Christiansen Christian Fynbo, Christensen Steffen, Mehnert Frank, Cummings Steven R, Chapurlat Roland D, Sørensen Henrik Toft
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, DK-8200 Aarhus N, Denmark.
Arch Intern Med. 2009 Oct 12;169(18):1677-83. doi: 10.1001/archinternmed.2009.297.
Glucocorticoid use is associated with increased risk of myocardial infarction, stroke, and heart failure, but data are limited on the risk of atrial fibrillation or flutter. We examined whether glucocorticoid use is associated with the risk of atrial fibrillation or flutter.
For this population-based, case-control study, we identified all patients with a first hospital diagnosis of atrial fibrillation or flutter from January 1, 1999, through December 31, 2005, in Northern Denmark (population, 1.7 million). For each case we selected 10 population controls matched by age and sex. We obtained data on glucocorticoid prescriptions within 60 days (current users) or longer before the index date (former users), comorbidity, and medications from medical databases. We used conditional logistic regression to compute odds ratios (ORs), controlling for potential confounders.
Among 20,221 patients with atrial fibrillation or flutter, 1288 (6.4%) were current glucocorticoid users and 2375 (11.7%) were former users. Among 202,130 population controls, 5245 (2.6%) were current glucocorticoid users and 19 940 (9.9%) were former users. Current glucocorticoid use was associated with an increased risk of atrial fibrillation or flutter compared with never use (adjusted OR, 1.92; 95% confidence interval [CI], 1.79-2.06). Among new glucocorticoid users, the adjusted OR was 3.62 (95% CI, 3.11-4.22) and among long-term users it was 1.66 (95% CI, 1.53-1.80). The increased risk remained robust in patients with and without pulmonary and cardiovascular diseases. Former glucocorticoid use was not associated with increased risk (adjusted OR, 1.00; 95% CI, 0.96-1.06).
Current glucocorticoid use was associated with an almost 2-fold increased risk of atrial fibrillation or flutter.
使用糖皮质激素会增加心肌梗死、中风和心力衰竭的风险，但关于心房颤动或心房扑动风险的数据有限。我们研究了使用糖皮质激素是否与心房颤动或心房扑动的风险相关。
在这项基于人群的病例对照研究中，我们确定了1999年1月1日至2005年12月31日在丹麦北部（人口170万）首次因心房颤动或心房扑动而住院诊断的所有患者。对于每例病例，我们选择10名按年龄和性别匹配的人群对照。我们从医疗数据库中获取了索引日期前60天内（当前使用者）或更早（既往使用者）的糖皮质激素处方数据、合并症和用药情况。我们使用条件逻辑回归计算比值比（OR），并对潜在混杂因素进行控制。
在20221例心房颤动或心房扑动患者中，1288例（6.4%）为当前糖皮质激素使用者，2375例（11.7%）为既往使用者。在202130名人群对照中，5245例（2.6%）为当前糖皮质激素使用者，19940例（9.9%）为既往使用者。与从未使用相比，当前使用糖皮质激素与心房颤动或心房扑动风险增加相关（调整后的OR为1.92；95%置信区间[CI]为1.79 - 2.06）。在新的糖皮质激素使用者中，调整后的OR为3.62（95%CI为3.11 - 4.22），在长期使用者中为1.66（95%CI为1.53 - 1.80）。无论有无肺部和心血管疾病，风险增加情况均依然显著。既往使用糖皮质激素与风险增加无关（调整后的OR为1.00；95%CI为0.96 - 1.06）。
当前使用糖皮质激素与心房颤动或心房扑动风险增加近2倍相关。
