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Correspondence |

Obesity As a Risk Factor for Developing Postoperative Atrial Fibrillation FREE TO VIEW

Miguel A. Arias, MD, PhD; Joaquín Sánchez-Gila, MD
Author and Funding Information

Affiliations: Complejo Hospitalario de Jaén, Jaén, Spain Hospital Universitario Virgen de las Nieves, Granada, Spain,  Memorial Sloan-Kettering Cancer Center, New York, NY

Correspondence to: Miguel A. Arias, MD, PhD, Pza del Zodiaco No. 8, 5°B, 23009 Jaén, Spain; e-mail: maapalomares@secardiologia.es



Chest. 2006;129(3):828-829. doi:10.1378/chest.129.3.828
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To the Editor:

We read with great interest the recent article by Amar et al (November 2005)1on reduction in the incidence of postoperative atrial fibrillation with the preoperative use of statin independent of levels of early markers of inflammation. Obesity may influence the plasma levels of such markers, which are nowadays considered as an indicator of subclinical inflammation.23 Importantly, however, levels of the analyzed markers of inflammation are influenced by many variables, and they are not related to a single one.

The risk of postoperative atrial fibrillation has been significantly associated with rising body mass index in a large cohort4of postoperative patients without a history of atrial fibrillation, and that association was independent of a broad range of clinical, surgical, and demographic factors known to influence the risk of atrial fibrillation. Some factors that have been linked to an increasing incidence of atrial fibrillation such as left atrial enlargement, enhanced neurohormonal activation, and left ventricular diastolic dysfunction are correlated with increasing body mass index or obesity.57 Indeed, those cardiac structural abnormalities, which are characterized by the presence of heart failure with preserved left ventricular systolic function, are also commonly observed in patients with diastolic heart failure.8Preliminary work by Fukuta et al9has shown that patients with diastolic heart failure might benefit from the use of statins, and the reported survival benefit might be explained by the effects of statins on cardiac hypertrophy,10endothelial function and vascular tone,11and systemic inflammation.12 Thus, it would be of interest to have the data on body mass index and body weight for patients with and without atrial fibrillation to further explain the results of the present study.

Amar, D, Zhang, H, Heerdt, PM, et al (2005) Statin use is associated with a reduction in atrial fibrillation after noncardiac thoracic surgery independent of C-reactive protein.Chest128,3421-3427. [CrossRef] [PubMed]
 
Das, UN Obesity, metabolic syndrome X, and inflammation.Nutrition2002;18,430-432. [CrossRef] [PubMed]
 
Visser, M, Bouter, LM, McQuillan, GM, et al Elevated C-reactive protein levels in overweight and obese adults.JAMA1999;282,2131-2135. [CrossRef] [PubMed]
 
Zacharias, A, Schwann, TA, Riordan, CJ, et al Obesity and risk of new-onset atrial fibrillation after cardiac surgery.Circulation2005;112,3247-3255. [CrossRef] [PubMed]
 
Pritchett, AM, Jacobsen, SJ, Mahoney, DW, et al Left atrial volume as an index of left atrial size: a population-based study.J Am Coll Cardiol2003;41,1036-1043. [CrossRef] [PubMed]
 
Engeli, S, Sharma, AM The renin-angiotensin system and natriuretic peptides in obesity-associated hypertension.J Mol Med2001;79,21-29. [CrossRef] [PubMed]
 
Iacobellis, G, Ribaudo, MC, Leto, G, et al Influence of excess fat on cardiac morphology and function: study in uncomplicated obesity.Obes Res2002;10,767-773. [CrossRef] [PubMed]
 
Aurigemma, GP, Gaasch, WH Clinical practice: diastolic heart failure.N Engl J Med2004;351,1097-1105. [CrossRef] [PubMed]
 
Fukuta, H, Sane, DC, Brucks, S, et al Statin therapy may be associated with lower mortality in patients with diastolic heart failure: a preliminary report.Circulation2005;112,357-363. [CrossRef] [PubMed]
 
Takemoto, M, Node, K, Nakagami, H, et al Statins as antioxidant therapy for preventing cardiac myocyte hypertrophy.J Clin Invest2001;108,1429-1437. [PubMed]
 
O’Driscoll, G, Green, D, Taylor, RR Simvastatin, an HMG-coenzyme A reductase inhibitor, improves endothelial function within 1 month.Circulation1997;95,1126-1131. [CrossRef] [PubMed]
 
Plenge, JK, Hernandez, TL, Weil, KM, et al Simvastatin lowers C-reactive protein within 14 days: an effect independent of low-density lipoprotein cholesterol reduction.Circulation2002;106,1447-1452. [CrossRef] [PubMed]
 
To the Editor:

The authors raise some important issues. Mean (± SD) body mass index did not differ in our patients who either did or did not develop atrial fibrillation (AF) [28 ± 5 vs 27 ± 4, respectively; p = 0.3]. We have previously found13 no difference in weight between patients with or without AF after noncardiac surgery. In two studies,34 male gender was significantly more prevalent among patients who developed postoperative AF. Men may have larger atria and hence a greater likelihood for AF. In contrast to the general population, however, the pathophysiology of our patients likely differs with respect to having obesity or diastolic dysfunction as important risk factors for postoperative AF.

References
Amar, D, Roistacher, N, Zhang, H, et al Signal averaged P-wave duration does not predict atrial fibrillation after thoracic surgery.Anesthesiology1999;91,16-23. [CrossRef] [PubMed]
 
Amar, D, Roistacher, N, Rusch, VW, et al Effects of diltiazem prophylaxis on the incidence and clinical outcome of atrial arrhythmias after thoracic surgery.J Thorac Cardiovasc Surg2000;120,790-798. [CrossRef] [PubMed]
 
Amar, D, Zhang, H, Leung, DHY, et al Older age is the strongest predictor of postoperative atrial fibrillation.Anesthesiology2002;96,352-356. [CrossRef] [PubMed]
 
Passman, RS, Gingold, DS, Amar, D, et al Prediction rule for atrial fibrillation after major noncardiac thoracic surgery.Ann Thorac Surg2005;79,1698-1703. [CrossRef] [PubMed]
 

Figures

Tables

References

Amar, D, Zhang, H, Heerdt, PM, et al (2005) Statin use is associated with a reduction in atrial fibrillation after noncardiac thoracic surgery independent of C-reactive protein.Chest128,3421-3427. [CrossRef] [PubMed]
 
Das, UN Obesity, metabolic syndrome X, and inflammation.Nutrition2002;18,430-432. [CrossRef] [PubMed]
 
Visser, M, Bouter, LM, McQuillan, GM, et al Elevated C-reactive protein levels in overweight and obese adults.JAMA1999;282,2131-2135. [CrossRef] [PubMed]
 
Zacharias, A, Schwann, TA, Riordan, CJ, et al Obesity and risk of new-onset atrial fibrillation after cardiac surgery.Circulation2005;112,3247-3255. [CrossRef] [PubMed]
 
Pritchett, AM, Jacobsen, SJ, Mahoney, DW, et al Left atrial volume as an index of left atrial size: a population-based study.J Am Coll Cardiol2003;41,1036-1043. [CrossRef] [PubMed]
 
Engeli, S, Sharma, AM The renin-angiotensin system and natriuretic peptides in obesity-associated hypertension.J Mol Med2001;79,21-29. [CrossRef] [PubMed]
 
Iacobellis, G, Ribaudo, MC, Leto, G, et al Influence of excess fat on cardiac morphology and function: study in uncomplicated obesity.Obes Res2002;10,767-773. [CrossRef] [PubMed]
 
Aurigemma, GP, Gaasch, WH Clinical practice: diastolic heart failure.N Engl J Med2004;351,1097-1105. [CrossRef] [PubMed]
 
Fukuta, H, Sane, DC, Brucks, S, et al Statin therapy may be associated with lower mortality in patients with diastolic heart failure: a preliminary report.Circulation2005;112,357-363. [CrossRef] [PubMed]
 
Takemoto, M, Node, K, Nakagami, H, et al Statins as antioxidant therapy for preventing cardiac myocyte hypertrophy.J Clin Invest2001;108,1429-1437. [PubMed]
 
O’Driscoll, G, Green, D, Taylor, RR Simvastatin, an HMG-coenzyme A reductase inhibitor, improves endothelial function within 1 month.Circulation1997;95,1126-1131. [CrossRef] [PubMed]
 
Plenge, JK, Hernandez, TL, Weil, KM, et al Simvastatin lowers C-reactive protein within 14 days: an effect independent of low-density lipoprotein cholesterol reduction.Circulation2002;106,1447-1452. [CrossRef] [PubMed]
 
Amar, D, Roistacher, N, Zhang, H, et al Signal averaged P-wave duration does not predict atrial fibrillation after thoracic surgery.Anesthesiology1999;91,16-23. [CrossRef] [PubMed]
 
Amar, D, Roistacher, N, Rusch, VW, et al Effects of diltiazem prophylaxis on the incidence and clinical outcome of atrial arrhythmias after thoracic surgery.J Thorac Cardiovasc Surg2000;120,790-798. [CrossRef] [PubMed]
 
Amar, D, Zhang, H, Leung, DHY, et al Older age is the strongest predictor of postoperative atrial fibrillation.Anesthesiology2002;96,352-356. [CrossRef] [PubMed]
 
Passman, RS, Gingold, DS, Amar, D, et al Prediction rule for atrial fibrillation after major noncardiac thoracic surgery.Ann Thorac Surg2005;79,1698-1703. [CrossRef] [PubMed]
 
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