Kamil-Rosenberg Shirit, Kokkinos Peter, Grune de Souza E Silva Christina, Yee Win Leth Shwe, Abella Joshua, Chan Khin, Myers Jonathan
Cardiology Division, Veterans Affairs Palo Alto Health Care System and Stanford University, Stanford, CA, United States.
Cardiology Division, Veterans Affairs Medical Center, Washington, DC and Georgetown University School of Medicine, Washington, DC, United States.
Int J Cardiol Heart Vasc. 2020 Oct 27;31:100663. doi: 10.1016/j.ijcha.2020.100663. eCollection 2020 Dec.
The interaction between cardiorespiratory fitness (CRF) and incidence of atrial fibrillation (AF) and the interaction between obesity and incidence of AF have been explored separately. Therefore, we evaluated the association between CRF, body mass index (BMI), and risk of developing AF in a cohort of middle-aged and older US Veterans.
Symptom limited exercise tests (ETT) were conducted among 16,397 Veterans (97% male) from January 9,1987 to December 31,2017. No history of AF was evident at the time of the ETTs. CRF was expressed as quartiles of peak metabolic equivalents (METs) achieved within each age decile. Weight status was classified as normal (BMI < 25 kg/m), overweight (BMI 25-30 kg/m), obese (BMI 30-35 kg/m), or severely obese (BMI > 35 kg/m). Multivariable Cox proportional hazards regression models were used to compare the association between BMI, CRF categories, and incidence of AF.
Over a median follow-up of 10.7 years, 2,155 (13.1%) developed AF. Obese and severely obese subjects had 13% and 32% higher risks for incidence of AF, respectively, vs. normal weight subjects. Overweight and obese subjects in the most fit quartile had 50% decline in AF risk compared to the least-fit subjects. Severely obese subjects had marked increases in AF risk (~50-60%) regardless of fitness level. Risk of developing AF increases with higher BMI and lower CRF.
Improving CRF should be advocated when assessing those at risk for developing AF.
心肺适能（CRF）与心房颤动（AF）发病率之间的相互作用以及肥胖与AF发病率之间的相互作用已分别进行了研究。因此，我们在一组美国中老年退伍军人中评估了CRF、体重指数（BMI）与发生AF风险之间的关联。
1987年1月9日至2017年12月31日期间，对16397名退伍军人（97%为男性）进行了症状限制性运动试验（ETT）。在进行ETT时，这些人无AF病史。CRF以每个年龄十分位数内达到的峰值代谢当量（METs）四分位数表示。体重状况分为正常（BMI<25kg/m²）、超重（BMI 25-30kg/m²）、肥胖（BMI 30-35kg/m²）或重度肥胖（BMI>35kg/m²）。采用多变量Cox比例风险回归模型比较BMI、CRF类别与AF发病率之间的关联。
在中位随访10.7年期间，2155人（13.1%）发生了AF。与正常体重受试者相比，肥胖和重度肥胖受试者发生AF的风险分别高13%和32%。最健康四分位数中的超重和肥胖受试者与最不健康受试者相比，AF风险降低了50%。无论健康水平如何，重度肥胖受试者的AF风险均显著增加（约50-60%）。发生AF的风险随着BMI升高和CRF降低而增加。
在评估有发生AF风险的人群时，应提倡改善CRF。
