Race, body mass index, and the risk of atrial fibrillation: The multi-ethnic study of atherosclerosis

Matthew J. Singleton*, Charles A. German, Mercedes Carnethon, Elsayed Z. Soliman, Alain G. Bertoni, Joseph Yeboah

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


BACKGROUND: Higher body mass index (BMI) is associated with increased risk of incident atrial fibrillation (AF), but it is not known whether this relationship varies by race/ethnicity. METHODS AND RESULTS: Eligible participants (6739) from MESA (Multi-Ethnic Study of Atherosclerosis) were surveilled for incident AF using MESA hospital surveillance, scheduled MESA study ECG, and Medicare claims data. After a median 13.8 years of follow-up, 970 participants (14.4%) had incident AF. With BMI modeled categorically in a Cox proportional hazards model, only those with grade II and grade III obesity had increased risks of AF (hazard ratio [HR], 1.50; 95% CI, 1.14-1.98, P=0.004 for grade II obesity and HR, 2.13; 95% CI, 1.48-3.05, P<0.0001 for grade III obesity). The relationship between BMI and AF risk was J-shaped. However, the risk of AF as a function of BMI varied substantially by race/ethnicity (P value for interaction=0.02), with Chinese-American participants having a much higher risk of AF with higher BMI and Black participants having minimal increased risk of AF with higher BMI. CONCLUSIONS: Obesity is associated with an increased risk of incident AF, but the relationship between BMI and the risk of AF is J-shaped and this relationship differs by race/ethnicity, such that Chinese-American participants have a more pronounced increased risk of AF with higher BMI, while Black participants have minimal increased risk. Further exploration of the differential effects of BMI by race/ethnicity on cardiovascular outcomes is needed.

Original languageEnglish (US)
Article numbere018592
Pages (from-to)1-13
Number of pages13
JournalJournal of the American Heart Association
Issue number1
StatePublished - 2021


  • Atrial fibrillation
  • Body mass index
  • Ethnicity
  • Race

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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