Weight loss, achieved and sustained through diet and exercise, is associated with fewer atrial fibrillation recurrences1
Trials showing the benefit of weight loss (in combination with other strategies for managing risk factors) in atrial fibrillation have primarily used high-protein, low-glycemic-index diets, along with low-intensity exercise, to achieve reductions in body mass index (BMI).1,2 Patients with intermittent atrial fibrillation and BMI ≥ 27 kg/m2 achieved the greatest increase in arrhythmia-free survival with a sustained weight loss of ≥ 10% of body weight (number need to treat [NNT] = 4.8).1–3
Recreational exercise confers cardioprotective benefits in atrial fibrillation independently of weight loss1–3
Observational studies show that exercise, at any recreational intensity, is associated with reduced risk of developing atrial fibrillation, and improved symptom control in patients with persistent atrial fibrillation.1,3,4 A useful goal is to progressively increase to 200 min/wk at moderate intensity (1000 metabolic equivalents [METs]), which is associated with an approximately 10% decrease in risk of incident atrial fibrillation.1,3
Reducing alcohol intake, in individuals who consume ≥ 14 drinks per week, is associated with a decreased burden of atrial fibrillation and decreased related hospital admissions1–3,5
There is conflicting evidence as to whether a linear dose–response relationship or a threshold effect exists between alcohol consumption and risk of atrial fibrillation.1,3 In a recent randomized controlled trial, abstinence in moderate drinkers (17 ± 8 drinks/wk) with intermittent atrial fibrillation was associated with reduced recurrence (NNT = 5).1 For patients who consume moderate to heavy amounts of alcohol, especially with binge drinking, it is appropriate to counsel them to reduce their intake.
Smoking cessation is recommended as part of strategies for preventing and managing atrial fibrillation1
A dose–dependent relationship has been suggested between smoking and atrial fibrillation.1 Moreover, smoking is strongly associated with the development of chronic obstructive pulmonary disease, an important risk factor for atrial fibrillation.1
Limiting caffeine intake is unlikely to be useful in reducing atrial fibrillation incidence or burden1,3
No evidence exists to suggest that limiting habitual caffeine intake confers any benefit in reducing the risk of atrial fibrillation.1
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Footnotes
Competing interests: None declared.
This article has been peer reviewed.
References
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