*Article* **Association between Cardiovascular Health and Incident Atrial Fibrillation in the General Japanese Population Aged** *≥***40 Years**

**Tetsuo Nishikawa 1,†, Yoshihiro Tanaka 2,3,†, Hayato Tada 1,\*, Toyonobu Tsuda 1, Takeshi Kato 1, Soichiro Usui 1, Kenji Sakata 1, Kenshi Hayashi 1, Masa-aki Kawashiri 1, Atsushi Hashiba <sup>4</sup> and Masayuki Takamura <sup>1</sup>**


**Abstract:** This study explores the association between lifestyle behavior and incident atrial fibrillation (AF) in the general Japanese population. Japanese residents aged ≥40 years undergoing a national health checkup in Kanazawa City were included. We hypothesized that better lifestyle behavior is associated with lower incidence of AF. Lifestyle behavior was evaluated by the total cardiovascular health (CVH) score (0 = poor to 14 = ideal), calculated as the sum of the individual scores on seven modifiable risk factors: smoking status, physical activity, obesity, patterns of eating schedule, blood pressure, total cholesterol, and blood glucose. The association between CVH and incident AF was assessed, adjusting for other factors. A total of 37,523 participants (mean age 72.3 ± 9.6 years, 36.8% men, and mean total CVH score 9 ± 1) were analyzed. During the median follow-up period of 5 years, 703 cases of incident AF were observed. Using a low CVH score as a reference, the upper group (ideal CVH group) had a significantly lower risk of incident AF (hazard ratio [HR] = 0.79, 95% confidence interval 0.65–0.96, *p* = 0.02), especially among those aged <75 years (HR = 0.68, 95% confidence interval 0.49–0.94, *p* = 0.02). Thus, ideal CVH is independently associated with a lower risk for incident AF, particularly in younger Japanese individuals (<75 years).

**Keywords:** cardiovascular health; atrial fibrillation; Japanese
