Shifting global landscape of BMI-related atrial fibrillation: a 50-year trend and projection analysis.

BACKGROUND

Atrial fibrillation and flutter (AF/AFL) are increasingly recognized as obesity-related cardiovascular conditions. However, the global burden of AF/AFL attributable to high body-mass index (BMI) has not been comprehensively quantified.

METHODS

Using data from the Global Burden of Disease Study 2021, we assessed trends in high BMI-attributable AF/AFL burden from 1990 to 2021 across 26 global regions. We analyzed age-standardized disability-adjusted life years (DALYs) and deaths by sex, region, and Socio-demographic Index (SDI). Joinpoint regression and decomposition methods were applied to assess trend inflections and component contributions, while ARIMA models forecasted burden through 2040.

RESULTS

From 1990 to 2021, global age-standardized DALY and death rates attributable to high BMI rose by 67.7% and 66.7%, with EAPCs of 1.64 (95% CI: 1.60-1.69) and 1.65 (95% CI: 1.59-1.70), respectively. In 2021, high BMI contributed to 333,778 DALYs and 1,034 deaths globally. East Asia and South Asia exhibited the fastest growth in burden, with death-related AAPCs of 7.76% and 7.72%, respectively. Decomposition analysis indicated that population aging and growth were the main drivers of burden increases. Forecasts project DALYs to reach 64.5 million and deaths 2,036 by 2040.

CONCLUSIONS

The AF/AFL burden attributable to high BMI has escalated globally, particularly in low- and middle-SDI regions. Without targeted strategies to reduce obesity, this upward trend is likely to continue, underscoring the need for integrated arrhythmia prevention within global obesity control frameworks.