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Author Notes:

Correspondence to: Zakaria Almuwaqqat, MD, MPH, Division of Cardiology, Department of Medicine, Emory School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322. E‐mail: zalmuwa@emory.edu

The authors thank the staff and participants of the ARIC (Atherosclerosis Risk in Communities) study for their important contributions.

Reagents for the NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) assays were donated by Roche Diagnostics Corporation.

Disclosures: None.


Research Funding:

This work was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH; award nos. UL1TR002378, TL1TR002382).

The ARIC (Atherosclerosis Risk in Communities) study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, NIH, Department of Health and Human Services (contract nos. HHSN268201700001I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I, HHSN2682017000021).

This work was supported by American Heart Association grant 16EIA26410001 (Dr. Alonso).

Dr. Selvin was supported by NIH and National Institute of Diabetes and Digestive and Kidney Diseases grants K24DK106414 and R01DK089174.


  • atrial fibrillation
  • brain natriuretic peptide
  • obesity

Joint Associations of Obesity and NT-proBNP With the Incidence of Atrial Fibrillation in the ARIC Study


Journal Title:

Journal of the American Heart Association


Volume 8, Number 19


, Pages e013294-e013294

Type of Work:

Article | Final Publisher PDF


Background Circulating NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, a well-known indicator of atrial wall stress and remodeling, inversely correlate with body mass index. Both are strongly predictive of atrial fibrillation (AF). Their potential interaction in relation to incident AF, however, has not been explored. Methods and Results In total, 9556 participants of the ARIC (Atherosclerosis Risk in Communities) study who had 2 measurements of NT-proBNP and no baseline AF or heart failure were followed from 1996 to 1998 through 2016 for the occurrence of incident AF. Participants were categorized as obese (body mass index ≥30) and nonobese (body mass index <30) and by NT-proBNP levels (using the median of 68.2 pg/mL as the cutoff). Over a median follow-up of 18.3 years, we identified 1806 incident cases of AF. Analysis using multivariable Cox regression models showed that obese participants with high NT-proBNP levels at visit 4 had a higher adjusted risk of incident AF (hazard ratio: 3.64; 95% CI, 3.15-4.22) compared with nonobese individuals with low NT-proBNP levels. The association of obesity with AF risk was not modified by NT-proBNP levels (P=0.46 for interaction). Increasing BNP among participants from 1990-1992 to 1996-1998 was associated with increased AF risk. After further adjustment for clinical risk factors and medications, results were similar. Conclusions Individuals who had both elevated body mass index and NT-proBNP and were free of clinically recognized heart failure were at higher risk of AF development. Those who experienced an increase in NT-proBNP levels between visits 2 and 4 were at higher risk of AF.

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© 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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