Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA.
J Gen Intern Med. 2013 Feb;28(2):247-53. doi: 10.1007/s11606-012-2220-4. Epub 2012 Sep 13.
After an initial episode of atrial fibrillation (AF), AF may recur and become permanent. AF progression is associated with higher morbidity and mortality. Understanding the risk factors for permanent AF could help identify people who would benefit most from interventions.
To determine whether body mass index (BMI), diabetes, hypertension, and blood pressure levels are associated with permanent AF among people whose initial AF episode terminated.
Population-based inception cohort study.
Enrollees in Group Health, an integrated health care system, aged 30-84 with newly diagnosed AF in 2001-2004, whose initial AF terminated within 6 months and who had at least 6 months of subsequent follow-up (N = 1,385).
Clinical characteristics were determined from medical records. Permanent AF was determined from medical records and ECG and administrative databases. Permanent AF was defined as AF present on two separate occasions 6-36 months apart, without any documented sinus rhythm between the two occasions. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs).
Five-year cumulative incidence of permanent AF was 24 %. Compared with normal BMI (18.5-24.9 kg/m(2)), BMI levels of 25.0-29.9 (overweight), 30.0-34.9 (obese 1), 35.0-39.9 (obese 2), and ≥ 40.0 kg/m(2) (obese 3) were associated with HRs of permanent AF of 1.26 (95 % CI: 0.92, 1.72); 1.35 (0.96, 1.91); 1.50 (0.97, 2.33); and 1.79 (1.13, 2.84), adjusted for age, sex, diabetes, hypertension, blood pressure, coronary heart disease, valvular heart disease, heart failure, and prior stroke. Diabetes, hypertension, and blood pressure were not associated with permanent AF.
For people whose initial AF episode terminates, benefits of having lower BMI may include a lower risk of permanent AF. Risk of permanent AF was similar for people with and without diabetes or hypertension and across blood pressure levels.
在首次心房颤动（AF）发作后，AF 可能会复发并成为永久性的。AF 的进展与更高的发病率和死亡率相关。了解永久性 AF 的危险因素有助于确定最受益于干预的人群。
确定体重指数（BMI）、糖尿病、高血压和血压水平是否与初始 AF 发作在 6 个月内终止的人群中的永久性 AF 相关。
基于人群的发病队列研究。
参加 Group Health 的患者，这是一个综合医疗保健系统，年龄在 30-84 岁之间，2001-2004 年新诊断为 AF，其初始 AF 在 6 个月内终止，且随后有至少 6 个月的随访（N=1385）。
从病历中确定临床特征。永久性 AF 通过病历、心电图和行政数据库确定。永久性 AF 定义为两次相隔 6-36 个月的 AF 发作，两次发作之间没有任何记录的窦性节律。使用 Cox 比例风险模型估计调整后的风险比（HR）。
永久性 AF 的 5 年累积发生率为 24%。与正常 BMI（18.5-24.9 kg/m2）相比，BMI 水平为 25.0-29.9（超重）、30.0-34.9（肥胖 1）、35.0-39.9（肥胖 2）和≥40.0 kg/m2（肥胖 3）与永久性 AF 的 HR 分别为 1.26（95%CI：0.92，1.72）；1.35（0.96，1.91）；1.50（0.97，2.33）和 1.79（1.13，2.84），调整年龄、性别、糖尿病、高血压、血压、冠心病、瓣膜性心脏病、心力衰竭和既往中风。糖尿病、高血压和血压与永久性 AF 无关。
对于初始 AF 发作终止的患者，较低 BMI 的益处可能包括永久性 AF 的风险降低。有和没有糖尿病或高血压以及血压水平不同的患者，永久性 AF 的风险相似。
