Can we prevent atrial fibrillation?

Prevention is the best

Atrial fibrillation is the most common persistent cardiac arrhythmia. One to two percent of people in industrialised countries suffer from it. In Europe, the current number of people affected is estimated at six million - with a strong increase to 14 to 17 million sufferers by 2060.

A few years ago, atrial fibrillation was considered a harmless heart rhythm disorder. Now we know about the connection between atrial fibrillation and stroke, heart failure, dementia and earlier death. High blood pressure, diabetes mellitus, coronary heart disease and heart muscle weakness clearly favour the occurrence of atrial fibrillation. But an unhealthy lifestyle can also significantly increase the risk of atrial fibrillation.

Preventing atrial fibrillation

What applies to the prevention of cardiovascular diseases in general is also important for the prophylaxis of atrial fibrillation.

1. Nutrition und Alcohol
   • Avoid and actively combat obesity: Obesity increases the risk of atrial fibrillation. Already a body mass index of 25 to 30 percent increases the risk of atrial fibrillation by 13 percent, a body mass index >31 increases the risk by 37 percent. Conversely, normalising body weight (BMI 18-25) reduces atrial fibrillation by 50 percent. This effect is stronger than the effect of most rhythm medications!
   • Significantly reduce or avoid alcohol: For most cardiovascular diseases, moderate alcohol consumption has a (small) preventive effect. However, alcohol increases the risk of atrial fibrillation with the first drop. For example, two glasses of wine - actually the upper limit for alcohol in most recommendations - already lead to a 17 percent increase in the probability of atrial fibrillation.
   • A consistent healthy diet: The Mediterranean diet, for example, comes very close to an optimal diet. The high proportion of vegetables, fruit, pulses, fibre, nuts, seeds, healthy fats and oils can prevent chronic cardiovascular diseases much better than a "western" diet. The highest positive effect is achieved if you maintain this diet for years, decades or even your whole life. And another argument in favour of a Mediterranean diet is that doing without is more likely to mean a gain in the versatility of the food on offer.
   • Avoid industrially processed foods: Many of these products contain sugar, sugar substitutes, a lot of salt, unhealthy fats, antioxidants and preservatives. At the same time, their content of vitamins, bioactive plant compounds and other vital substances is greatly reduced. The permanent regular consumption of these products can increase the likelihood of high blood pressure and obesity and lead to the cardiovascular diseases and atrial fibrillation mentioned above
2. Smoking
   Several studies have shown a very clear influence of smoking on the probability of getting atrial fibrillation. Depending on the duration of smoking, the risk increases by 40 to 100 percent. Smoking increases oxidative stress, generates an underlying chronic inflammatory response and leads to increased connective tissue deposition in the muscles of the atrium - processes that are directly involved in the development of atrial fibrillation.
3. Sleep patterns and quality
   "A good laugh and a long sleep are the best cures in the doctor's book" says an old Irish proverb. Sleep is increasingly becoming a focus of attention for lifestyle factors that can be influenced in the development of cardiovascular diseases. While the connection between sleep-related breathing disorders (e.g. obstructive sleep apnoea syndrome) and atrial fibrillation is well known, the influence of sleep duration and sleep quality, but also shift work and time zone shifts, have only come into the focus of scientific studies in recent years. Sleep duration: Studies have shown that sleeping less than six hours and more than eight hours can significantly increase the likelihood of atrial fibrillation. Poor sleep quality (frequent night awakenings, multiple trips to the toilet at night) also increases the likelihood of atrial fibrillation. How to improve your sleep: First of all, all common sayings like "sleep is the enemy of success" or "I can still sleep when I am dead" should be pushed far aside. These points can help for a healthy sleep:
4. Stressmanagement
   Even though the fight and flight reflex with the activation of the sympathetic part of the autonomic nervous system and the release of "stress hormones" is a natural and vital process, permanent stress due to high professional demands, family problems and permanent conflicts has negative health effects - also with regard to the development of atrial fibrillation. Many patients with atrial fibrillation of working age report permanent stress. First and foremost, stress increases blood pressure (both acute and chronic). And increased blood pressure is one of the main factors in the changes in the muscles of the (left) atrium that can lead to atrial fibrillation. A number of techniques that relax the mind can lower blood pressure acutely and in the longer term. Some small studies show a positive effect for atrial fibrillation as well. The most effective relaxation techniques include yoga, autogenic training, tai chi and controlled breathing exercises
5. Physical activities and sport As in the prevention of cardiovascular diseases in general, regular physical activity also plays a major role in the prevention of atrial fibrillation. In general, the WHO recommends 150 to 300 minutes of physical activity per week. However, a British study published in 2020 with over 400,000 participants showed surprising results: In women, a more significant risk reduction for atrial fibrillation was observed through physical activity than in men - regardless of activity level and duration. In men, the protective effect was only observed with moderate exercise. Beyond that, the protection is no longer detectable and a twelve percent increased risk for atrial fibrillation was found with high exercise volume.