性别特异性危险因素与女性新发心房颤动风险的关联。

Association Between Sex-Specific Risk Factors and Risk of New-Onset Atrial Fibrillation Among Women.

机构信息

Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.

Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.

出版信息

JAMA Netw Open. 2022 Sep 1;5(9):e2229716. doi: 10.1001/jamanetworkopen.2022.29716.

DOI:10.1001/jamanetworkopen.2022.29716

PMID:36048441

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9437751/

Abstract

IMPORTANCE

Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide, with different epidemiological and pathophysiological processes for women vs men and a poorer prognosis for women. Further investigation of sex-specific risk factors associated with AF development in women is warranted.

OBJECTIVE

To investigate the linear and potential nonlinear associations between sex-specific risk factors and the risk of new-onset AF in women.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study obtained data from the 2006 to 2010 UK Biobank study, a cohort of more than 500 000 participants aged 40 to 69 years. Participants were women without AF and history of hysterectomy and/or bilateral oophorectomy at baseline. Median follow-up period for AF onset was 11.6 years, and follow-up ended on October 3, 2020.

EXPOSURES

Self-reported, sex-specific risk factors, including age at menarche, history of irregular menstrual cycle, menopause status, age at menopause, years after menopause, age at first live birth, years after last birth, history of spontaneous miscarriages, history of stillbirths, number of live births, and total reproductive years.

MAIN OUTCOMES AND MEASURES

The primary outcome was new-onset AF, which was defined by the use of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code I48.

RESULTS

A total of 235 191 women (mean [SD] age, 55.7 [8.1] years) were included in the present study. During follow-up, 4629 (2.0%) women experienced new-onset AF. In multivariable-adjusted models, history of irregular menstrual cycle was associated with higher AF risk (hazard ratio [HR], 1.34; 95% CI, 1.01-1.79). Both early menarche (age 7-11 years; HR, 1.10 [95% CI, 1.00-1.21]) and late menarche (age 13-18 years; HR, 1.08 [95% CI, 1.00-1.17]) were associated with AF incidence. Early menopause (age 35-44 years; HR, 1.24 [95% CI, 1.10-1.39]) and delayed menopause (age ≥60 years; HR, 1.34 [95% CI, 1.10-1.78]) were associated with higher risk of AF. Compared with women with 1 to 2 live births, those with 0 live births (HR, 1.13; 95% CI, 1.04-1.24) or 7 or more live births (HR, 1.67; 95% CI, 1.03-2.70) both had significantly higher AF risk.

CONCLUSIONS AND RELEVANCE

Results of this study suggest that irregular menstrual cycles, nulliparity, and multiparity were associated with higher risk of new-onset AF among women. The results highlight the importance of taking into account the reproductive history of women in devising screening strategies for AF prevention.

摘要

重要性

心房颤动（AF）是全球最常见的心律失常，女性与男性的流行病学和病理生理学过程不同，女性的预后较差。有必要进一步研究与女性 AF 发生相关的特定于性别的风险因素。

目的

研究特定于性别的风险因素与女性新发 AF 风险之间的线性和潜在非线性关系。

设计、地点和参与者：这项基于人群的队列研究从 2006 年至 2010 年英国生物银行研究中获取数据，该研究是一项超过 500000 名 40 至 69 岁参与者的队列研究。参与者为基线时无 AF 病史和子宫切除术和/或双侧卵巢切除术史的女性。新发 AF 发病的中位随访期为 11.6 年，随访于 2020 年 10 月 3 日结束。

暴露

自我报告的特定于性别的风险因素，包括初潮年龄、月经周期不规则史、绝经状态、绝经年龄、绝经后年限、初产年龄、最后生育后年限、自然流产史、死产史、活产数和总生育年限。

主要结果和测量

主要结局是新发 AF，其定义为使用国际疾病分类和相关健康问题第十次修订版代码 I48。

结果

本研究共纳入 235191 名女性（平均[标准差]年龄，55.7[8.1]岁）。随访期间，4629 名（2.0%）女性发生新发 AF。在多变量调整模型中，月经周期不规则史与更高的 AF 风险相关（风险比[HR]，1.34；95%置信区间，1.01-1.79）。初潮早（7-11 岁；HR，1.10[95%CI，1.00-1.21]）和晚（13-18 岁；HR，1.08[95%CI，1.00-1.17]）均与 AF 发生率相关。早绝经（35-44 岁；HR，1.24[95%CI，1.10-1.39]）和晚绝经（≥60 岁；HR，1.34[95%CI，1.10-1.78]）与更高的 AF 风险相关。与生育 1 至 2 个活产的女性相比，生育 0 个活产（HR，1.13；95%CI，1.04-1.24）或生育 7 个或更多活产的女性（HR，1.67；95%CI，1.03-2.70）的 AF 风险均显著增加。