Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
Department of Biostatistics, University of Washington, Seattle, WA, USA.
Vasc Health Risk Manag. 2021 Mar 11;17:95-102. doi: 10.2147/VHRM.S297720. eCollection 2021.
Endothelial dysfunction is associated with common risk factors for AF and has been implicated in the pathophysiology of atrial fibrillation (AF) through a variety of mechanisms. We determined the prospective association of brachial flow-mediated dilation (FMD) with incident AF among older adults.
We included 2027 Cardiovascular Health Study participants (mean age=78.3 years, male=39%, Black=17%) who underwent brachial FMD measurement at the 1997 to 1998 clinic visit. Incident AF was ascertained by study electrocardiograms, hospital discharge diagnosis coding and Medicare claims data. Cox regression models were used to examine the association between FMD and incident AF.
We identified 754 incident of AF cases (37%) over a median follow-up of 11.0 years. After adjusting for age, sex, race, height, weight, cardiovascular disease, cigarette smoking, hypertension, diabetes, kidney function, c-reactive protein, physical activity, alcohol consumption, and statins, the risk of AF did not differ according to brachial FMD response (4th vs 1st quartile hazard ratio (HR)=1.01, 95% confidence interval (CI): 0.81, 1.26; per FMD unit increment HR=1.01, 95% CI: 0.97, 1.05).
We found no relationship between brachial FMD and the risk of developing AF in this elderly cohort. Our findings suggest that the utility of brachial FMD as a risk marker for AF in older individuals is minimal.
内皮功能障碍与 AF 的常见危险因素相关，并通过多种机制被牵连到心房颤动（AF）的病理生理学中。我们确定了肱动脉血流介导的扩张（FMD）与老年人中 AF 事件的前瞻性关联。
我们纳入了 2027 名心血管健康研究参与者（平均年龄 78.3 岁，男性 39%，黑人 17%），他们在 1997 年至 1998 年的临床就诊时接受了肱动脉 FMD 测量。通过研究心电图、医院出院诊断编码和医疗保险索赔数据确定 AF 事件。Cox 回归模型用于检查 FMD 与 AF 事件的关联。
在中位数为 11.0 年的随访期间，我们确定了 754 例 AF 事件（37%）。在调整年龄、性别、种族、身高、体重、心血管疾病、吸烟、高血压、糖尿病、肾功能、C 反应蛋白、体力活动、饮酒和他汀类药物后，肱动脉 FMD 反应（第 4 四分位与第 1 四分位的 HR=1.01，95%CI：0.81，1.26；每 FMD 单位增加 HR=1.01，95%CI：0.97，1.05）与 AF 的风险无差异。
我们在这个老年队列中没有发现肱动脉 FMD 与 AF 风险之间的关系。我们的研究结果表明，肱动脉 FMD 作为老年人 AF 风险标志物的效用很小。
