Risk Factors for New-Onset Atrial Fibrillation in Thai Adults with Hypertension
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Background
Limited data exist on new-onset atrial fibrillation (NOAF) risk factors in Asian populations with hypertension (HTN). This study identified predictors of NOAF in Thai adults with HTN.
Methods
We conducted a retrospective cohort study of adults (≥18 years) newly diagnosed with HTN at Ramathibodi Hospital, Bangkok (2010–2023). Patients with prior atrial fibrillation or predisposing conditions (e.g., valvular heart disease, hyperthyroidism) were excluded. Baseline demographics, comorbidities, and medication use were analyzed as time-varying covariates using a multivariate Cox proportional hazards model.
Results
Of 293,798 HTN patients, 168,441 met inclusion criteria. Over a median 3.7-year follow-up (range: 2.2–8.0), 5,028 developed NOAF (incidence: 5.7 per 1,000 person-years). An age–body mass index (BMI) interaction was observed. In patients <60 years, low BMI increased NOAF risk [hazard ratio (HR) 2.3; 95% CI: 1.4–3.6], while overweight [HR 1.1; 0.8–1.4] and obesity [HR 0.8; 0.6–1.1] showed no significant effect. In patients ≥60 years, NOAF risk rose 2- to 4-fold across BMI categories. Male sex and comorbidities (vascular disease, stroke, heart failure, chronic kidney disease, hyperuricemia) increased risk by 1.2–1.8-fold. Statin use reduced risk [HR 0.8; 0.7–0.9]; sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists showed a non-significant protective trend [HR 0.8; 0.7–1.1].
Conclusions
Older age, male sex, abnormal BMI, and the presence of comorbidities are significant risk factors for NOAF in Thai patients with HTN. In contrast, statin use may offer a protective effect.
