Risk Factors for New-Onset Atrial Fibrillation in Thai Adults with Hypertension

BackgroundLimited data exist on new-onset atrial fibrillation (NOAF) risk factors in Asian populations with hypertension (HTN). This study identified predictors of NOAF in Thai adults with HTN. MethodsWe conducted a retrospective cohort study of adults ([&ge;]18 years) newly diagnosed with HTN at Ramathibodi Hospital, Bangkok (2010-2023). Patients with prior atrial fibrillation or predisposing conditions (e.g., valvular heart disease, hyperthyroidism) were excluded. Baseline demographics, comorbidities, and medication use were analyzed as time-varying covariates using a multivariate Cox proportional hazards model. ResultsOf 293,798 HTN patients, 168,441 met inclusion criteria. Over a median 3.7-year follow-up (range: 2.2-8.0), 5,028 developed NOAF (incidence: 5.7 per 1,000 person-years). An age-body mass index (BMI) interaction was observed. In patients <60 years, low BMI increased NOAF risk [hazard ratio (HR) 2.3; 95% CI: 1.4-3.6], while overweight [HR 1.1; 0.8-1.4] and obesity [HR 0.8; 0.6-1.1] showed no significant effect. In patients [&ge;]60 years, NOAF risk rose 2- to 4-fold across BMI categories. Male sex and comorbidities (vascular disease, stroke, heart failure, chronic kidney disease, hyperuricemia) increased risk by 1.2-1.8-fold. Statin use reduced risk [HR 0.8; 0.7-0.9]; sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists showed a non-significant protective trend [HR 0.8; 0.7-1.1]. ConclusionsOlder age, male sex, abnormal BMI, and the presence of comorbidities are significant risk factors for NOAF in Thai patients with HTN. In contrast, statin use may offer a protective effect.