or blocked. This is due to fatty plaques on the inner walls of the arteries. Over time, these plaques can harden or rupture, reducing or blocking blood flow to the heart. This is a common comorbidity as 17–47% of patients with atrial fibrillation also have coronary artery disease and 1–5% of patients with coronary artery disease also have atrial fibrillation.

A review paper addressing the interconnections between these conditions highlights how CAD plays a crucial role in worsening atrial fibrillation by increasing the frequency and severity of Afib episodes. Ischemia caused by CAD can disrupt the heart’s electrical pathways and lead to structural changes in the atria. In addition, both CAD and Afib share underlying factors such as inflammation and endothelial dysfunction, making their management interconnected.

An increased risk of myocardial infarction in Afib patients

Recent studies have shown that the risk of myocardial infarction (heart attack) is increased by atrial fibrillation. The leading cause of myocardial infarction is coronary artery disease. This further shows the interconnected nature of risk factors and comorbidities. In a cohort study done in Korea, among 497,366 adults, over a 4.2-year follow-up, Afib was associated with a threefold increased risk of myocardial infarction, with similar risks for both men and women.

Steps to manage Afib and its connections

Managing Afib and its comorbidities may seem like an overwhelming prospect but management of these conditions is possible. Here are a few of the ways lifestyle and personalized treatment can help you:

Eat heart-healthy foods

Eating a diet rich in antioxidants, healthy fats and plenty of vitamins and minerals is key for managing Afib symptoms. A whole-foods plant-based diet and a Mediterranean diet positively impact several risk factors associated with atrial fibrillation. They help lower the risk of hypertension and mitigate the effects of diabetes.  Additionally, these diets support weight loss and reduce obesity, both of which are significant risk factors for Afib. A plant-based diet can also improve inflammatory conditions, such as rheumatoid arthritis, and reduce coronary artery diseases.

Are you interested in reading more about diet? Check out our review paper on diet and Afib.

Make healthy lifestyle changes

Minor changes in lifestyle can support your cardiac health and make your heart stronger. Physical activity, like daily walking or cycling 3 times a week, supports heart health, while moderate exercises such as yoga can also reduce atrial fibrillation risk.

Meditative practices, including yoga, tai chi, and qigong, are gaining attention for their ability to stabilize heart rate and reduce Afib symptoms by lowering stress and promoting cardiac health. Stress and anxiety are known Afib triggers. Methods like meditation and cognitive therapy can help manage these triggers.

Additionally, prioritizing sleep is extremely important. Good quality sleep is essential, especially if you have sleep apnea. A sleep trial found that poor sleep quality increased the odds of self-reported Afib episodes by 30%. This shows that even small changes can impact your health outcomes greatly.

Read more about lifestyle factors.

Create an Afib treatment plan that works for you

Creating a personalized treatment plan is essential for effectively managing atrial fibrillation alongside other health conditions. Many Afib patients also have comorbidities, which require careful, individualized management to reduce health risks and improve quality of life. Sticking to your medication plan, as prescribed, is critical for controlling Afib and related conditions. Consult your doctor about what works best for you and about potential alternatives if you notice your symptoms worsening. Staying connected with your healthcare team through regular checkups allows for early detection of changes and adjustments to your treatment plan, ensuring optimal support for both Afib and any comorbidities.

References

Shantsila, E., Choi, E., Lane, D. A., Joung, B., & Lip, G. Y. (2024). Atrial fibrillation: comorbidities, lifestyle, and patient factors. The Lancet Regional Health – Europe, 37, 100784. https://doi.org/10.1016/j.lanepe.2023.100784

Gawałko, M. and Linz, D. (2023). Atrial fibrillation detection and management in hypertension. Hypertension, 80(3), 523-533. https://doi.org/10.1161/hypertensionaha.122.19459

Predictors of thromboembolism in atrial fibrillation: I. Clinical features of patients at risk. The Stroke Prevention in Atrial Fibrillation Investigators. (1992). Annals of internal medicine, 116(1), 1–5. https://doi.org/10.7326/0003-4819-116-1-1

Ding, W. Y., Kotalczyk, A., Blomström‐Lundqvist, C., Fauchier, L., Tavazzi, L., Maggioni, A. P., … & Pitt-Kerby, T. (2022). Impact of diabetes on the management and outcomes in atrial fibrillation: an analysis from the esc-ehra eorp-af long-term general registry. European Journal of Internal Medicine, 103, 41-49. https://doi.org/10.1016/j.ejim.2022.04.026

Goudis, C. A., & Ketikoglou, D. G. (2017). Obstructive sleep and atrial fibrillation: Pathophysiological mechanisms and therapeutic implications. International journal of cardiology, 230, 293–300. https://doi.org/10.1016/j.ijcard.2016.12.120

Goudis, C. A. and Ketikoglou, D. G. (2017). Obstructive sleep and atrial fibrillation: pathophysiological mechanisms and therapeutic implications. International Journal of Cardiology, 230, 293-300. https://doi.org/10.1016/j.ijcard.2016.12.120

Jongnarangsin, K., Chugh, A., Good, E., Mukerji, S. S., Dey, S., Crawford, T., … & Oral, H. (2008). Body mass index, obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation. Journal of Cardiovascular Electrophysiology, 19(7), 668-672. https://doi.org/10.1111/j.1540-8167.2008.01118.x

Fein, A. S., Shvilkin, A., Shah, D., Haffajee, C. I., Das, S., Kumar, K., … & Anter, E. (2013). Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence after catheter ablation. Journal of the American College of Cardiology, 62(4), 300-305. https://doi.org/10.1016/j.jacc.2013.03.052

Michniewicz, E., Młodawska, E., Łopatowska, P., Tomaszuk‐Kazberuk, A., & Małyszko, J. (2018). Patients with atrial fibrillation and coronary artery disease – double trouble. Advances in Medical Sciences, 63(1), 30-35. https://doi.org/10.1016/j.advms.2017.06.005

Batta, A., Hatwal, J., Batta, A., Verma, S., & Sharma, Y. P. (2023). Atrial fibrillation and coronary artery disease: An integrative review focusing on therapeutic implications of this relationship. World journal of cardiology, 15(5), 229–243. https://doi.org/10.4330/wjc.v15.i5.229

Ojha, N., & Dhamoon, A. S. (2023). Myocardial Infarction. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537076/

Lee, H. Y., Yang, P. S., Kim, T. H., Uhm, J. S., Pak, H. N., Lee, M. H., & Joung, B. (2017). Atrial fibrillation and the risk of myocardial infarction: a nation-wide propensity-matched study. Scientific reports, 7(1), 12716. https://doi.org/10.1038/s41598-017-13061-4