Harms Peter P, Himmelreich Jelle C L, Blom Marieke T, Beulens Joline W J, Nijpels Giel, Elders Petra, Lucassen Wim A M
Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice Medicine, Boelelaan 1117, Amsterdam, the Netherlands.
Amsterdam Public Health, Personalized Medicine, and Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands.
Am Heart J Plus. 2023 Sep 6;34:100321. doi: 10.1016/j.ahjo.2023.100321. eCollection 2023 Oct.
Premature atrial contractions (PACs) are potential markers for imminent onset of both atrial fibrillation (AF) and brain ischemia (BI; transient ischemic attack [TIA] or ischemic stroke). We investigated the association of PACs with incident AF and BI events separately, and of incident AF with BI events in people with type 2 diabetes (T2D) without pre-existing AF or cerebrovascular disease.
A prospective longitudinal study of 12,242 people with T2D without known AF or cerebrovascular disease from the Hoorn Diabetes Care System cohort. Annual measurements (1998-2018) included cardiovascular risk factors, over 85,000 ECGs, and self-reported cardiovascular events. We assessed the association of PACs with incident AF and BI events and of incident AF with BI events using time-dependent Cox-regression models, adjusted for time-varying cardiovascular risk factors and medication use (Hazard Ratios with 95%CIs).
The baseline mean age was 62.2 ± 11.9 years. During a median follow-up of 7.0 (IQR 3.4-11.0) years, 1031 (8.4 %) participants had PACs, and 566 (4.6 %) had incident AF at any of the median 6 (IQR 3-10) annual ECG recordings. BI events occurred in 517 (4.2 %) people (304 TIAs, 213 ischemic strokes). After adjustment, PACs were associated with incident AF (Hazard Ratio, 1.96 (95%CI, 1.53-2.50)), but not with overall BI events (1.09 (0.76-1.56)), or with TIA (0.91 (0.57-1.46)) or ischemic stroke (1.50 (0.88-2.54)) separately. AF was not associated with BI events (0.95 (0.55-1.63)).
In people with T2D without a history of AF or BI events, PACs are associated with a two-fold increased risk of incident AF.
房性早搏（PACs）是心房颤动（AF）和脑缺血（BI；短暂性脑缺血发作[TIA]或缺血性卒中）即将发作的潜在标志物。我们分别研究了PACs与新发AF和BI事件的关联，以及在无既往AF或脑血管疾病的2型糖尿病（T2D）患者中，新发AF与BI事件的关联。
对来自霍伦糖尿病护理系统队列的12242例无已知AF或脑血管疾病的T2D患者进行前瞻性纵向研究。年度测量（1998 - 2018年）包括心血管危险因素、超过85000份心电图以及自我报告的心血管事件。我们使用时间依赖性Cox回归模型评估PACs与新发AF和BI事件的关联，以及新发AF与BI事件的关联，并对随时间变化的心血管危险因素和药物使用情况进行调整（风险比及95%置信区间）。
基线平均年龄为62.2±11.9岁。在中位随访7.0（四分位间距3.4 - 11.0）年期间，1031例（8.4%）参与者有PACs，在中位6次（四分位间距3 - 10次）年度心电图记录中的任何一次记录时，566例（4.6%）有新发AF。517例（4.2%）患者发生BI事件（304例TIA，213例缺血性卒中）。调整后，PACs与新发AF相关（风险比，1.96（95%置信区间，1.53 - 2.50）），但与总体BI事件无关（1.09（0.76 - 1.56）），与TIA（0.91（0.57 - 1.46））或缺血性卒中（1.50（0.88 - 2.54））分别无关。AF与BI事件无关（0.95（0.55 - 1.63））。
在无AF或BI事件病史的T2D患者中，PACs与新发AF风险增加两倍相关。
