Associations of high-normal blood pressure and impaired fasting glucose with atrial fibrillation

Objective To investigate the association of high-normal blood pressure (BP) and impaired fasting glucose (IFG) with the risk of atrial fibrillation (AF) in two cohorts. Methods The Korean National Health Insurance Service-Health Screening (K-NHIS-HealS, 2002–2003, follow-up until 2013) Study and the UK Biobank (2007–2010, follow-up until 2021) were evaluated. We used Cox proportional hazards regression models to evaluate the associations of high-normal BP and IFG with incident AF. Results In the K-NHIS-HealS and the UK Biobank, 2346 and 5314 incident AF events were recorded during the mean follow-up of 7.4 and 11.8 years. The adjusted HRs (95% CIs) for AF in the Korean and UK cohorts were 1.11 (1.02 to 1.21) and 1.07 (1.01 to 1.13) in individuals with high-normal BP; and 1.14 (1.04 to 1.25) and 1.10 (1.01 to 1.20) in individuals with IFG, respectively. The AF risk showed a dose–response relationship with BP and fasting blood glucose level. The risk of incident AF was increased by the combination of high-normal BP and IFG. Conclusions In healthy individuals, high-normal BP and IFG were important risk factors for AF. When high-normal BP and IFG were combined, the risk of new-onset AF was significantly increased. These findings may suggest that lifestyle interventions for high-normal BP and IFG should be considered to reduce the risk of AF.