Increased prevalence of atrial fibrillation after the Great East Japan Earthquake: Results from the Fukushima Health Management Survey

doi:10.1016/j.ijcard.2015.06.151

International Journal of Cardiology

Volume 198, 1 November 2015, Pages 102-105

https://doi.org/10.1016/j.ijcard.2015.06.151 Get rights and content

Abstract

Background

Previous studies have shown that control of cardiovascular risk factors deteriorates among residents after a natural disaster. This study assessed the hypothesis that the prevalence of atrial fibrillation (AF) increased among residents in the evacuation zone of Fukushima prefecture after the Great East Japan Earthquake.

Methods and results

This longitudinal study examined subjects aged 40–90 years using data collected from 26,163 participants (11,628 men and 14,535 women) sourced from general health checkups conducted in twelve communities, including the evacuation zone specified by the government, between 2008 and 2010. The study obtained 12-lead ECG tracings and conducted follow-up examinations from June 2011 to the end of March 2013. A total of 12,410 participants (5704 men and 6706 women, follow-up proportion: 47%) received follow-up examinations after the earthquake, with an average follow-up of 1.4 years. The prevalence of AF increased among participants after the earthquake (before: 1.9% vs. after: 2.4%, P < .001). During the follow-up period, 79 incidences of AF occurred among participants. Excess ethanol intake (≥ 44 g/day) and obesity showed associations with an increased risk of AF after the earthquake, with multivariable-adjusted hazard ratios (95% confidence interval) of 3.07 (1.55–6.08) and 1.87 (1.19–2.94), respectively.

Conclusions

The prevalence of AF increased among residents in the evacuation zone of Fukushima prefecture after the Great East Japan Earthquake, with excess alcohol intake and obesity associated with an increased risk of AF.

Introduction

The Great East Japan Earthquake that occurred on March 11, 2011, and the subsequent tsunami and Fukushima nuclear accident caused physical and mental stress among the residents of Fukushima Prefecture [1], [2]. Previous studies found that stress after natural disasters could trigger cardiovascular events, such as myocardial infarctions, strokes, and pulmonary embolisms [3], [4], [5], [6]. In addition, we recently showed that the number of hospitalizations due to decompensated heart failure increased after the Great East Japan Earthquake [7], [8]. However, little is known about the association between the incidence of arrhythmias and catastrophic disasters.

Atrial fibrillation (AF) is the most common sustained clinical arrhythmia and is associated with an increased risk of stroke and heart failure [9]. Accordingly, it is significant to investigate whether the natural disaster increases the prevalence of AF, which may influence the rate of cardiovascular events such as stroke and heart failure. Recently, AF has emerged as a potential world health problem of epidemic proportions due to the incidence of AF increasing with age [10], [11], [12]. Epidemical studies identified several risk factors for AF, including hypertension, diabetes mellitus, heart failure, obesity, and heavy alcohol intake [13], [14], [15]. The disaster in Fukushima prefecture forced many residents from the government-designated evacuation zone to change aspects of their lifestyle such as physical exercise, diet, smoking, and alcohol habits. Therefore, evacuees may have developed risk factors for AF, such as hypertension, diabetes mellitus, and obesity, after the Great East Japan Earthquake.

The purpose of this study was to determine whether the Great East Japan Earthquake and its subsequent disasters increased the prevalence of AF among residents in the evacuation zone of Fukushima prefecture. Furthermore, it examined the association between AF risk factors, including hypertension, diabetes mellitus, obesity, alcohol consumption, and AF incidence.

Section snippets

Study subjects and design

The subjects of this study were residents living in the evacuation zone in Fukushima prefecture, which included Tamura City, Minamisoma City, Kawamata-machi, Hirono-machi, Naraha-machi, Tomioka-machi, Kawauchi-mura, Okuma-machi, Namie-machi, Katsurao-mura, Iitate-mura, and Date City. In these communities, annual health checkups focusing on metabolic syndromes have been conducted since 2008 for insured persons/dependents aged 40 years or older according to Health Care Insurers. This study limited

Characteristics of the participants

Table 1 shows baseline characteristics of the participants with and without AF. The prevalence of AF was higher in men than in women. The mean age, body mass index and the ration of obesity, as well as the prevalence of hypertension and diabetes mellitus, were higher among participants with AF than those without AF. There were no differences in the incidences of excess ethanol intake and current smoking between participants with and without AF.

Prevalence of AF before and after the earthquake

Table 2 shows changes in the prevalence of AF

Discussion

The present study demonstrated that the prevalence of AF increased among residents in the evacuation zone of Fukushima prefecture after the Great East Japan Earthquake. In addition, excess alcohol intake and obesity were associated with an increased risk of AF. To our knowledge, this is the first study to show an association between an increased prevalence of AF and catastrophic disasters. Moreover, the findings in the present study suggest that lifestyle factors such as alcohol habits,

Conclusions

The prevalence of AF increased among residents in the evacuation zone of Fukushima prefecture after the Great East Japan Earthquake, with excess alcohol intake and obesity showing associations with an increased risk of AF. These results suggest that providing adequate mental care and lifestyle support for evacuees may not only decrease the risk of AF, but also prevent stroke and heart failure related to AF after natural disasters.

Conflict of interest

The Department of Arrhythmia and Cardiac Pacing is supported by St. Jude Medical Japan Co., Ltd., Boston Scientific Japan Co., Ltd., Japan Lifeline Co., Ltd. and Nippon Boehringer Ingelheim Co., Ltd.

Acknowledgments

The National Health Fund for Children and Adults Affected by the Nuclear Incident supported this survey. The findings and conclusions of this article are solely the responsibility of the authors and do not represent the official views of the Fukushima Prefecture government.

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Cited by (37)

Mechanisms and Therapeutic Opportunities in Atrial Fibrillation in Relationship to Alcohol Use and Abuse
2022, Canadian Journal of Cardiology
Excessive drinking has detrimental effects on the cardiovascular system. Atrial fibrillation (AF) after alcohol binge drinking, also named “holiday heart syndrome,” is well established. However, chronic lower levels of alcohol intake also may increase AF risk. In this review, we aim to provide a comprehensive overview of the epidemiology and pathophysiology by which alcohol may be responsible for AF and discuss whether alcohol abstinence is required for optimal rhythm control as well as to maintain sinus rhythm in patients with AF. The pathophysiologic mechanisms responsible for the relationship between alcohol consumption and AF may include both direct and chronic effects increasing AF burden. Acute effects may include arrhythmogenic changes (such as shortening in atrial refractoriness, slowing in conduction velocity, and increased atrial ectopy) and an autonomic imbalance. Chronic changes contributing to the development of an arrhythmogenic substrate involve atrial structural and functional remodelling processes due to atrial dilation, elevated pressures, and fibrosis formation. In addition, alcohol consumption contributes to developing concomitant AF risk factors such as obesity, sleep-disordered breathing, and hypertension. Alcohol abstinence is associated with a reduction in AF recurrence and overall burden and moreover improves AF risk factor development such as obesity, hypertension, sleep apnea, and AF-related consequences such as stroke. In conclusion, alcohol consumption is associated with atrial arrhythmia and a wide range of cardiovascular comorbidities. Although further evidence is needed, current knowledge indicates that there might not be a safe level of alcohol consumption that does not increase AF risk.
L'excès d'alcool a des effets néfastes sur le système cardiovasculaire. Une fibrillation auriculaire (FA) succédant à une consommation excessive d'alcool, également appelée "syndrome du cœur en vacances", est un phénomène bien établi. Cependant, une consommation chronique d'alcool à des niveaux plus faibles peut également augmenter le risque de FA. Dans cette revue de littérature, nous visons à fournir un aperçu complet de l'épidémiologie et de la pathophysiologie par lesquelles l'alcool peut être responsable de la FA et à discuter si une abstinence d'alcool s'avère nécessaire pour un contrôle optimal du rythme ainsi que pour maintenir un rythme sinusal chez les patients souffrant de FA. Les mécanismes pathophysiologiques responsables de la relation entre consommation d'alcool et FA peuvent inclure des effets directs et chroniques, augmentant le fardeau que constitue la FA. Les effets aigus peuvent inclure des perturbations arythmogènes (telles que le raccourcissement de la période réfractaire au niveau auriculaire, un ralentissement de la vitesse de conduction, et une augmentation d'évènements auriculaires ectopiques) et un déséquilibre du système nerveux autonome. Les changements chroniques contribuant au développement d'un substrat arythmogène impliquent des processus de remodelages structurel et fonctionnel de l'oreillette dus à la dilatation de l'oreillette, aux pressions élevées, et à la formation de fibrose. En outre, la consommation d'alcool contribue à l'apparition de facteurs de risque de FA concomitants tels que l'obésité, les troubles respiratoires du sommeil et l'hypertension. L'abstinence d'alcool est associée à une réduction de la récurrence de la FA et du fardeau qu'elle représente globalement, et elle améliore de surcroît la régulation de facteurs de risque de FA tels que l'obésité, l'hypertension, l'apnée du sommeil et des conséquences liées à la FA telles que l'accident vasculaire cérébral. En conclusion, la consommation d'alcool est associée à l'occurence d'arythmies auriculaires et à un large éventail de comorbidités cardiovasculaires. Bien que des preuves supplémentaires soient nécessaires, les connaissances actuelles indiquent qu'il n'existe peut-être pas de niveau de consommation d'alcool sans danger qui n'augmente pas le risque de FA.
Lifestyle-related diseases caused by evacuation: Results of the comprehensive health check in the Fukushima health management survey
2022, Health Effects of the Fukushima Nuclear Disaster
The Comprehensive Health Check is a detailed survey of the Fukushima Health Management Survey (FHMS). Due to the Great East Japan Earthquake and the Fukushima Nuclear Power Plant accident, many residents were forced to live as evacuees, and their lifestyles drastically changed. Thus, this survey aims to evaluate the health status of the residents in the evacuation area and to prevent lifestyle-related diseases. The subjects comprised almost 210,000 men and women who were registered as residents in the evacuation area in Fukushima Prefecture between March 11, 2011, and April 1, 2012, and this area includes 13 municipalities. Annual health check-ups have been conducted among residents of all ages in these communities since 2011. Although a downward trend in body weight was noted in the evacuation areas between fiscal year (FY) 2011 and 2018, the body weight of boys and girls in the evacuation areas tended to be higher than those in the national data. The prevalence of hypertriglyceridemia increased between FY 2011 and 2018 for boys and girls. For adults, the proportion of overweight people in all age groups among men showed a decreasing trend between FY 2011 and 2014, but an increasing trend between FY 2014 and 2018. The prevalence of renal dysfunction, hyperuricemia, and glucose intolerance increased in all age groups between FY 2011 and 2018, and evacuation is a significant risk factor for incidence of chronic kidney disease and diabetes mellitus. The effects of the evacuation persisted more than 7 years after the disaster and might be associated with increased risk of cardiovascular diseases.
Changes in the mental health status of adolescents following the Fukushima Daiichi nuclear accident and related factors: Fukushima Health Management Survey
2020, Journal of Affective Disorders
Citation Excerpt :
An increased prevalence of obesity and lifestyle-related disorders was reported among residents in the evacuation zones in the Fukushima Prefecture who were forced to evacuate due to the Great East Japan Earthquake (Tsubokura et al., 2013; Satoh et al., 2015; Ohira et al., 2016; Hashimoto et al., 2017). This was attributed to lifestyle changes after residing in a temporary house or outside the hometown, disruption of eating habits, and increased stress level (Kunii et al., 2016; Sakai et al., 2014; Suzuki et al., 2015b; Uemura et al., 2016; Zhang et al., 2017). Accordingly, even in young individuals, anxiety regarding radiation not only increases stress and promotes deterioration of mental health but may also be a risk factor for the onset of obesity and lifestyle-related disorders.
The present study examined the data from the Fukushima Health Management Survey conducted after the Great East Japan Earthquake to identify disaster-related factors affecting the mental health status of adolescents following the disaster and obtained basic data necessary in providing mental healthcare.
The study included 2808 adolescents aged 15–19 years (male: 1327; female: 1481) who completed the 2011 edition of the registered questionnaire. The Kessler Psychological Distress Scale scores, age, sex, health status, sleep satisfaction level, Great East Japan Earthquake experience, experience of losing a loved one, change in employment status, change in residence, and awareness of the impact of radiation on health were examined.
Psychological distress was significantly correlated with sex, health status, sleep satisfaction of, experience of losing a loved one, change in employment status, extreme anxiety regarding the acute health impact of radiation, and extreme anxiety regarding the impact of radiation on health in adolescents and the next generation.
The present study is limited because of its cross-sectional design, due to which, the causal relationship between each factor and psychological distress could not be clarified.
The results of the present study suggest that appropriate mental healthcare should be administered immediately following an earthquake to adolescents who have lost a loved one and experienced anxiety regarding the health impact of radiation following a nuclear accident.
Diabetes mellitus, blood glucose and the risk of atrial fibrillation: A systematic review and meta-analysis of cohort studies
2018, Journal of Diabetes and its Complications
Citation Excerpt :
In addition, we are not aware of any previous meta-analyses on prediabetes or blood glucose and the risk of atrial fibrillation. At least 25 additional cohort studies (22 publications) with >456,000 cases and >10.1 million participants6,16–37 have since been published. Thus, we conducted an up-to-date systematic review and meta-analysis of diabetes mellitus, prediabetes, blood glucose and risk of atrial fibrillation to clarify the association and to investigate sources of heterogeneity by conducting subgroup and sensitivity analyses.
Diabetes and elevated blood glucose have been associated with increased risk of atrial fibrillation in a number of epidemiological studies, however, the findings have not been entirely consistent. We conducted a systematic review and meta-analysis to clarify the association.
We searched the PubMed and Embase databases for studies of diabetes and blood glucose and atrial fibrillation up to July 18th 2017. Cohort studies were included if they reported relative risk (RR) estimates and 95% confidence intervals (CIs) of atrial fibrillation associated with a diabetes diagnosis, prediabetes or blood glucose. Summary RRs were estimated using a random effects model.
Thirty four studies were included in the meta-analysis of diabetes, pre-diabetes or blood glucose and atrial fibrillation. Thirty two cohort studies (464,229 cases, >10,244,043 participants) were included in the analysis of diabetes mellitus and atrial fibrillation. The summary RR for patients with diabetes mellitus versus patients without diabetes was 1.30 (95% CIs: 1.03–1.66), however, there was extreme heterogeneity, I² = 99.9%) and evidence of publication bias with Begg's test, p < 0.0001. After excluding a very large and outlying study the summary RR was 1.28 (95% CI: 1.22–1.35, I² = 90%, n = 31, 249,772 cases, 10,244,043 participants). The heterogeneity was mainly due to differences in the size of the association between studies and the results persisted in a number of subgroup and sensitivity analyses. The summary RR was 1.20 (95% CI: 1.03–1.39, I² = 30%, n = 4, 2392 cases, 58,547 participants) for the association between prediabetes and atrial fibrillation. The summary RR was 1.11 (95% CI: 1.04–1.18, I² = 61%, n = 4) per 20 mg/dl increase of blood glucose in relation to atrial fibrillation (3385 cases, 247,447 participants) and there was no evidence of nonlinearity, p_nonlinearity = 0.34.
This meta-analysis suggest that prediabetes and diabetes increase the risk of atrial fibrillation by 20% and 28%, respectively, and there is a dose-response relationship between increasing blood glucose and atrial fibrillation. Any further studies should clarify whether the association between diabetes and blood glucose and atrial fibrillation is independent of adiposity.
The Global Burden of Atrial Fibrillation and Stroke: A Systematic Review of the Clinical Epidemiology of Atrial Fibrillation in Asia
2017, Chest
Our previous review reported great variability in the incidence and prevalence of atrial fibrillation (AF) in non-Western cohorts, especially from Asian countries; in recent years, epidemiologic studies on AF have been increasingly reported from Asia.
The goal of this updated systematic review was to present the current knowledge base of AF epidemiology in Asian countries since our previous review. We also explored AF incidence and the risk of stroke in AF by using a meta-analysis, with I² testing the heterogeneity. Third, “real-world” antithrombotic drug use for ischemic stroke (IS) prevention associated with AF was studied.
A total of 58 articles from eight countries in Asia were included in the analysis. The summary annual incidence of AF was 5.38 (95% CI, 4.53-6.24; I² = 99.5%; n = 10) per 1,000 person-years, and the IS annual risk in AF was 3.0% (1.60%-4.95%; I² = 99.8%; n = 8) when meta-analysis was performed on hospital- and community-based studies. Hospital- and community-based AF prevalence ranged from 0.37% to 3.56% and 2.8% to 15.8%, respectively. IS prevalence in AF ranged from 1.9% to 6.0% and 0.36% to 28.3% in community- and hospital-based studies. Warfarin use in Chinese subjects is relatively low (1.0%-4.1%) compared with Japanese subjects (49.1%-70.0%) in community-based studies. The rate of warfarin use was < 50% in hospital-based studies.
The incidence and prevalence of AF have increased in recent years, although great variability still exists in Asian countries. Variability in annual IS risk in patients with AF was apparent between hospital- and community-based studies. However, the rate of warfarin use was < 50% in hospital studies from Asian countries.
Persistent prevalence of polycythemia among evacuees 4 years after the Great East Japan Earthquake: A follow-up study
2017, Preventive Medicine Reports
We previously reported that the lifestyle of evacuees significantly increased the prevalence of polycythemia compared with non-evacuees at an average of 1.6 years (2011–2012) from the previous annual health checkup before the Great East Japan Earthquake (GEJE). Here we analyzed how the prolonged evacuation affected the prevalence of polycythemia an average of 2.5 years (2013–2014) after the previous data. Subjects were individuals aged 40–90 years living in the vicinity of the Fukushima Daiichi Nuclear Power Plant in Fukushima Prefecture who had attended the annual health checkups since 2008. The prevalence of polycythemia and changes in its defining factors of red blood cell count (RBC), hemoglobin (Hb) level, hematocrit (Ht) level were compared between before and after the GEJE in 7713 individuals (3349 men and 4364 women) receiving follow-up examinations both 2011–2012 and 2013–2014. RBC, Hb levels and Ht levels in 2011–2012 were higher among evacuees than non-evacuees in both men and women. However, all levels in 2013–2014 were on the decline from those in 2011–2012. On the other hand, among evacuees, Hb and Ht levels continued to be higher than before the GEJE in both men and women evacuees. The prevalence of polycythemia, which was diagnosed if one of the defining factors was beyond the standard value, was significantly higher among evacuees than non-evacuees regardless of the presence or the absence of overweight/obesity, smoking, and hypertension. Therefore, prolonged evacuation is a cause of polycythemia even 3 to 4 years after the GEJE and regular health management of evacuees is important.

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Increased prevalence of atrial fibrillation after the Great East Japan Earthquake: Results from the Fukushima Health Management Survey

Abstract

Background

Methods and results

Conclusions

Introduction

Section snippets

Study subjects and design

Characteristics of the participants

Prevalence of AF before and after the earthquake

Discussion

Conclusions

Conflict of interest

Acknowledgments

Lancet

Lancet

Lancet

Am. J. Cardiol.

Int. J. Cardiol.

Int. J. Cardiol.

Int. J. Cardiol.

Study protocol for the Fukushima Health Management Survey

J. Epidemiol.

Acute pulmonary embolism after an earthquake in Japan

Semin. Thromb. Hemost.

Impact of the Great East Japan Earthquake on acute myocardial infarction in Fukushima prefecture

Disaster Med. Public Health Prep.

Efficacy of intrathoracic impedance and remote monitoring in patients with an implantable device after the 2011 Great East Japan Earthquake

Int. Heart J.

Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the anticoagulation and risk factors in atrial fibrillation (atria) study

JAMA

Prevalence, age, distribution, and gender of patients with atrial fibrillation. Analysis and implications

Arch. Intern. Med.