From the Division of General Internal Medicine, University of Alberta, Edmonton, Canada (F.A.M.).
Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada (L.Y., L.L.R., L.M.L.).
Stroke. 2019 Sep;50(9):2322-2328. doi: 10.1161/STROKEAHA.119.025124. Epub 2019 Jul 24.
Background and Purpose- Cryptogenic strokes are often the first clinical manifestation of undiagnosed atrial fibrillation (AF). We designed this study to test whether parental AF is a risk factor for stroke in young adults. Methods- Population-based cohort study using linked administrative databases from April 1, 1972 to March 31, 2016 in Manitoba, Canada for 325 333 offspring (age ≥18 years) with at least 1 linked parent (total 582 195 parents). We examined the association between parental history of AF and stroke or transient ischemic attack (TIA) in the offspring using multivariable Cox proportional hazards models. Results- Offspring median age at study entry was 18 years. During 5.533 million person-years of follow-up (mean 17 years), 8678 offspring had an incident stroke or TIA (5.2% of the 24 583 offspring with a parental history of AF compared with 2.5% of the 300 750 offspring with no parental history of AF), and 1430 were diagnosed with AF (1.9% versus 0.3%). Incidence rates for stroke/TIA were higher in offspring with a parental history of AF (195.0 versus 156.6 per 100 000 person-years). Parental AF was associated with elevated risk in offspring of stroke/TIA (hazard ratio 1.11; 95% CI, 1.04-1.18) or AF (hazard ratio 1.75; 95% CI, 1.55-1.97) and a higher frequency of other cardiovascular risk factors. After adjusting for demographics, region of residence, socioeconomic status, and other stroke risk factors in offspring, parental AF was associated with AF in their offspring in young adulthood (adjusted hazard ratio 1.61; 95% CI, 1.43-1.82); the association of parental AF with offspring stroke/TIA was attenuated (adjusted hazard ratio 1.05; 95% CI, 0.99-1.12) after adjusting for the other cardiovascular risk factors. Conclusions- Parental AF is associated with increased risk of AF and other cardiovascular risk factors in their offspring during early adulthood, resulting in increased stroke risk.
背景与目的- 隐源性卒中常常是未诊断的心房颤动（AF）的首发临床表现。我们设计本研究旨在检验父母 AF 是否是年轻人卒中的危险因素。
方法- 采用加拿大马尼托巴省 1972 年 4 月 1 日至 2016 年 3 月 31 日期间基于人群的队列研究，利用行政数据库进行数据链接，纳入至少有 1 位关联父母的 325333 名年龄≥18 岁的子女（共计 582195 位父母）。我们使用多变量 Cox 比例风险模型，检验父母 AF 史与子女卒中或短暂性脑缺血发作（TIA）之间的关联。
结果- 入组时子女的中位年龄为 18 岁。在 553.3 万人年（平均 17 年）的随访期间（24583 名子女的父母有 AF 史，占 5.2%；300750 名子女的父母无 AF 史，占 2.5%），8678 名子女发生了卒中或 TIA（24583 名子女的父母有 AF 史者中，卒中/TIA 的发生率为 195.0/10 万人年；300750 名子女的父母无 AF 史者中，卒中/TIA 的发生率为 156.6/10 万人年），1430 名子女被诊断为 AF（1.9% 比 0.3%）。有父母 AF 史的子女卒中/TIA 的发生率更高（195.0 比 156.6/10 万人年）。父母 AF 与子女卒中/TIA 风险增加相关（风险比 1.11；95%可信区间为 1.04-1.18）或 AF 风险增加相关（风险比 1.75；95%可信区间为 1.55-1.97），且与子女的其他心血管危险因素的频率较高相关。在调整了子女的人口统计学、居住地区、社会经济地位和其他卒中危险因素后，父母 AF 与子女在年轻成年时发生 AF 相关（校正风险比 1.61；95%可信区间为 1.43-1.82）；调整其他心血管危险因素后，父母 AF 与子女卒中/TIA 的关联减弱（校正风险比 1.05；95%可信区间为 0.99-1.12）。
结论- 父母 AF 与子女在成年早期 AF 及其他心血管危险因素风险增加相关，从而导致卒中风险增加。
