Lu Yingli, Sun Ying, Cai Lingli, Yu Bowei, Wang Yuying, Tan Xiao, Wan Heng, Xu Dachun, Zhang Junfeng, Qi Lu, Sanders Prashanthan, Wang Ningjian
Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhizaoju Road, Huangpu District, Shanghai 200011, China.
School of Public Health, Zhejiang University, Hangzhou, China.
Eur Heart J. 2025 Mar 3;46(9):784-804. doi: 10.1093/eurheartj/ehae887.
Atrial fibrillation (AF) has become the pre-dominant arrhythmia worldwide and is associated with high morbidity and mortality. Its pathogenesis is intricately linked to the deleterious impact of cardiovascular risk factors, emphasizing the pivotal imperative for early detection and mitigation strategies targeting these factors for the prevention of primary AF. While traditional risk factors are well recognized, an increasing number of novel risk factors have been identified in recent decades. This review explores the emerging non-traditional risk factors for the primary prevention of AF, including unhealthy lifestyle factors in current society (sleep, night shift work, and diet), biomarkers (gut microbiota, hyperuricaemia, and homocysteine), adverse conditions or diseases (depression, epilepsy, clonal haematopoiesis of indeterminate potential, infections, and asthma), and environmental factors (acoustic pollution and other environmental factors). Unlike traditional risk factors, individuals have limited control over many of these non-traditional risk factors, posing challenges to conventional prevention strategies. The purpose of this review is to outline the current evidence on the associations of non-traditional risk factors with new-onset AF and the potential mechanisms related to these risk factors. Furthermore, this review aims to explore potential interventions targeting these risk factors at both the individual and societal levels to mitigate the growing burden of AF, suggesting guideline updates for primary AF prevention.
心房颤动（AF）已成为全球主要的心律失常，与高发病率和死亡率相关。其发病机制与心血管危险因素的有害影响密切相关，这凸显了针对这些因素进行早期检测和缓解策略以预防原发性AF的关键必要性。虽然传统危险因素已广为人知，但近几十年来已发现越来越多的新危险因素。本综述探讨了原发性AF一级预防中新兴的非传统危险因素，包括当前社会中的不健康生活方式因素（睡眠、夜班工作和饮食）、生物标志物（肠道微生物群、高尿酸血症和同型半胱氨酸）、不良状况或疾病（抑郁症、癫痫、意义未明的单克隆造血、感染和哮喘）以及环境因素（噪音污染和其他环境因素）。与传统危险因素不同，个体对许多这些非传统危险因素的控制有限，这给传统预防策略带来了挑战。本综述的目的是概述关于非传统危险因素与新发AF关联的现有证据以及与这些危险因素相关的潜在机制。此外，本综述旨在探讨针对这些危险因素在个体和社会层面的潜在干预措施，以减轻AF日益加重的负担，为原发性AF预防提出指南更新建议。
