Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, Utah.
Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, Utah; Stanford University, Department of Internal Medicine, Palo Alto, California.
Am J Cardiol. 2018 Nov 1;122(9):1489-1495. doi: 10.1016/j.amjcard.2018.07.031. Epub 2018 Aug 3.
There are a paucity of data regarding the role of gender and atrial fibrillation (AF) on cognitive decline and incidence of dementia. Such data may provide insight into the disproportionate incidence of dementia in women and may help identify high-risk characteristics to target for prevention. We examined patients who underwent coronary angiography at an Intermountain Healthcare Medical Center and enrolled in a prospective cardiovascular database. To be included, patients could not have a previous diagnosis of AF or dementia and had to have 5years of follow-up. Endpoints included incident AF and dementia. Study cohort consisted of 35,608 patients without a previous history of AF or dementia, with 14,377 (40.4%) being woman. Women had lower rates of hypertension, diabetes, coronary artery disease, and prior myocardial infarction, but higher rates of prior stroke. Men had a higher incidence of 5-year and long-term AF. However, women trended toward a higher incidence of 5-year and long-term dementia and stroke compared with men. In all groups of patients with and without AF, prior stroke predicted cognitive decline. In patients without a history of or development of AF, diabetes significantly increased risk of dementia. Women have higher rates of dementia over time than men, driven by higher baseline stroke rates and nontraditional cardiovascular risk factors. The higher dementia rates were in the setting of lower AF rates. However, in both men and women who develop AF, dementia rates are increased and do not show gender-based differences in risk.
关于性别和心房颤动 (AF) 在认知能力下降和痴呆发生率中的作用的数据很少。这些数据可能有助于深入了解女性痴呆发病率不成比例的原因，并有助于确定针对预防的高风险特征。我们检查了在 Intermountain Healthcare 医疗中心接受冠状动脉造影并参加前瞻性心血管数据库的患者。要被纳入，患者不能有 AF 或痴呆的先前诊断，并且必须有 5 年的随访。终点包括新发 AF 和痴呆。研究队列包括 35608 名无 AF 或痴呆既往史的患者，其中 14377 名（40.4%）为女性。女性的高血压、糖尿病、冠状动脉疾病和既往心肌梗死发生率较低，但既往中风发生率较高。男性的 5 年和长期 AF 发生率较高。然而，与男性相比，女性在 5 年和长期痴呆和中风的发生率上呈上升趋势。在有或无 AF 的所有患者组中，既往中风预测认知能力下降。在没有 AF 病史或发展的患者中，糖尿病显著增加了痴呆的风险。女性的痴呆发生率随着时间的推移呈上升趋势，原因是基线中风率较高和非传统心血管危险因素。痴呆发生率较高的原因是 AF 发生率较低。然而，在患有 AF 的男性和女性中，痴呆的发生率都增加了，并且风险没有基于性别的差异。
