Atrial fibrillation: Stress, insomnia linked to AFib after menopause

Evan Walker
Evan Walker TheMediTary.Com |
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Researchers say stress can raise the rise of atrial fibrillation in older women. Igor Alecsander/Getty Images
  • The association between psychosocial factors and atrial fibrillation is not well understood.
  • Insomnia and stressful life events were most strongly associated with atrial fibrillation in a new study.
  • Researchers said women are far more likely to experience fatigue and weakness from AFib than men.

In a new study, researchers used insights from the Women’s Health Initiative research to look at risk factors for atrial fibrillation (AFib).

They analyzed factors contributing to the development of AFib, including insomnia and stressful life events as well as psychosocial constructs such as optimism and social support.

Their findings were published today in the Journal of the American Heart Association.

The study included 83,736 women between 50 and 79, with an average age of nearly 64 years. There were 23,954 incidents of AFIB in the group with some participants having multiple incidents.

The participants were recruited between 1994 and 1998.

They completed a baseline questionnaire with demographics such as medical history, Health habits, social support, optimism, and insomnia.

  • Questions about stressful life events included illness, divorce, financial pressures, domestic abuse (verbal and physical), and the loss of a loved one.
  • Questions about sleeping habits focused on trouble falling asleep, waking up during the night, and overall sleep quality.
  • Questions about optimism included a general outlook on life, friends, a sense of optimism, and having help with household chores.

Participants also had an examination, including vital signs and laboratory testing.

The scientists determined the presence of atrial fibrillation through medical records via Medicare.

Researchers followed up with the participants for approximately 10 years after completion of the questionnaire and other initial requirements.

Some of the results of the study included:

  • For each additional point on the insomnia scale, there was a 4% higher likelihood of developing AFib.
  • For each additional point on the stressful life event scale, there was a 2% higher likelihood.
  • The development of atrial fibrillation was strongly linked to stressful life events and insomnia.

AFib primarily affects older adults and can lead to blood clots, stroke, heart failure, or cardiovascular complications. It is expected that more than 12 million people in the United States will develop the condition by 2030, according to the American Heart Association.

“We know stress is a big driver of AFib,” said Dr. Paul Drury, a cardiologist and associate medical director of electrophysiology at MemorialCare Saddleback Medical Center in California. “Stress is something we thought might cause AF, but this is the first time it has been documented.”

“The researchers saw a 3 to 5 percent increase in risk, so it isn’t a large increase,” Drury told Medical News Today. “But if we can reduce the chance of someone developing AFib, then we should try to do so. As cardiologists, we typically ask about high blood pressure and other heart-related conditions; however, this study shows that we should also ask about anxiety, stress, insomnia, and depression, which are all treatable conditions.”

“We may not be able to treat these conditions, but we can direct our patients to other resources such as counseling, psychiatrists, or support groups that can offer them help,” he added.

The researchers noted that stressful life events, poor sleep, and feelings such as depression, anxiety, or feeling overwhelmed are often interrelated.

Stressful life events, although significant and traumatic to an individual, might not be long-lasting and may not contribute to AFib, they noted.

They added that it can be challenging to know whether these factors accumulate gradually or increase to increase the risk of atrial fibrillation.

They said the findings highlight the need for mental well-being evaluations to be included with physical Health examinations.

“This important study evaluated a large cohort of post-menopausal women (the Women’s Health Initiative) and found that mental health-related risk factors were associated with increased incidence of atrial fibrillation, especially those with lower traditional AFib risk factors,” said Dr. Sarina van der Zee, a cardiac electrophysiologist and cardiologist at Providence Saint John’s Health Center in California.

“Stress in many forms is a known trigger for atrial fibrillation,” van der Zee told Medical News Today. “The stress response, including hormonal activation and inflammation, impacts the cardiovascular system directly and affects other aspects of health, including sleep, weight, and alcohol use, known to be atrial fibrillation risk factors.”

“Addressing stress with cardiovascular health is an important part of cardiology practice,” she added. “I strive in each visit to help patients identify specific links between stress and cardiovascular health and craft approaches to mitigate its impact.”

Women with atrial fibrillation have a higher risk of stroke and treatment complications, according to a report published in 2022. It is less prevalent in women, but more women live with AFib because they live longer, the report noted.

Women are also more symptomatic than men but are more likely to seek medical attention, according to a study published in Health">Nature Reviews Cardiology.

Symptoms of AFib in women include:

  • Racing heart
  • Palpitations
  • Shortness of breath
  • Chest pain

In addition, women may also experience fatigue and weakness.

“I haven’t seen symptoms differ based on gender,” Drury said. “Women tend to live longer and therefore they live longer with AFib. The problems that come up such as hypertension or problems taking blood thinners, or heart disease all develop more often as people age. I see the problems related to gender more than age.”

Women with AFib have a higher prevalence of hypertension and valvular heart disease and a lower prevalence of coronary heart disease than men.

“The study will encourage me to think about emotional drivers of AFib more than I have in the past,” said Drury.

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