Risk of atrial fibrillation in athletes: a systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational cohort and case-control studies
PubMed 34253538 · doi:10.1136/bjsports-2021-103994
What was done
A systematic review, meta-analysis, and meta-regression were conducted across PubMed, MEDLINE, ScienceDirect, SPORTDiscus, and the Cochrane Library (1990 to December 2, 2020). Eligible studies were cohort or case-control designs comparing the incidence or cases of atrial fibrillation (AF) in athletes versus non-athlete controls (physically active or inactive) that allowed odds ratio (OR) calculation. Covariates for meta-regression were mode of exercise (endurance vs mixed sports) and age (<55 vs ≥55 years).
What was found
Athletes had a significantly higher risk of developing AF compared with non-athlete controls (OR: 2.46; 95% CI 1.73 to 3.51; p < 0.001, Z = 4.97). Exercise mode was moderately correlated with AF risk (B = 0.1259, p = 0.0193), with mixed sport conferring greater risk than endurance sport (B = -0.5476, p = 0.0204). Younger athletes (<55 years) were significantly more likely to develop AF compared with older athletes (≥55 years) (B = -0.02293, p < 0.001).
Why it matters
This meta-analysis demonstrates that athletic participation is associated with more than double the risk of atrial fibrillation compared to non-athletes, with elevated risks observed in younger cohorts and mixed-discipline sports.
Limits
The total number of included studies and overall participant count were not reported in the abstract. Included designs were limited to observational (case-control and cohort) studies, precluding causal inference. Control groups varied between physically active and inactive populations, and detailed exercise dosage parameters were not established.
Cited by
- context Competitive endurance athletes have an approximately fivefold increased risk of developing atrial fibrillation compared to non-athletes.