Effect of the variability of blood pressure, glucose level, total cholesterol level, and body mass index on the risk of atrial fibrillation in a healthy population

Background: The variability of metabolic parameters might have an impact on the pathophysiology of atrial fibrillation (AF). Objective: The purpose of this study was to evaluate the effect of the variability of 4 metabolic components including systolic blood pressure (BP), glucose level, total cholesterol (TC) level, and body mass index (BMI) on the risk of AF in the healthy population without hypertension, diabetes, or dyslipidemia. Methods: We identified 6,819,829 adult subjects without hypertension, diabetes, or dyslipidemia who had ≥3 health checkups provided by the Korean National Health Insurance Corporation between 2005 and 2012. Glucose level, BP, TC level, and BMI were measured at each visit. Variability was defined as variability independent of the mean (VIM), and VIM of each parameter was divided into 4 groups. High variability was defined as having values in the highest quartile of each parameter. Results: During a mean follow-up of 5.3 ± 1.1 years, 31,302 subjects were newly diagnosed with AF (0.86 per 1000 person-years). Subjects with the highest VIM quartile of BP, TC level, and BMI showed an increased risk of AF compared with those with the lowest VIM quartile, whereas glucose level variability had a marginal association. The composite of the high variability of metabolic parameters showed a graded risk of AF. After multivariable adjustment, subjects having 1, 2, 3, and 4 parameters of the highest VIM had an ∼7%, 13%, 20%, and 35% increased risk of AF compared with those without any highest variability of metabolic parameters. Conclusion: The variability of metabolic parameters showed a close association with the risk of AF in those without cardiovascular comorbidities.