Atrial Fibrillation

By Reed Mangels, PhD, RD

A VRG member contacted us with questions about a condition called atrial fibrillation.

According to the Centers for Disease Control and Prevention, when a person has atrial fibrillation, “the normal beating in the upper chambers of the heart (the two atria) is irregular, and blood doesn’t flow as well as it should from the atria to the lower chambers of the heart (the two ventricles).” This means that not enough blood may be pumped to your lungs and the rest of your body.

The National Heart, Lung and Blood Institute (part of NIH) adds, “Atrial fibrillation causes your heart to beat much faster than normal. … You feel tired or dizzy, or you may feel like your heart is skipping a beat, fluttering, pounding, or beating too hard or fast. You may also feel chest pain. Blood may pool in your heart, which increases your risk of forming clots and can lead to strokes or other complications.” Atrial fibrillation causes 15-20% of ischemic strokes, the most common type of stroke (1).

At least 2.7 million people in the United States have atrial fibrillation; it occurs more commonly now than in the past as the population ages (2).

Risk factors for atrial fibrillation include obesity, high blood pressure, diabetes, chronic kidney disease, moderate to heavy alcohol use, smoking, and advancing age (3). Vegans and vegetarians have a lower risk of developing some of these conditions including obesity, high blood pressure, and type 2 diabetes. There have been no studies looking specifically at the risk for atrial fibrillation in vegans or vegetarians.

One recent case-control study found that people who did not have atrial fibrillation had higher intakes of plant-based foods such as vegetables, fruits, and nuts than did people with atrial fibrillation who were of a similar age (4). Another study found no association between greater adherence to a plant-based (not necessarily vegan or vegetarian) diet and risk of atrial fibrillation (5). Low carbohydrate diets have been associated with a greater risk of atrial fibrillation (6).

Treatment of atrial fibrillation can include medications, medical procedures, and lifestyle changes. In many cases, long-term use of medications to reduce the risk of blood clots is recommended except in those determined by their physician to be at low risk for stroke (1). Specific dietary changes to treat atrial fibrillation are rarely addressed other than a recommendation for those with obesity to lose weight (7,8). Weight loss, where indicated, is associated with a reduced risk of progression to more severe atrial fibrillation (9,10). A recent workshop on research priorities identified diet’s role in reducing risk of atrial fibrillation recurrence or progression as a critical area in which research is needed (7).

References

1. American Academy of Family Physicians. Updated clinical practice guideline. Pharmacologic management of newly detected atrial fibrillation. https://www.aafp.org/dam/AAFP/documents/patient_care/clinical_recommendations/a-fib-guideline.pdf 2017.
2. Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Epidemiology of atrial fibrillation in the 21st century: Novel methods and new insights. Circ Res. 2020;127(1):4-20.
3. 3.Centers for Disease Control and Prevention. Atrial fibrillation. https://www.cdc.gov/heartdisease/atrial_fibrillation.htm. 2022.
4. Neumann FA, Jagemann B, Makarova N, et al. Mediterranean diet and atrial fibrillation: Lessons learned from the AFHRI Case-Control Study. Nutrients. 2022;14(17):3615.
5. Glenn AJ, Lo K, Jenkins DJA, et al. Relationship between a plant-based dietary portfolio and risk of cardiovascular disease: Findings From the Women’s Health Initiative Prospective Cohort Study. J Am Heart Assoc. 2021;10(16):e021515.
6. Zhang S, Zhuang X, Lin X, et al. Low-carbohydrate diets and risk of incident atrial fibrillation: A prospective cohort study. J Am Heart Assoc. 2019;8(9):e011955.
7. Benjamin EJ, Al-Khatib SM, Desvigne-Nickens P, et al. Research priorities in the secondary prevention of atrial fibrillation: A National Heart, Lung, and Blood Institute virtual workshop report. J Am Heart Assoc. 2021;10(16):e021566.
8. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation. 2019;140(2):e125-e151.
9. Pathak RK, Middeldorp ME, Meredith M, et al. Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up Study (LEGACY). J Am Coll Cardiol. 2015;65(20):2159-2169.
10. Middeldorp ME, Pathak RK, Meredith M, et al. PREVEntion and regReSsive Effect of weight-loss and risk factor modification on Atrial Fibrillation: the REVERSE-AF study. Europace. 2018;20(12):1929-1935.

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