Atrial Fibrillation Prevalence Linked to Higher Levels of Perceived Stress

Analysis of a large patient cohort indicates a strong association between self-reported stress levels and atrial fibrillation (AF).

Records from the 25,530 participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study provided information about each patient’s perceived level of stress and each patient’s heart health.

A multivariable logistic regression enabled the researchers to compare the incidence of AF in patients with different levels of self-reported stress. Patients who reported “moderate” stress were 27% more likely to suffer atrial fibrillation than patients who reported no stress (95% confidence interval [CI], 1.11-1.47). Patients who reported “high” levels of stress were 60% more likely to suffer AF than those who reported no stress (95% CI, 1.39-1.84).

Patients who reported “low” stress were 12% more likely to suffer atrial fibrillation than those who reported no stress, but the finding was not significant: 95% CI, 0.98-1.27.

Although the cohort population was 41% African American, it reflected the overall demographics of Americans with atrial fibrillation reasonably well in terms of age and sex. The mean participant age was 65 years ± 9.4 years, and the group was 54% female.

“Increased levels of stress are associated with several cardiovascular outcomes. For example, elevated stress in women of lower occupational status is associated with a higher incidence of hypertension. Chronic stress has also been implicated in the development of diabetes, coronary heart disease and stroke,” the study authors wrote in Annals of Behavioral Medicine.

“Atrial fibrillation shares several risk factors with the aforementioned cardiovascular outcomes… Additionally data from the Framingham Offspring Study have implicated tension, anger and hostility as risk factors for atrial fibrillation in males.”

The REGARDS study measured patient stress at baseline with a short version of the Cohen Perceived Stress Scale. Participants faced questions about their self-perceived ability to cope with life’s challenges and provided numeric answer that ranged from “0=never” to “4=very often.”

Atrial fibrillation was identified at baseline, either by a positive result on an electrocardiogram or by an affirmative answer to the question, “Has a physician or a health professional ever told you that you had atrial fibrillation?”

There is, of course, considerable evidence that high levels of stress can actually cause some health problems, but REGARDS data do not allow for any such inferences. Information about stress and AF were both taken at baseline, so it’s not even possible to determine whether stress tended to precede AF or AF tended to precede stress.

The Framingham Offspring Study, on the other hand, had personality data for 3,873 men and women at baseline and a decade of follow-up to look for new cases of AF. Analysis of that data, which appeared 11 years ago in Circulation, found that symptoms of anger (relative risk [RR], 1.2) and hostility (RR, 1.3) predicted AF in men (but not women), even after controlling for age, diabetes, hypertension, history of myocardial infarction, history of congestive heart failure, and valvular heart disease.

A number of smaller studies have also found connections between acute emotional stress (rather than long-term stress) and cardiac arrhythmias, according to a 2007 article in JAMA, which explained the mechanisms that might enable stress to impair heart function: “Recent evidence indicates that asymmetric brain activity is particularly important in making the heart more susceptible to ventricular arrhythmias. Lateralization of cerebral activity during emotional stress may stimulate the heart asymmetrically and produce areas of inhomogeneous repolarization that create electrical instability and facilitate the development of cardiac arrhythmias.”