Christopher J Rowan1, Michael A Eskander2, Edmond Seabright3, Daniel Eid Rodriguez4,5, Edhitt Cortez Linares5, Raul Quispe Gutierrez5, Juan Copajira Adrian5, Daniel Cummings3, Bret Beheim6, Kirsten Tolstrup7, Abinash Achrekar8, Thomas Kraft9, David E Michalik10,11, Michael I Miyamoto12, Adel H Allam13, L Samuel Wann14, Jagat Narula15, Benjamin C Trumble16, Jonathan Stieglitz17, Randall C Thompson18,19, Gregory S Thomas20,21, Hillard S Kaplan22, Michael D Gurven9. 1. Renown Institute for Heart and Vascular Health, Reno, Nevada, USA. 2. Western Washington Medical Group, Everett, Washington, USA. 3. University of New Mexico, Department of Anthropology, New Mexico, USA. 4. Universidad de San Simon, Bolivia. 5. Tsimane Health and Life History Project, San Borja, Beni, Bolivia. 6. Max Plank Institute of Evolutionary Anthropology, Department of Human Behavior, Culture and Ecology, Leipzig, Germany. 7. Cardiology, Dept. of Medicine, University of California, San Francisco, CA, USA. 8. University of New Mexico, Division of Cardiology, Albuquerque, New Mexico, USA. 9. University of California, Santa Barbara, Department of Anthropology, USA. 10. Miller Children's and Women's Hospital Long Beach, CA, USA. 11. Division of Pediatric Infectious Diseases, University of California, Irvine, CA, USA. 12. Providence St. Joseph Health, Mission Viejo CA. 13. Al Azhar University, Cairo, Egypt. 14. Ascension Healthcare, Milwaukee, Wisconsin, USA. 15. Icahn School of Medicine at Mount Sinai, Department of Cardiology, NY, USA. 16. Arizona State University, School of Human Evolution and Social Change, Center for Evolution and Medicine, Arizona State University, Tempe, AZ, USA. 17. Institute for Advanced Study in Toulouse, France. 18. Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA. 19. University of Missouri-Kansas City, USA. 20. MemorialCare, Southern California, USA. 21. Division of Cardiology, University of California, Irvine, Orange, California, USA. 22. Chapman University, Department of Health Economics and Anthropology, Economic Science Institute, Argyros School of Business and Economics, Orange, California, USA.
Abstract
Background: Atrial fibrillation is the most common arrhythmia in post-industrialized populations. Older age, hypertension, obesity, chronic inflammation, and diabetes are significant atrial fibrillation risk factors, suggesting that modern urban environments may promote atrial fibrillation. Objective: Here we assess atrial fibrillation prevalence and incidence among tropical horticulturalists of the Bolivian Amazon with high levels of physical activity, a lean diet, and minimal coronary atherosclerosis, but also high infectious disease burden and associated inflammation. Methods: Between 2005-2019, 1314 Tsimane aged 40-94 years (52% female) and 534 Moseten Amerindians aged 40-89 years (50% female) underwent resting 12-lead electrocardiograms to assess atrial fibrillation prevalence. For atrial fibrillation incidence assessment, 1059 (81% of original sample) Tsimane and 310 Moseten (58%) underwent additional ECGs (mean time to follow up 7.0, 1.8 years, respectively). Findings: Only one (male) of 1314 Tsimane (0.076%) and one (male) of 534 Moseten (0.187%) demonstrated atrial fibrillation at baseline. There was one new (female) Tsimane case in 7395 risk years for the 1059 participants with >1 ECG (incidence rate = 0.14 per 1,000 risk years). No new cases were detected among Moseten, based on 542 risk years. Conclusion: Tsimane and Moseten show the lowest levels of atrial fibrillation ever reported, 1/20 to ~1/6 of rates in high-income countries. These findings provide additional evidence that a subsistence lifestyle with high levels of physical activity, and a diet low in processed carbohydrates and fat is cardioprotective, despite frequent infection-induced inflammation. Findings suggest that atrial fibrillation is a modifiable lifestyle disease rather than an inevitable feature of cardiovascular aging. Copyright:
Background: Atrial fibrillation is the most common arrhythmia in post-industrialized populations. Older age, hypertension, obesity, chronic inflammation, and diabetes are significant atrial fibrillation risk factors, suggesting that modern urban environments may promote atrial fibrillation. Objective: Here we assess atrial fibrillation prevalence and incidence among tropical horticulturalists of the Bolivian Amazon with high levels of physical activity, a lean diet, and minimal coronary atherosclerosis, but also high infectious disease burden and associated inflammation. Methods: Between 2005-2019, 1314 Tsimane aged 40-94 years (52% female) and 534 Moseten Amerindians aged 40-89 years (50% female) underwent resting 12-lead electrocardiograms to assess atrial fibrillation prevalence. For atrial fibrillation incidence assessment, 1059 (81% of original sample) Tsimane and 310 Moseten (58%) underwent additional ECGs (mean time to follow up 7.0, 1.8 years, respectively). Findings: Only one (male) of 1314 Tsimane (0.076%) and one (male) of 534 Moseten (0.187%) demonstrated atrial fibrillation at baseline. There was one new (female) Tsimane case in 7395 risk years for the 1059 participants with >1 ECG (incidence rate = 0.14 per 1,000 risk years). No new cases were detected among Moseten, based on 542 risk years. Conclusion: Tsimane and Moseten show the lowest levels of atrial fibrillation ever reported, 1/20 to ~1/6 of rates in high-income countries. These findings provide additional evidence that a subsistence lifestyle with high levels of physical activity, and a diet low in processed carbohydrates and fat is cardioprotective, despite frequent infection-induced inflammation. Findings suggest that atrial fibrillation is a modifiable lifestyle disease rather than an inevitable feature of cardiovascular aging. Copyright:
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