ESC Congress 2026 Abstract · Oct 26, 2026
Lifestyle profile and adverse outcomes in atrial fibrillation: a modified life’s simple 7 (LS7) analysis from two prospective observational registries from europe and east Asia
By Tartaglia E, Rivera-Caravaca JM, Bucci T et al.
Background: Atrial fibrillation (AF) often coexists with an unfavorable lifestyle profile and cardiometabolic comorbidities. However, how these factors interact to shape risk stratification and outcomes in contemporary AF patients remains poorly defined. Purpose: To evaluate associations between lifestyle profile and the risk of adverse events in AF patients. Methods: Post-hoc analysis of two prospective registries from Europe and Asia. Lifestyle profile was assessed at baseline using a modified Life’s Simple 7 (LS7) score (range 0–14), based on seven domains: body mass index, blood pressure, total cholesterol, glucose metabolism, smoking status, physical activity, and alcohol consumption. Each metric was graded 0–2 points; patients were categorized as Ideal (10–14), Intermediate (5–9), or Poor (0–4), with non-ideal defined as Intermediate/Poor. Logistic regression was used to identify factors associated with non-ideal lifestyle. Cox regression estimated hazard ratios (HRs) and 95% CIs for adverse outcomes according to lifestyle profile. The primary outcome was a composite of all-cause death (ACD) and major adverse cardiovascular events (MACE). Secondary outcomes were individual components and major bleeding. Exploratory analyses evaluated individual MACE components (CV death, acute coronary syndrome, and thromboembolic events). Mediation analyses assessed the contribution of CHA2DS2-VASc-related comorbidities, and interaction analyses explored differences between European and Asian cohorts. Results: We included 4,052 AF patients, of whom 1,151 (28.4%) had an ideal, 2,727 (67.3%) an intermediate, and 174 (4.3%) a poor LS7 lifestyle profile. Compared with the ideal group, patients with intermediate/poor lifestyle were younger, less often female, and had higher cardiometabolic burden. On multivariable logistic regression, younger age, heart failure, hypertension, diabetes, and vascular disease were associated with non-ideal LS7 lifestyle, whereas prior thromboembolism was inversely associated. After a median follow-up of 721 (IQR 377–740) days, 425 primary outcomes occurred. Compared with the intermediate group, ideal LS7 lifestyle was associated with lower incidence of the composite outcome and ACD (Table 1). On univariable analysis, ideal lifestyle showed a lower risk of the composite outcome (HR 0.69, 95%CI 0.54–0.87) (Figure 1) and ACD (HR 0.58, 95%CI 0.42–0.79); these associations remained significant after age- and sex-adjustment but not after full adjustment. Mediation analyses showed that 53.5% of the association between non-ideal lifestyle and the primary outcome was explained by comorbidity burden. No significant interaction by cohort was observed. Conclusions: In AF patients, a non-ideal LS7 lifestyle profile was associated with increased risk of adverse events, largely mediated by cardiometabolic comorbidities. These findings highlight the role of lifestyle optimization in modulating risk in AF patients.