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