肥胖指标对男性和女性心房颤动风险的独立影响：一项涉及 50 万人的研究。
Independent effects of adiposity measures on risk of atrial fibrillation in men and women: a study of 0.5 million individuals.
机构信息
Nuffield Department of Population Health, University of Oxford, Oxford, UK.
MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
出版信息
Int J Epidemiol. 2022 Jun 13;51(3):984-995. doi: 10.1093/ije/dyab184.
BACKGROUND
Atrial fibrillation (AF) has a higher prevalence in men than in women and is associated with measures of adiposity and lean mass (LM). However, it remains uncertain whether the risks of AF associated with these measures vary by sex.
METHODS
Among 477 904 UK Biobank participants aged 40-69 without prior AF, 23 134 incident AF cases were identified (14 400 men, 8734 women; median follow-up 11.1 years). Cox proportional hazards models were used to estimate the covariate adjusted hazard ratios (HRs) describing the association of AF with weight, measures of adiposity [fat mass (FM), waist circumference (WC)] and LM, and their independent relevance, by sex.
RESULTS
Weight and WC were independently associated with risk of AF [HR: 1.25 (1.23-1.27) per 10 kg, HR: 1.11 (1.09-1.14) per 10 cm, respectively], with comparable effects in both sexes. The association with weight was principally driven by LM, which, per 5 kg, conferred double the risk of AF compared with FM when mutually adjusted [HR: 1.20 (1.19-1.21), HR: 1.10 (1.09-1.11), respectively]; however, the effect of LM was weaker in men than in women (p-interaction = 4.3 x 10-9). Comparing the relative effects of LM, FM and WC identified different patterns within each sex; LM was the strongest predictor for both, whereas WC was stronger than FM in men but not in women.
CONCLUSIONS
LM and FM (as constituents of weight) and WC are risk factors for AF. However, the independent relevance of general adiposity for AF was more limited in men than in women. The relevance of both WC and LM suggests a potentially important role for visceral adiposity and muscle mass in AF development.
背景
心房颤动（AF）在男性中的患病率高于女性，与肥胖和瘦体重（LM）的指标有关。然而，目前尚不确定与这些指标相关的 AF 风险是否因性别而异。
方法
在没有先前 AF 的 477904 名英国生物库参与者中，确定了 23134 例新发 AF 病例（男性 14400 例，女性 8734 例；中位随访时间 11.1 年）。使用 Cox 比例风险模型估计描述 AF 与体重、肥胖指标[脂肪量（FM）、腰围（WC）]和 LM 之间关联的协变量调整后的风险比（HRs），并按性别评估其独立性。
结果
体重和 WC 与 AF 风险独立相关[每增加 10kg 的 HR：1.25（1.23-1.27），每增加 10cm 的 HR：1.11（1.09-1.14）]，两性之间的效果相当。与体重的关联主要由 LM 驱动，当相互调整时，每增加 5kg，LM 导致 AF 的风险增加一倍，而 FM 则增加一倍[HR：1.20（1.19-1.21），HR：1.10（1.09-1.11）]；然而，LM 的影响在男性中弱于女性（p 交互作用=4.3x10-9）。比较 LM、FM 和 WC 的相对效应，在每个性别中都确定了不同的模式；LM 是两者的最强预测因子，而在男性中 WC 比 FM 更强，但在女性中则不然。
结论
LM、FM（体重的组成部分）和 WC 是 AF 的危险因素。然而，一般肥胖对 AF 的独立相关性在男性中比女性中更为有限。WC 和 LM 的相关性都表明内脏脂肪和肌肉量在 AF 发展中可能起着重要作用。
Zotero 插件