哮喘与心房颤动的关联——一项基于全国人群的巢式病例对照研究。
The association of asthma and atrial fibrillation--a nationwide population-based nested case-control study.
作者信息
Chan Wan-Leong, Yang Kun-Pin, Chao Tze-Fan, Huang Chin-Chou, Huang Po-Hsun, Chen Yu-Chun, Chen Tzeng-Ji, Lin Shing-Jong, Chen Jaw-Wen, Leu Hsin-Bang
机构信息
Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
出版信息
Int J Cardiol. 2014 Sep 20;176(2):464-9. doi: 10.1016/j.ijcard.2014.07.087. Epub 2014 Aug 1.
BACKGROUND
Asthma and atrial fibrillation (AF) have been reported to be related to an increased risk of cardiovascular events. However, the relationship between asthma and AF has not been fully elucidated. The purpose of this study was to examine the association between asthma and AF risk.
METHODS
We conducted a population-based nested case-control study including a total of 7439 newly-diagnosed adult patients with AF and 10,075 age-, gender-, comorbidity-, and cohort entry date-matched subjects without AF from the Taiwan National Health Insurance database. Exposure to asthma as well as medications including bronchodilators and corticosteroid before the index date was evaluated to investigate the association between AF and asthma as well as concurrent medications.
RESULTS
AF patients were 1.2 times (adjusted OR 1.2, 95% CI 1.109-1.298) more likely to be associated with a future occurrence of asthma independent of comorbidities and treatment with corticosteroids and bronchodilator. In addition, the risks of new-onset AF were significantly higher among current users of inhaled corticosteroid, oral corticosteroids, and bronchodilators. Newly users (within 6 months) have the highest risk (inhaled corticosteroid: OR, 2.13; 95% CI, 1.226-3.701, P=0.007; oral corticosteroid: OR, 1.932; 95% CI, 1.66-2.25, P<0.001; non-steroid bronchodilator: OR, 2.849; 95% CI, 2.48-3.273, P<0.001). A graded association with AF risk was also observed among subjects treated with corticosteroid (inhaled and systemic administration) and bronchodilators. New users (within 6 months) of these medications had the highest risk of AF (ICS: OR, 2.13; 95% CI, 1.226-3.701, P=0.007; oral corticosteroid: OR, 1.932; 95% CI, 1.66-2.25, P<0.001; non-steroid bronchodilator: OR, 2.849; 95% CI, 2.48-3.273, P<0.001). A graded association with AF risk was also observed among subjects treated with ICS or bronchodilator.
CONCLUSIONS
Asthma was associated with an increased risk of developing future AF.
背景
据报道，哮喘和心房颤动（AF）与心血管事件风险增加有关。然而，哮喘与AF之间的关系尚未完全阐明。本研究的目的是探讨哮喘与AF风险之间的关联。
方法
我们进行了一项基于人群的巢式病例对照研究，共纳入了7439例新诊断的成年AF患者以及10075例年龄、性别、合并症和队列入组日期相匹配的无AF受试者，数据来自台湾国民健康保险数据库。评估在索引日期之前是否暴露于哮喘以及包括支气管扩张剂和皮质类固醇在内的药物，以研究AF与哮喘以及同时使用药物之间的关联。
结果
AF患者发生未来哮喘的可能性是对照组的1.2倍（校正比值比1.2，95%可信区间1.109-1.298），且不受合并症以及皮质类固醇和支气管扩张剂治疗的影响。此外，吸入性皮质类固醇、口服皮质类固醇和支气管扩张剂的当前使用者发生新发AF的风险显著更高。新使用者（6个月内）风险最高（吸入性皮质类固醇：比值比，2.13；95%可信区间，1.226-3.701，P=0.007；口服皮质类固醇：比值比，1.932；95%可信区间，1.66-2.25，P<0.001；非类固醇支气管扩张剂：比值比，2.849；95%可信区间，2.48-3.273，P<0.001）。在接受皮质类固醇（吸入和全身给药）和支气管扩张剂治疗的受试者中，也观察到与AF风险的分级关联。这些药物的新使用者（6个月内）AF风险最高（吸入性皮质类固醇：比值比，2.13；95%可信区间，1.226-3.701，P=0.007；口服皮质类固醇：比值比，1.932；95%可信区间，1.66-2.25，P<0.001；非类固醇支气管扩张剂：比值比，2.849；95%可信区间，2.48-3.273，P<0.001）。在接受吸入性皮质类固醇或支气管扩张剂治疗的受试者中，也观察到与AF风险的分级关联。
结论
哮喘与未来发生AF的风险增加有关。
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