Framingham Heart Study, MA 01702-5803, USA.
Circulation. 2010 Feb 9;121(5):667-74. doi: 10.1161/CIRCULATIONAHA.109.885806. Epub 2010 Jan 25.
Increased left atrial diameter (LAD) is associated with elevated risk of atrial fibrillation (AF) and cardiovascular disease. Information is limited regarding the short- or long-term correlates of LAD.
We evaluated clinical correlates of LAD for a 16-year period in 4403 Framingham Study participants (mean age, 45 years; 52% women; median observations/participant=3) using multilevel modeling. We related age, sex, body mass index (BMI), systolic and diastolic blood pressure (BP), diabetes, and antihypertensive treatment to LAD. Sex-specific growth curves for LAD were estimated for individuals with low, intermediate, and high risk factor burden. We also related risk factors to changes in LAD during a 4-year period in 3365 participants. Age, male sex (3.83 mm compared to women), greater BMI, higher systolic BP (0.24 mm per 10 mm Hg increment), and antihypertensive treatment (0.54 mm) were associated positively with LAD (P<0.001). Men had a greater increase in LAD with BMI than women (2.02 versus 1.77 mm in women, per 5-unit increment), and individuals receiving antihypertensive treatment experienced a greater increase in LAD with age (0.95 versus 0.63 mm per 10-year age increment) when compared with those not receiving antihypertensive treatment. Overall, greater risk factor burden was positively associated with LAD. These risk factors were also associated positively with 4-year change in LAD (P<0.001).
Our longitudinal study of a large community-based sample identified higher BP and greater BMI as key modifiable correlates of LAD, suggesting that maintaining optimal levels of these risk factors through the life course may prevent atrial remodeling and AF.
左心房直径（LAD）增大与心房颤动（AF）和心血管疾病的风险增加有关。关于 LAD 的短期或长期相关性的信息有限。
我们使用多层次模型评估了 4403 名弗雷明汉研究参与者（平均年龄 45 岁；52%为女性；中位数观察/参与者=3）在 16 年内 LAD 的临床相关性。我们将年龄、性别、体重指数（BMI）、收缩压和舒张压（BP）、糖尿病和降压治疗与 LAD 相关联。对于低、中、高危因素负担的个体，估计了 LAD 的性别特异性生长曲线。我们还将危险因素与 3365 名参与者在 4 年内 LAD 的变化相关联。年龄、男性（与女性相比为 3.83 毫米）、更大的 BMI、更高的收缩压（每 10 毫米汞柱增加 0.24 毫米）和降压治疗（0.54 毫米）与 LAD 呈正相关（P<0.001）。与女性相比，男性的 BMI 与 LAD 增加更大（女性每增加 5 个单位，LAD 增加 2.02 毫米，女性增加 1.77 毫米），与未接受降压治疗的患者相比，接受降压治疗的患者随着年龄的增长，LAD 的增加更大（每增加 10 年，LAD 增加 0.95 毫米，而不是 0.63 毫米）。总的来说，更大的危险因素负担与 LAD 呈正相关。这些危险因素也与 4 年内 LAD 的变化呈正相关（P<0.001）。
我们对大型社区样本的纵向研究确定了更高的 BP 和更大的 BMI 是 LAD 的关键可改变的相关性，这表明通过整个生命周期保持这些风险因素的最佳水平可能预防心房重构和 AF。
