Ohsawa Masaki, Okamura Tomonori, Tanno Kozo, Ogasawara Kuniaki, Itai Kazuyoshi, Yonekura Yuki, Konishi Kazuki, Omama Shinichi, Miyamatsu Naomi, Turin Tanvir Chowdhury, Morino Yoshihiro, Itoh Tomonori, Onoda Toshiyuki, Sakata Kiyomi, Ishibashi Yasuhiro, Makita Shinji, Nakamura Motoyuki, Tanaka Fumitaka, Kuribayashi Toru, Ohta Mutsuko, Okayama Akira
Department of Internal Medicine, Iwate Medical University, Morioka, Japan; Department of Internal Medicine, Morioka Tsunagi Onsen Hospital, Morioka, Japan.
Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan.
J Epidemiol. 2017 Aug;27(8):360-367. doi: 10.1016/j.je.2016.08.012. Epub 2017 Apr 5.
The relative and absolute risks of stroke and heart failure attributable to atrial fibrillation (AF) have not been sufficiently examined.
A prospective study of 23,731 community-dwelling Japanese individuals was conducted. Participants were divided into two groups based on the presence or absence of prevalent AF (n = 338 and n = 23,393, respectively). Excess events (EE) due to AF and relative risks (RRs) determined using the non-AF group as the reference for incident stroke and heart failure were estimated using Poisson regression stratified by age groups (middle-aged: 40-69 years old; elderly: 70 years of age or older) after adjustment for sex and age.
There were 611 cases of stroke and 98 cases of heart failure during the observation period (131,088 person-years). AF contributed to a higher risk of stroke both in middle-aged individuals (EE 10.4 per 1000 person-years; RR 4.88; 95% confidence interval [CI], 2.88-8.29) and elderly individuals (EE 18.3 per 1000 person-years; RR 3.05; 95% CI, 2.05-4.54). AF also contributed to a higher risk of heart failure in middle-aged individuals (EE 3.7 per 1000 person-years; RR 8.18; 95% CI, 2.41-27.8) and elderly individuals (EE 15.4 per 1000 person-years; RR 7.82; 95% CI, 4.11-14.9). Results obtained from multivariate-adjusted analysis were similar (stroke: EE 8.9 per 1000 person-years; RR 4.40; 95% CI, 2.57-7.55 in middle-aged and EE 17.4 per 1000 person-years; RR 2.97; 95% CI, 1.99-4.43 in elderly individuals; heart failure: EE 3.1 per 1000 person-years; RR 7.22; 95% CI, 2.06-25.3 in middle-aged and EE 14.1 per 1000 person-years; RR 7.41; 95% CI, 3.86-14.2 in elderly individuals).
AF increased the risk of stroke by the same magnitude as that reported previously in Western countries. AF increased the RR of heart failure more than that in Western populations.
房颤（AF）所致中风和心力衰竭的相对及绝对风险尚未得到充分研究。
对23731名居住在社区的日本个体进行了一项前瞻性研究。参与者根据是否存在房颤分为两组（分别为n = 338和n = 23393）。以非房颤组作为参考，采用按年龄组（中年：40 - 69岁；老年：70岁及以上）分层的泊松回归，在对性别和年龄进行调整后，估计房颤导致的额外事件（EE）以及中风和心力衰竭的相对风险（RR）。
在观察期（131088人年）内，有611例中风病例和98例心力衰竭病例。房颤在中年个体（EE为每1000人年10.4；RR为4.88；95%置信区间[CI]，2.88 - 8.29）和老年个体（EE为每1000人年18.3；RR为3.05；95% CI，2.05 - 4.54）中均导致中风风险升高。房颤在中年个体（EE为每1000人年3.7；RR为8.18；95% CI，2.41 - 27.8）和老年个体（EE为每1000人年15.4；RR为7.82；95% CI，4.11 - 14.9）中也导致心力衰竭风险升高。多变量调整分析结果相似（中风：中年个体EE为每1000人年8.9；RR为4.40；95% CI，2.57 - 7.55，老年个体EE为每1000人年17.4；RR为2.97；95% CI，1.99 - 4.43；心力衰竭：中年个体EE为每1000人年3.1；RR为7.22；95% CI，2.06 - 25.3，老年个体EE为每1000人年14.1；RR为7.41；95% CI，3.86 - 14.2）。
房颤增加中风风险的幅度与西方国家先前报道的相同。房颤增加心力衰竭RR的幅度大于西方人群。
