绝经后妇女的失眠、应激事件和其他心理社会因素与房颤事件的关系:来自妇女健康倡议的见解。

Association Between Insomnia, Stress Events, and Other Psychosocial Factors and Incident Atrial Fibrillation in Postmenopausal Women: Insights From the Women's Health Initiative.

机构信息

Division of Cardiology, Department of Medicine Santa Clara Valley Medical Center San Jose CA USA.

Division of Internal Medicine & Public Health, Vanderbilt Ingram Cancer Center Vanderbilt University Nashville TN USA.

出版信息

J Am Heart Assoc. 2023 Sep 5;12(17):e030030. doi: 10.1161/JAHA.123.030030. Epub 2023 Aug 30.

Abstract

Background The association between psychosocial factors and atrial fibrillation (AF) is poorly understood. Methods and Results Postmenopausal women from the Women's Health Initiative were retrospectively analyzed to identify incident AF in relation to a panel of validated psychosocial exposure variables, as assessed by multivariable Cox proportional hazard regression and hierarchical cluster analysis. Among the 83 736 women included, the average age was 63.9±7.0 years. Over an average of 10.5±6.2 years follow-up, there were 23 954 cases of incident AF. Hierarchical cluster analysis generated 2 clusters of highly correlated psychosocial variables: the Stress Cluster included stressful life events, depressive symptoms, and insomnia, and the Strain Cluster included optimism, social support, social strain, cynical hostility, and emotional expressiveness. Incident AF was associated with higher values in the Stress Cluster (hazard ratio [HR], 1.07 per unit cluster score [95% CI, 1.05-1.09]) and the Strain Cluster (HR, 1.03 per unit cluster score [95% CI, 1.00-1.05]). Of the 8 individual psychosocial predictors that were tested, insomnia (HR, 1.04 [95% CI, 1.03-1.06]) and stressful life events (HR, 1.02 [95% CI, 1.01-1.04]) were most strongly associated with increased incidence of AF in Cox regression analysis after multivariate adjustment. Subgroup analyses showed that the Strain Cluster was more strongly associated with incident AF in those with lower traditional AF risks ( for interaction=0.02) as determined by the cohorts for heart and aging research in genomic epidemiology for atrial fibrillation score. Conclusions Among postmenopausal women, 2 clusters of psychosocial stressors were found to be significantly associated with incident AF. Further research is needed to validate these associations.

摘要

背景 心理社会因素与心房颤动(AF)之间的关联尚未得到充分了解。

方法和结果 回顾性分析了妇女健康倡议中的绝经后妇女,以确定与经过验证的心理社会暴露变量面板相关的 AF 发生率,该面板由多变量 Cox 比例风险回归和层次聚类分析评估。在纳入的 83736 名女性中,平均年龄为 63.9±7.0 岁。在平均 10.5±6.2 年的随访期间,有 23954 例新发 AF。层次聚类分析生成了 2 个高度相关的心理社会变量聚类:应激聚类包括生活压力事件、抑郁症状和失眠,紧张聚类包括乐观、社会支持、社会紧张、愤世嫉俗的敌意和情感表达。新发 AF 与应激聚类(HR,每个单位聚类得分增加 1.07[95%CI,1.05-1.09])和紧张聚类(HR,每个单位聚类得分增加 1.03[95%CI,1.00-1.05])的分值较高相关。在 Cox 回归分析中,经过多变量调整后,对 8 种个体心理社会预测因子进行了测试,失眠(HR,1.04[95%CI,1.03-1.06])和生活压力事件(HR,1.02[95%CI,1.01-1.04])与 AF 发生率的增加最为密切相关。亚组分析表明,在由心脏和衰老研究基因组流行病学心房颤动评分确定的传统 AF 风险较低的人群中(交互作用=0.02),紧张聚类与 AF 发生率的相关性更强。

结论 在绝经后妇女中,发现 2 个心理社会应激源聚类与 AF 的发生显著相关。需要进一步的研究来验证这些关联。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d91f/10547347/65468a7555ba/JAH3-12-e030030-g001.jpg

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