Factors Associated with New-Onset Atrial Fibrillation in Thai Adults with Hypertension
1 Chulalongkorn University International Medical Program, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
2 Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
3 Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
4 School of Medicine and Public Health, University of Newcastle, Australia
5 Hunter Medical Research Institute, Newcastle, Australia
Abstract
Background: Data on risk factors for new-onset atrial fibrillation (NOAF) in hypertensive Asian populations are limited. This study aimed to identify predictors of NOAF in Thai adults with hypertension (HTN).
Methods: We conducted a retrospective cohort study of adults (≥18 years) newly diagnosed with HTN at Ramathibodi Hospital, Bangkok, from 2010 to 2023. Patients with prior AF or predisposing conditions (e.g., valvular disease and hyperthyroidism) were excluded. Baseline demographics, comorbidities, and medication use were analyzed as time-varying covariates using multivariable Cox models.
Results: Of 293,798 hypertensive patients, 168,441 met the criteria. Over a median follow-up of 3.7 years, 5,028 developed NOAF (5.7 per 1,000 person-years). A significant interaction between age and BMI was observed. In patients <60 years, low BMI increased NOAF risk (HR: 2.3; 95% CI: 1.4–3.6), while overweight and obesity did not. In those ≥60–79 years, NOAF risk increased 2- to 3-fold across all abnormal BMI categories. In patients ≥80 years, risk was 3- to 4-fold higher across all BMI categories. Male sex and comorbidities (vascular disease, stroke, heart failure, chronic kidney disease, and hyperuricemia) were associated with a 1.2–1.8-fold increased risk. Statin use reduced NOAF risk (HR: 0.8; 95% CI: 0.7–0.9), while SGLT2 inhibitors and GLP-1 receptor agonists showed a non-significant protective trend.
Conclusions: In Thai hypertensive patients, older age, male sex, abnormal BMI, and comorbidities predict NOAF, while statin use may be protective. Further prospective studies are needed to confirm these findings.
