Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Office Na-2714, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
Department of Hematology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
Europace. 2023 Mar 30;25(3):804-811. doi: 10.1093/europace/euac244.
The underlying mechanisms of atrial fibrillation (AF) are largely unknown. Inflammation may underlie atrial remodelling. Autoimmune diseases, related to increased systemic inflammation, may therefore be associated with new-onset AF.
Participants from the population-based UK Biobank were screened for rheumatic fever, gastrointestinal autoimmune diseases, autoimmune diseases targeting the musculoskeletal system and connective tissues, and neurological autoimmune diseases. Between 2006 and 2022, participants were followed for incident AF. Cox proportional hazards regression analyses were performed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) to quantify associations. 494 072 participants free from AF were included (median age 58.0 years, 54.8% women). After a median of 12.8 years, 27 194 (5.5%) participants were diagnosed with new-onset AF. Rheumatic fever without heart involvement (HR, 95% CI: 1.47, 1.26-1.72), Crohn's disease (1.23, 1.05-1.45), ulcerative colitis (1.17, 1.06-1.31), rheumatoid arthritis (1.39, 1.28-1.51), polyarteritis nodosa (1.82, 1.04-3.09), systemic lupus erythematosus (1.82, 1.41-2.35), and systemic sclerosis (2.32, 1.57-3.44) were associated with a larger AF risk. In sex-stratified analyses, rheumatic fever without heart involvement, multiple sclerosis, Crohn's disease, seropositive rheumatoid arthritis, psoriatic and enteropathic arthropathies, systemic sclerosis and ankylosing spondylitis were associated with larger AF risk in women, whereas only men showed a larger AF risk associated with ulcerative colitis.
Various autoimmune diseases are associated with new-onset AF, more distinct in women. Our findings elaborate on the pathophysiological differences in autoimmunity and AF risk between men and women.
心房颤动（AF）的潜在机制在很大程度上尚不清楚。炎症可能是心房重构的基础。因此，与全身性炎症增加相关的自身免疫性疾病可能与新发 AF 相关。
从基于人群的英国生物库中筛选出风湿热、胃肠道自身免疫性疾病、针对肌肉骨骼系统和结缔组织的自身免疫性疾病以及神经自身免疫性疾病的参与者。在 2006 年至 2022 年期间，对参与者进行新发 AF 的随访。使用 Cox 比例风险回归分析计算风险比（HR）和 95%置信区间（CI）来量化关联。纳入了 494072 名无 AF 的参与者（中位年龄 58.0 岁，54.8%为女性）。在中位随访 12.8 年后，27194 名（5.5%）参与者被诊断为新发 AF。无心脏受累的风湿热（HR，95%CI：1.47，1.26-1.72）、克罗恩病（1.23，1.05-1.45）、溃疡性结肠炎（1.17，1.06-1.31）、类风湿关节炎（1.39，1.28-1.51）、结节性多动脉炎（1.82，1.04-3.09）、系统性红斑狼疮（1.82，1.41-2.35）和系统性硬皮病（2.32，1.57-3.44）与更大的 AF 风险相关。在性别分层分析中，无心脏受累的风湿热、多发性硬化症、克罗恩病、血清阳性类风湿关节炎、银屑病和肠炎性关节病、系统性硬皮病和强直性脊柱炎与女性更大的 AF 风险相关，而只有男性与溃疡性结肠炎相关的 AF 风险更大。
各种自身免疫性疾病与新发 AF 相关，在女性中更为明显。我们的研究结果阐述了男性和女性之间自身免疫和 AF 风险的病理生理学差异。
