Can we prevent atrial fibrillation?

Prevention is the best

Atrial fibrillation is the most common persistent heart rhythm disorder. One to two percent of people in industrialized nations suffer from it. In Europe, the current number of people affected is estimated at six million—with a significant increase to 14 to 17 million people by 2060.

Just a few years ago, atrial fibrillation was still considered a harmless heart rhythm disorder. Since then, we have come to understand the link between atrial fibrillation and stroke, heart failure, dementia, and premature death. High blood pressure, diabetes mellitus, coronary heart disease, and heart failure significantly increase the likelihood of developing atrial fibrillation. However, an unhealthy lifestyle can also significantly increase the risk of atrial fibrillation.

Preventing Atrial Fibrillation

The general principles for preventing cardiovascular disease also apply to the prevention of atrial fibrillation. 

1. Diet and Alcohol
   • Avoid and actively combat excess weight: Excess weight increases the risk of atrial fibrillation. Even a Body Mass Index of 25 to 30 percent increases the risk of atrial fibrillation by 13 percent, while a Body Mass Index >31 increases the risk by 37 percent. Conversely, normalizing your body weight (BMI 18–25) reduces the risk of atrial fibrillation by 50 percent. This effect is stronger than the effect of most antiarrhythmic medications!
   • Significantly reduce or avoid alcohol: For most cardiovascular diseases, moderate alcohol consumption has a (slight) preventive effect. However, alcohol increases the risk of atrial fibrillation starting with the very first drop. For example, two glasses of wine—which is actually the upper limit for alcohol consumption in most recommendations—already lead to a 17 percent increase in the likelihood of atrial fibrillation.
   • A consistent healthy diet: The Mediterranean diet, for example, comes very close to an optimal diet. The high proportion of vegetables, fruits, legumes, fiber, nuts, seeds, healthy fats, and oils can help prevent chronic cardiovascular diseases significantly better than a “Western” diet. The greatest positive effect is achieved when this diet is maintained for years, decades, or even a lifetime. Another advantage of the Mediterranean diet is that cutting out certain foods actually enhances the diversity of the diet’s offerings
   • Avoiding industrially processed foods: Many of these products contain sugar, sugar substitutes, high amounts of salt, unhealthy fats, antioxidants, and preservatives. At the same time, their content of vitamins, bioactive plant compounds, and other essential substances is significantly reduced. Regular, long-term consumption of these products can increase the likelihood of high blood pressure and obesity and lead to the aforementioned cardiovascular diseases and atrial fibrillation
2. Smoking
   Several studies have demonstrated a very clear influence of smoking on the likelihood of developing atrial fibrillation. Depending on the duration of smoking, the risk increases by 40 to 100 percent. Smoking increases oxidative stress, triggers a low-grade chronic inflammatory response, and leads to increased connective tissue buildup in the muscles of the atrium—processes that are directly involved in the development of atrial fibrillation.
3. Sleep “A
   good laugh and a long sleep are the best cures in the doctor’s book,” says an old Irish proverb. Sleep is increasingly coming into the spotlight as a modifiable lifestyle factor in the development of cardiovascular diseases. While the link between sleep-related breathing disorders (e.g., obstructive sleep apnea syndrome) and atrial fibrillation is well known, the effects of sleep duration and sleep quality—as well as as well as shift work and time zone changes, have only recently—in the last few years—come into the focus of scientific research. Sleep duration: Studies have shown that a sleep duration of less than six hours and more than eight hours can significantly increase the likelihood of atrial fibrillation. Poor sleep quality (frequent nighttime awakenings, multiple nighttime trips to the bathroom) also increases the likelihood of atrial fibrillation. How to improve your sleep: First, you should set aside all the common sayings like “Sleep is the enemy of success” or “I can sleep when I’m dead.” These tips can help you get a healthy night’s sleep:
4. Stress
   Management: Even though the fight-or-flight response—involving the activation of the sympathetic branch of the autonomic nervous system and the release of “stress hormones”—is a natural and vital process, chronic stress caused by high job demands, family problems, and ongoing conflicts has negative health effects—including an increased risk of developing atrial fibrillation. Many patients with atrial fibrillation of working age report chronic stress. First and foremost, stress raises blood pressure (both acutely and chronically). And elevated blood pressure is one of the main factors behind the changes in the musculature of the (left) atrium that can lead to atrial fibrillation. A number of techniques that relax the mind can lower blood pressure both acutely and over the long term. Some small studies also show a positive effect on atrial fibrillation. Among the most effective relaxation techniques are yoga, autogenic training, tai chi, and controlled breathing exercises
5. Sports and Exercise
   As with the prevention of cardiovascular diseases in general, regular physical activity also plays a major role in preventing 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 reduction in the risk of atrial fibrillation due to physical activity was observed than in men—regardless of the level or duration of activity. In men, the protective effect was observed only with moderate exercise. Furthermore, the protective effect is no longer detectable, and with a high volume of exercise, a 12 percent increase in the risk of atrial fibrillation was observed.