Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
JACC Clin Electrophysiol. 2020 Dec 14;6(13):1713-1720. doi: 10.1016/j.jacep.2020.08.008. Epub 2020 Oct 28.
This study sought to characterize the relationship between obesity and the risk of atrial fibrillation (AF) in diabetes.
Obesity is associated with increased risk of AF in the general population, but there is evidence that this relationship may differ in those with diabetes.
Cox proportional hazards models were used to examine the association between body mass index (BMI) and incident AF on study electrocardiogram in participants from the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial.
Among 10,074 ACCORD participants (age 62.7 ± 6.6 years, 38.7% women, 62.2% white), 8.4% were normal weight, 29.0% were overweight, 53.1% were obese, and 9.5% were severely obese. Participants with obesity and severe obesity had increased risks of AF compared with normal weight (hazard ratio [HR]: 1.91; 95% confidence interval [CI]: 1.03 to 3.93; and HR: 3.69; 95% CI: 1.79 to 8.22, respectively). There was a 51% increased risk of AF per SD (5.4 U) BMI increase. However, there was a sex and BMI interaction-in men, obesity and severe obesity were associated with a substantially increased AF risk (HR: 3.19; 95% CI: 1.27 to 7.31; and HR: 4.79; 95% CI: 2.11 to 11.93, respectively), whereas there was no statistically significant association in women.
In those with diabetes, obesity and severe obesity are associated with increased risk of AF, but there is an interaction between sex and BMI, such that elevated BMI appears to confer a much greater risk of AF in men than in women. Further studies exploring the differential effects of BMI on AF risk in men and women are needed.
本研究旨在探讨肥胖与糖尿病患者心房颤动（AF）风险之间的关系。
肥胖与普通人群中 AF 风险增加相关，但有证据表明，这种关系在糖尿病患者中可能有所不同。
使用 Cox 比例风险模型来检查 ACCORD（控制心血管风险行动中的糖尿病）试验中研究心电图上的体重指数（BMI）与新发 AF 之间的关联。
在 10074 名 ACCORD 参与者（年龄 62.7±6.6 岁，38.7%为女性，62.2%为白人）中，8.4%为正常体重，29.0%为超重，53.1%为肥胖，9.5%为重度肥胖。与正常体重相比，肥胖和重度肥胖患者的 AF 风险增加（风险比[HR]：1.91；95%置信区间[CI]：1.03 至 3.93；和 HR：3.69；95% CI：1.79 至 8.22）。BMI 每增加 1 个标准差（5.4 U），AF 的风险增加 51%。然而，存在性别和 BMI 交互作用——在男性中，肥胖和重度肥胖与 AF 风险显著增加相关（HR：3.19；95% CI：1.27 至 7.31；和 HR：4.79；95% CI：2.11 至 11.93），而女性中没有统计学意义上的关联。
在患有糖尿病的患者中，肥胖和重度肥胖与 AF 风险增加相关，但性别和 BMI 之间存在交互作用，即 BMI 升高似乎使男性发生 AF 的风险比女性高得多。需要进一步研究探索 BMI 对男性和女性 AF 风险的差异影响。
