Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada.
Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada; Department of Pharmacy, Faculty of Pharmacy, Université Laval, Québec City, Québec, Canada.
Can J Cardiol. 2024 Sep;40(9):1566-1575. doi: 10.1016/j.cjca.2024.02.002. Epub 2024 Feb 9.
Cardiometabolic diseases increase the risk of postoperative atrial fibrillation (POAF), a complication leading to higher long-term risk of major cardiovascular events (MACE). It remains unknown whether the effect of these risk factors differs according to sex. We sought to evaluate the sex-specific predictors of POAF after coronary artery bypass grafting (CABG).
In a prospective registry of patients undergoing isolated CABG, we compared predictors of POAF between sexes with logistic regression models. Because of high prevalence of abdominal obesity in women, > 80% having a waist circumference (WC) ≥ 88 cm, median WC values were used to define abdominal obesity (men ≥ 102 cm, women ≥ 100 cm).
This analysis included 6177 individuals (17% women). Mean age was 65.6 ± 8.9 years. POAF occurred in 32% of men and 28% of women (P < 0.05). Compared with men, women with POAF had similar WC; higher prevalence of hypertension and diabetes; lower high-density lipoprotein (HDL)-cholesterol; and higher glucose, triglyceride, low- density lipoprotein (LDL)-cholesterol, and C-reactive protein levels (all P < 0.05). After adjustment, age and abdominal obesity were associated with POAF in both sexes (P < 0.05). The interaction of WC with sex suggested a worse impact of WC on POAF risk among women (adjusted odds ratio [OR], 1.97; 95% confidence interval [CI], 1.48-2.62 vs in men 1.33; 95% CI, 1.17-1.50; P for interaction = 0.01).
Abdominal obesity is a major predictor of POAF in both sexes, with higher risk in women. These results emphasize the need for enhanced strategies to manage abdominal obesity and its cardiometabolic consequences in the general population and the potential to develop sex-specific preventive interventions to reduce risk of POAF.
心脏代谢疾病增加了术后心房颤动（POAF）的风险，这是一种导致主要心血管事件（MACE）长期风险增加的并发症。目前尚不清楚这些危险因素的影响是否因性别而异。我们旨在评估冠状动脉旁路移植术（CABG）后 POAF 的性别特异性预测因素。
在一项接受单纯 CABG 的患者前瞻性登记研究中，我们使用逻辑回归模型比较了男女之间 POAF 的预测因素。由于女性腹部肥胖的患病率较高，超过 80%的女性腰围（WC）≥88cm，因此使用中位数 WC 值来定义腹部肥胖（男性≥102cm，女性≥100cm）。
这项分析共纳入了 6177 名患者（17%为女性）。平均年龄为 65.6±8.9 岁。男性 POAF 发生率为 32%，女性为 28%（P＜0.05）。与男性相比，POAF 女性的 WC 相似；高血压和糖尿病的患病率更高；高密度脂蛋白（HDL）-胆固醇水平更低；血糖、甘油三酯、低密度脂蛋白（LDL）-胆固醇和 C 反应蛋白水平更高（均 P＜0.05）。调整后，年龄和腹部肥胖与两性的 POAF 均相关（P＜0.05）。WC 与性别的交互作用表明 WC 对女性 POAF 风险的影响更差（调整后的优势比[OR]，1.97；95%置信区间[CI]，1.48-2.62 与男性 1.33；95%CI，1.17-1.50；交互作用 P 值=0.01）。
腹部肥胖是两性 POAF 的主要预测因素，女性风险更高。这些结果强调需要制定强化策略来管理普通人群中的腹部肥胖及其代谢后果，并有可能制定针对女性的特定预防干预措施来降低 POAF 的风险。
