Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland.
Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
Swiss Med Wkly. 2023 Aug 23;153:40109. doi: 10.57187/smw.2023.40109.
To assess the associations of chocolate consumption with neurocognitive function, brain lesions on magnetic resonance imaging (MRI), and cardiovascular outcome in patients with atrial fibrillation (AF).
We analysed data from patients of two prospective multicentre Swiss atrial fibrillation cohort studies (Swiss-AF) and (BEAT-AF). Assessments of MRI findings and neurocognitive function were performed only in the Swiss-AF population (in 1727 of 2415 patients [71.5%] with a complete data set), as patients enrolled in BEAT-AF were not systematically evaluated for these outcomes. Otherwise, the two cohorts had an equivalent set of clinical assessments. Clinical outcome analysis was performed in 3931 patients of both cohorts. Chocolate consumption was assessed by questionnaire. Patients were categorised as no/low chocolate consumption (No/Low-Ch) ≤1 servings/week, moderate chocolate consumption (Mod-Ch) >1-6 servings/week, and high chocolate consumption (High-Ch) >6 servings/week, respectively. Brain lesions were evaluated by MRI. Assessment of cognitive function was performed by neurocognitive functional testing and included global cognition measurement with a cognitive construct score. Cerebral MRI and cognition were evaluated at baseline. Cross-sectional associations between chocolate consumption and MRI findings were analysed by multivariate logistic regression models and associations with neurocognitive function by multivariate linear regression models. Clinical outcome events during follow-up were recorded and assessed by a clinical event committee. The associations between chocolate consumption and clinical outcomes were evaluated by Cox regression models. The median follow-up time was 6 years.
Chocolate consumption was not associated with prevalence or volume of vascular brain lesions on MRI, nor major adverse cardiac events (ischaemic stroke, myocardial infarction, cardiovascular death). However, No/Low-Ch was independently associated with a lower cognitive construct score compared to Mod-Ch (No/Low-Ch vs. Mod-Ch: coeff. -0.05, 95% CI -0.10-0), whereas other neurocognitive function tests were not independently associated with chocolate consumption categories. In addition, there was a higher risk of heart failure hospitalisation (No/Low-Ch vs. Mod-Ch: HR 1.24, 95% CI 1.01-1.52) and of all-cause mortality (No/Low-Ch vs. Mod-Ch: HR 1.29, 95% CI 1.06-1.58) in No/Low-Ch compared to Mod-Ch. No significant associations with the evaluated outcomes were observed when High-Ch was compared to Mod-Ch.
While chocolate consumption was not associated with MRI findings and major adverse cardiac events in an atrial fibrillation population, No/Low-Ch was associated with a lower cognitive construct score, higher risk of heart failure hospitalisation and increased all-cause mortality compared to Mod-Ch.
gov Identifier: NCT02105844.
评估巧克力摄入与神经认知功能、磁共振成像（MRI）上的脑损伤以及心房颤动（AF）患者心血管结局之间的关联。
我们分析了来自两个前瞻性瑞士心房颤动队列研究（Swiss-AF）和（BEAT-AF）的患者数据。仅在 Swiss-AF 人群中进行 MRI 结果和神经认知功能评估（在 2415 名患者中有 1727 名[71.5%]有完整数据集），因为 BEAT-AF 中的患者没有系统地评估这些结果。否则，两个队列都进行了相同的临床评估。对两个队列的 3931 名患者进行临床结局分析。巧克力摄入量通过问卷调查评估。患者分为无/低巧克力摄入量（No/Low-Ch）≤1 份/周、中量巧克力摄入量（Mod-Ch）>1-6 份/周和高巧克力摄入量（High-Ch）>6 份/周。通过 MRI 评估脑损伤。通过神经认知功能测试进行认知功能评估，包括使用认知结构评分进行整体认知测量。基线时评估大脑 MRI 和认知功能。通过多变量逻辑回归模型分析巧克力摄入与 MRI 结果之间的横断面关联，并通过多变量线性回归模型分析与神经认知功能的关联。记录随访期间的临床结局事件，并由临床事件委员会进行评估。通过 Cox 回归模型评估巧克力摄入与临床结局之间的关联。中位随访时间为 6 年。
巧克力摄入与 MRI 上血管性脑损伤的患病率或体积、主要不良心脏事件（缺血性卒中、心肌梗死、心血管死亡）无关。然而，与 Mod-Ch 相比，No/Low-Ch 与认知结构评分较低独立相关（No/Low-Ch 与 Mod-Ch：系数-0.05，95%CI-0.10-0），而其他神经认知功能测试与巧克力摄入类别无独立相关性。此外，与 Mod-Ch 相比，No/Low-Ch 发生心力衰竭住院（No/Low-Ch 与 Mod-Ch：HR 1.24，95%CI 1.01-1.52）和全因死亡率（No/Low-Ch 与 Mod-Ch：HR 1.29，95%CI 1.06-1.58）的风险更高。与评估的结局相比，当比较 High-Ch 与 Mod-Ch 时，未观察到与结局显著相关。
在心房颤动人群中，尽管巧克力摄入与 MRI 结果和主要不良心脏事件无关，但与 Mod-Ch 相比，No/Low-Ch 与认知结构评分较低、心力衰竭住院风险较高和全因死亡率增加相关。
gov 标识符：NCT02105844。
