Very Low Prevalence and Incidence of Atrial Fibrillation among Bolivian Forager-Farmers. Issue 1 (16th February 2021)

• Record Type: Journal Article
• Authors: Rowan, Christopher J.; Eskander, Michael A.; Seabright, Edmond; Rodriguez, Daniel Eid; Linares, Edhitt Cortez; Gutierrez, Raul Quispe; Adrian, Juan Copajira; Cummings, Daniel; Beheim, Bret; Tolstrup, Kirsten; Achrekar, Abinash; Kraft, Thomas; Michalik, David E.; Miyamoto, Michael I.; Allam, Adel H.; Wann, L. Samuel; Narula, Jagat; Trumble, Benjamin C.; Stieglitz, Jonathan; Thompson, Randall C.; Thomas, Gregory S.; Kaplan, Hillard S.; Gurven, Michael D.
• Is Part Of: Annals of global health. Volume 87:Issue 1(2021)
• Publication Date: 2021-02-16
• Subjects: 362.1
• DOI: 10.5334/aogh.3252
• Languages: English
• ISSNs: 2214-9996

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.