根据年龄和遗传易感性评估获得性风险因素与房颤事件的相关性。
Acquired risk factors and incident atrial fibrillation according to age and genetic predisposition.
机构信息
Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China.
School of Public Health, Zhejiang University, Hangzhou, China.
出版信息
Eur Heart J. 2023 Dec 14;44(47):4982-4993. doi: 10.1093/eurheartj/ehad615.
BACKGROUND AND AIMS
Atrial fibrillation (AF) is the most common sustained arrhythmia in adults. Investigations of risk factor profiles for AF according to age and genetic risk groups are essential to promote individualized strategies for the prevention and control of AF.
METHODS
A total of 409 661 participants (mean age, 56 years; 46% men) free of AF at baseline and with complete information about risk factors were included from the UK Biobank cohort. The hazard ratios and population-attributable risk (PAR) percentages of incident AF associated with 23 risk factors were examined, including 3 social factors, 7 health behaviours, 6 cardiometabolic factors, 6 clinical comorbidities, and the genetic risk score (GRS), across 3 age groups (40-49, 50-59, and 60-69 years) and 3 genetic risk groups (low, moderate, and high GRS).
RESULTS
After a follow-up of 5 027 587 person-years, 23 847 participants developed AF. Most cardiometabolic factors and clinical comorbidities showed a significant interaction with age, whereby the associations were generally strengthened in younger groups (Pinteraction < .002). However, only low LDL cholesterol, renal dysfunction, and cardiovascular disease showed a significant interaction with genetic risk, and the associations with these factors were stronger in lower genetic risk groups (Pinteraction < .002). Cardiometabolic factors consistently accounted for the largest number of incident AF cases across all age groups (PAR: 36.2%-38.9%) and genetic risk groups (34.0%-41.9%), with hypertension and overweight/obesity being the two leading modifiable factors. Health behaviours (PAR: 11.5% vs. 8.7%) and genetic risk factors (19.1% vs. 14.3%) contributed to more AF cases in the 40-49 years group than in the 60-69 years group, while the contribution of clinical comorbidities remained relatively stable across different age groups. The AF risk attributable to overall cardiometabolic factors (PAR: 41.9% in the low genetic risk group and 34.0% in the high genetic risk group) and clinical comorbidities (24.7% and 15.9%) decreased with increasing genetic risk. The impact of social factors on AF was relatively low across the groups by age and genetic risk.
CONCLUSIONS
This study provided comprehensive information about age- and genetic predisposition-related risk factor profiles for AF in a cohort of UK adults. Prioritizing risk factors according to age and genetic risk stratifications may help to achieve precise and efficient prevention of AF.
背景和目的
心房颤动（AF）是成年人中最常见的持续性心律失常。根据年龄和遗传风险群体研究 AF 的危险因素谱对于促进 AF 的预防和控制的个体化策略至关重要。
方法
本研究共纳入了英国生物库队列中 409661 名基线时无 AF 且具有完整危险因素信息的参与者（平均年龄为 56 岁，46%为男性）。研究分析了与 23 个危险因素相关的 AF 发病的风险比和人群归因风险（PAR）百分比，包括 3 个社会因素、7 个健康行为、6 个心血管代谢因素、6 种临床合并症和遗传风险评分（GRS），并按 3 个年龄组（40-49、50-59 和 60-69 岁）和 3 个遗传风险组（低、中和高 GRS）进行了分析。
结果
在 5027587 人年的随访后，有 23847 名参与者发生了 AF。大多数心血管代谢因素和临床合并症与年龄呈显著交互作用，即这些关联在较年轻的人群中普遍增强（P 交互<0.002）。然而，只有低 LDL 胆固醇、肾功能障碍和心血管疾病与遗传风险呈显著交互作用，且这些因素在遗传风险较低的人群中关联更强（P 交互<0.002）。在所有年龄组（PAR：36.2%-38.9%）和遗传风险组（PAR：34.0%-41.9%）中，心血管代谢因素一直占 AF 发病病例数的最大比例，高血压和超重/肥胖是两个主要的可改变因素。健康行为（PAR：11.5%比 8.7%）和遗传危险因素（19.1%比 14.3%）导致 40-49 岁组比 60-69 岁组发生更多的 AF 病例，而临床合并症的贡献在不同年龄组之间相对稳定。总体心血管代谢因素（低遗传风险组的 PAR：41.9%，高遗传风险组的 PAR：34.0%）和临床合并症（PAR：24.7%和 15.9%）归因于 AF 的风险随着遗传风险的增加而降低。按年龄和遗传风险分层，社会因素对 AF 的影响在各组中相对较低。
结论
本研究提供了英国成年人队列中与年龄和遗传易感性相关的 AF 危险因素谱的综合信息。根据年龄和遗传风险分层优先考虑危险因素可能有助于实现 AF 的精确和有效的预防。
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