AFib can increase dementia risk by 21%, new evidence from Spain indicates.
- Atrial fibrillation is a
common arrhythmia, and experts are interested in the relationship between
atrial fibrillation and other conditions like dementia.
- Recent study results suggest
that atrial fibrillation increases the risk of dementia and that the risk
association is stronger for younger individuals.
- The results suggest the
importance of treating atrial fibrillation as soon as possible and
emphasizing possible preventative measures.
Atrial
fibrillation (AFib) affects
Recent
study findings regarding AFib and dementia risk
were presented at the European Heart Rhythm Association (EHRA) 2025.
The research — called
“Association between atrial fibrillation and dementia, with a particular focus
on early-onset dementia: A longitudinal population-based study in Catalonia,
Spain” — from medical institutions in Spain, involved over 2.5 million
participants, and researchers found that having AFib was a weak predictor of
dementia.
When looking at risk in various age groups,
participants with AFib were at a 21% greater risk for dementia if they were
below 70 years old.
The risk
was greatest for dementia diagnosis before age 65. In contrast, the associated
risk for dementia was no longer statistically significant for participants over
seventy.
This study
results have not yet been published in a peer-reviewed journal.
What
is the impact of AFib on dementia?
The authors of
this study noted that there are mixed results when it comes to AFib affecting
dementia risk, and that there is a lack of data focusing on the Mediterranean
population.
They also
noted that gaining more data about which subpopulations have the greatest
associations between AFib and dementia can help experts understand why and help
with finding specific, preventative strategies. Thus, they sought to “assess
the independent association between [atrial fibrillation] and incident
dementia.”
This study
was a population-based observational study among participants in Catalonia,
Spain. Researchers used data from the System for the Development of Research in
Primary Care. This system allowed researchers to look at vast anonymized data.
Researchers
used demographic records, ICD-10 codes, laboratory data, and drug prescription
data in their analyses. The ICD-10 codes and drug prescription data were used
to identify the cases of dementia.
All
participants were at least 45 years old. After excluding people who had
previous cognitive impairment or dementia, the overall analysis included
2,458,905 individuals.
The
researchers also conducted a separate analysis that further excluded
participants who had prevalent or incident stroke,
ultimately including 2,377,638 participants in this analysis.
The
average follow-up time with participants was 13 years. Of the study population,
3.25% had AFib. Throughout the follow-up, researchers found a greater crude
incidence of dementia among participants who had AFib, and the univariate
analysis showed AFib was a strong predictor of someone developing dementia.
However,
after they adjusted for potential confounders, AFib was only a weak predictor of
someone developing dementia.
When
looking at participants based on age, the risk for dementia in participants
with AFib decreased with increased age.
Of note,
once participants were older than 70, the risk for dementia associated with
AFib was no longer at a level that was statistically significant.
In participants under 70, AFib “independently
increased the risk of dementia by 21%.” Participants with AFib under seventy
were also at a 36% increased risk for early-onset dementia. For this study,
that meant getting a diagnosis of dementia before age 65.
Researchers
observed similar findings when excluding participants with baseline stroke or
those who experienced a stroke during the follow-up. In this group, AFib
appeared to increase the risk for early onset dementia by 52%.
Study
author Julian Rodriguez-Garcia, MD, from the Bellvitge
University Hospital, Hospitalet de Llobregat, Barcelona, Spain, highlighted the
following components of the findings to Medical News Today:
“Our study
highlights that [atrial fibrillation] is an independent predictor of dementia,
with a stronger association in individuals under 70 years of age, especially
for early-onset dementia. Notably, the association between [atrial
fibrillation] and dementia weakened in individuals over 70, suggesting that the
impact of [atrial fibrillation] may diminish as other factors contributing to
cognitive decline become more dominant in older age groups.”
What should researchers investigate next?
Since the full
study has not been published, this makes it challenging to examine the full
limitations of the work. Complete publication of the work will allow for a more
in-depth view of the findings.
However,
the study focused on individuals in Spain, so greater diversity in future
studies could be helpful, as well as focusing on other populations.
While
researchers were able to adjust for potential confounders, residual confounding
is likely still possible. They used codes and prescription data to confirm
dementia cases, but it is possible that they missed some cases of dementia or
that some participants received an incorrect diagnosis.
Additionally,
it is important to note that the research only describes an increased risk for
dementia, not that AFib causes dementia.
Paul Drury, MD, a board-certified cardiologist
and associate medical director of electrophysiology at MemorialCare Saddleback
Medical Center in Laguna Hills, CA, who was not involved in the study, noted to MNT that
“[t]here are interesting findings [in this study]; however, it is retrospective
and does not tease out which specific treatments patients received or other
comorbidities.”
“There
does however [appear to] be a much stronger association with dementia the
earlier a person is diagnosed with AFib, which implies that AFib has potential
mechanisms that can lead to dementia. Larger studies that involve more diverse
patient populations and are able to control for specific treatments such as
anticoagulation use, rate vs rhythm control or ablation will be needed to
confirm the causality of dementia from AFib,” Drury advised.
Rodriguez-Garcia
further noted that:
“Future
research should focus on understanding the underlying mechanisms by which
[atrial fibrillation] contributes to dementia, particularly in younger
individuals. Exploring how [atrial fibrillation] leads to changes in brain
structure, such as brain atrophy or microinfarcts, could offer new insights.
Additionally, longitudinal studies that assess the impact of early intervention
for [atrial fibrillation], including rhythm control and management of
cardiovascular risk factors, are needed to determine whether these strategies
can reduce dementia risk in the long term.”
Preventing AFib
may lower dementia risk
These study
results add to the understanding of the relationship between dementia and AFib
and drew on data from a very large study population.
Drury
noted that:
“Multiple
prior studies have shown an increased risk of dementia in patients with AFib.
Some small trials have shown the ability to decrease the risk of dementia with
more aggressive treatment such as cardiac ablation or chronic anticoagulation
therapy. This study supplements these prior findings, however discovering a way
to alter the risk of dementia in a young patient diagnosed with AFib is still
necessary.”
Overall,
these study results highlight how AFib may particularly increase the risk for
dementia in younger individuals.
“From a
clinical perspective,”, Rodriguez-Garcia, added, “our findings emphasize the
importance of actively managing [atrial fibrillation], particularly in younger
individuals.”
“While the
increased risk of dementia in those with [atrial fibrillation] is well-established,
preventing the onset of [atrial fibrillation] through cardiovascular health
management could significantly reduce the likelihood of cognitive decline later
in life,” he advised.
“Furthermore,
the association of [atrial fibrillation] with dementia in patients under 70
suggests that proactive monitoring for cognitive impairment in these
individuals could allow for early intervention. The findings also call for a
deeper exploration of how rhythm control strategies and other [atrial fibrillation]
treatments might potentially mitigate cognitive decline in affected patients,”
said Rodriguez-Garcia.
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