Center for Arrhythmia Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Am Coll Cardiol. 2010 May 25;55(21):2319-27. doi: 10.1016/j.jacc.2010.02.029.
The purpose of this study was to characterize the relationship between changes in body mass index (BMI) and incident atrial fibrillation (AF) in a large cohort of women.
Obesity and AF are increasing public health problems. The importance of dynamic obesity-associated AF risk is uncertain, and mediators are not well characterized.
Cases of AF were confirmed by medical record review in 34,309 participants in the Women's Health Study. Baseline and updated measures of BMI were obtained from periodic questionnaires.
During 12.9 +/- 1.9 years of follow-up, 834 AF events were confirmed. BMI was linearly associated with AF risk, with a 4.7% (95% confidence interval [CI]: 3.4 to 6.1, p < 0.0001) increase in risk with each kilogram per square meter. Adjustment for inflammatory markers minimally attenuated this risk. When updated measures of BMI were used to estimate dynamic risk, overweight (hazard ratio [HR]: 1.22; 95% CI: 1.02 to 1.45, p = 0.03), and obesity (HR: 1.65; 95% CI: 1.36 to 2.00; p < 0.0001) were associated with adjusted short-term increases in AF risk. Participants becoming obese during the first 60 months had a 41% adjusted increase in risk of the development of AF (p = 0.02) compared with those maintaining BMI <30 kg/m(2). The prevalence of overweight and obesity increased over time. The adjusted proportion of incident AF attributable to short-term elevations in BMI was substantial (18.3%).
In this population of apparently healthy women, BMI was associated with short- and long-term increases in AF risk, accounting for a large proportion of incident AF independent of traditional risk factors. A strategy of weight control may reduce the increasing incidence of AF. (Women's Health Study [WHS]: A Randomized Trial of Low-Dose Aspirin and Vitamin E in the Primary Prevention of Cardiovascular Disease and Cancer; NCT00000479).
本研究旨在描述大量女性人群中体重指数（BMI）变化与心房颤动（AF）事件发生之间的关系。
肥胖和 AF 是日益严重的公共健康问题。动态肥胖相关 AF 风险的重要性尚不确定，且其介导因素尚不清楚。
通过医疗记录回顾，在 Women's Health Study 中的 34309 名参与者中确诊 AF 病例。通过定期问卷调查获得 BMI 的基线和更新测量值。
在 12.9 +/- 1.9 年的随访期间，共确诊 834 例 AF 事件。BMI 与 AF 风险呈线性相关，每平方米增加 1 公斤，风险增加 4.7%（95%置信区间[CI]：3.4 至 6.1，p < 0.0001）。调整炎症标志物后，该风险略有降低。当使用 BMI 的更新测量值来估计动态风险时，超重（风险比[HR]：1.22；95%CI：1.02 至 1.45，p = 0.03）和肥胖（HR：1.65；95%CI：1.36 至 2.00；p < 0.0001）与 AF 短期风险的调整后增加相关。在前 60 个月内肥胖的参与者发生 AF 的风险增加了 41%（p = 0.02），而 BMI <30 kg/m(2)的参与者则没有增加。超重和肥胖的患病率随时间推移而增加。BMI 短期升高导致的 AF 发生率的调整比例相当大（18.3%）。
在本研究中，该人群中 BMI 与 AF 风险的短期和长期增加相关，独立于传统危险因素，占 AF 发病的很大比例。控制体重的策略可能会降低不断增加的 AF 发病率。（Women's Health Study [WHS]：低剂量阿司匹林和维生素 E 用于心血管疾病和癌症一级预防的随机试验；NCT00000479）。
