Lee HyunJung, Choi Eue-Keun, Lee Seung-Hwan, Han Kyung-Do, Rhee Tae-Min, Park Chan-Soon, Lee So-Ryoung, Choe Won-Seok, Lim Woo-Hyun, Kang Si-Hyuck, Cha Myung-Jin, Oh Seil
Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Int J Cardiol. 2017 Aug 1;240:221-227. doi: 10.1016/j.ijcard.2017.03.103. Epub 2017 Mar 28.
Metabolically healthy obese (MHO) individuals are reported to have a marginal increase in cardiovascular risk; however, their atrial fibrillation (AF) risk is unclear. We aimed to assess AF risk in MHO individuals and identify whether AF development is associated with obesity or influenced by metabolic comorbidities.
A retrospective cohort of 389,321 individuals (age, 45.6±14.5years; male, 52.1%) was extracted from the Korean National Health Insurance sample database between 2004 and 2006 and followed-up for new-onset AF until 2013. Subjects with diabetes mellitus, hypertension, and/or dyslipidemia were classified as "metabolically unhealthy." The cohort was stratified into four groups according to obesity and metabolic healthiness: metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), MHO, and metabolically unhealthy obese (MUO).
AF was newly diagnosed in 5106 (1.3%) individuals during a mean follow-up of 7.5±1.5years. The AF incidence rates for the MHNO, MUNO, MHO, and MUO groups were 0.76, 2.66, 1.10, and 2.88 per 1000 person-years, respectively. Compared with the MHNO group, the MHO group had increased AF risk (adjusted hazard ratio, 1.30; 95% CI, 1.14-1.48) on multivariate analysis. One fourth of the MHO cohort became metabolically unhealthy, contributing to increased AF risk. Obesity was an independent risk factor for AF, and increased AF risk by 20%. Metabolic unhealthiness increased AF risk by around 40%, and of its components, hypertension contributed the most.
MHO individuals are at increased risk for AF development, and obesity was independently associated with elevated AF risk.
据报道，代谢健康的肥胖（MHO）个体心血管风险略有增加；然而，他们患心房颤动（AF）的风险尚不清楚。我们旨在评估MHO个体的AF风险，并确定AF的发生是否与肥胖相关或受代谢合并症影响。
从2004年至2006年的韩国国民健康保险样本数据库中提取了389321名个体（年龄45.6±14.5岁；男性52.1%）的回顾性队列，并随访至2013年新发AF情况。患有糖尿病、高血压和/或血脂异常的受试者被归类为“代谢不健康”。根据肥胖和代谢健康状况，该队列被分为四组：代谢健康的非肥胖（MHNO）、代谢不健康的非肥胖（MUNO）、MHO和代谢不健康的肥胖（MUO）。
在平均7.5±1.5年的随访期间，5106名（1.3%）个体新诊断出AF。MHNO、MUNO、MHO和MUO组的AF发病率分别为每1000人年0.76、2.66、1.10和2.88。多因素分析显示，与MHNO组相比，MHO组的AF风险增加（调整后风险比，1.30；95%CI，1.14-1.48）。四分之一的MHO队列变得代谢不健康，导致AF风险增加。肥胖是AF的独立危险因素，使AF风险增加20%。代谢不健康使AF风险增加约40%，其中高血压贡献最大。
MHO个体发生AF的风险增加，肥胖与AF风险升高独立相关。
