Department of Public Health, Dokkyo Medical University School of Medicine.
Ibaraki Health Plaza.
J Atheroscler Thromb. 2021 Mar 1;28(3):241-248. doi: 10.5551/jat.53629. Epub 2020 Jun 18.
The association between atrial fibrillation (AF) and risk of stroke mortality among men and women without traditional cerebrocardiovascular risk factors (TCVRFs) is unclear. This study aimed to determine whether AF was a risk factor for stroke and total cardiovascular disease mortality among individuals without TCVRFs.
A total of 90,629 Japanese subjects from the Ibaraki Prefectural Health Study aged 40-79 years, with and without TCVRFs, were studied from 1993 to 2013. Hazard ratios (HRs) were calculated using the Cox proportional hazard regression model stratified by sex and the presence of TCVRFs. Covariates were age, systolic blood pressure, anti-hypertensive medication use, and serum total cholesterol levels. A standard 12-lead electrocardiogram at rest was used to screen AF. Cause-specific mortality was classified according to the International Classification of Disease code.
Compared with participants without AF, multivariable-adjusted hazard ratios (with 95% confidence intervals) for stroke mortality among participants without TCVRFs were 4.3 (1.1-17.8) and 15.0 (5.5-40.8) for men and women with AF, respectively. HRs for total cardiovascular disease mortality were 6.2 (2.8-14.2) for men and 10.7 (4.8-24.1) for women. For participants with TCVRFs, multivariable-adjusted HRs for stroke mortality were 3.1 (2.2-4.6) and 4.3 (2.6-7.3), whereas HRs for total cardiovascular disease mortality were 2.9 (2.2-3.8) and 3.5 (2.4-5.1) for men and women, respectively.
AF was found to be an independent risk factor for stroke and total cardiovascular mortality even in individuals without other TCVRFs.
在没有传统心脑血管危险因素（TCVRFs）的男性和女性中，心房颤动（AF）与中风死亡率之间的关联尚不清楚。本研究旨在确定 AF 是否是无 TCVRFs 个体中风和全因心血管疾病死亡率的危险因素。
本研究共纳入了来自日本茨城县健康研究的 90629 名年龄在 40-79 岁的受试者，分为有和无 TCVRFs 两组，从 1993 年至 2013 年进行随访。使用 Cox 比例风险回归模型，按照性别和 TCVRFs 的存在情况进行分层，计算风险比（HR）。协变量为年龄、收缩压、降压药物使用和血清总胆固醇水平。使用标准的静息 12 导联心电图筛查 AF。根据国际疾病分类代码对特定原因的死亡率进行分类。
与无 AF 的参与者相比，无 TCVRFs 的男性和女性 AF 患者的多变量调整后的中风死亡率的风险比（95%置信区间）分别为 4.3（1.1-17.8）和 15.0（5.5-40.8）。男性和女性的全因心血管疾病死亡率的 HR 分别为 6.2（2.8-14.2）和 10.7（4.8-24.1）。对于有 TCVRFs 的参与者，多变量调整后的中风死亡率的 HR 分别为 3.1（2.2-4.6）和 4.3（2.6-7.3），而全因心血管疾病死亡率的 HR 分别为 2.9（2.2-3.8）和 3.5（2.4-5.1）。
即使在没有其他 TCVRFs 的个体中，AF 也被发现是中风和全因心血管死亡率的独立危险因素。
