在中国嘉道理生物银行25000名参与者的前瞻性研究中房颤的相关因素及后果
Correlates and consequences of atrial fibrillation in a prospective study of 25 000 participants in the China Kadoorie Biobank.
作者信息
Turnbull Iain, Camm Christian Fielder, Halsey Jim, Du Huaidong, Bennett Derrick A, Chen Yiping, Yu Canqing, Sun Dianyianji, Liu Xiaohong, Li Liming, Chen Zhengming, Clarke Robert
机构信息
Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
Department of Epidemiology and Biostatistics, Peking University, Beijing, China.
出版信息
Eur Heart J Open. 2024 Mar 19;4(2):oeae021. doi: 10.1093/ehjopen/oeae021. eCollection 2024 Mar.
AIMS
The prevalence of atrial fibrillation (AF) is positively correlated with prior cardiovascular diseases (CVD) and CVD risk factors but is lower in Chinese than Europeans despite their higher burden of CVD. We examined the prevalence and prognosis of AF and other electrocardiogram (ECG) abnormalities in the China Kadoorie Biobank.
METHODS AND RESULTS
A random sample of 25 239 adults (mean age 59.5 years, 62% women) had a 12-lead ECG recorded and interpreted using a Mortara VERITAS™ algorithm in 2013-14. Participants were followed up for 5 years for incident stroke, ischaemic heart disease, heart failure (HF), and all CVD, overall and by CHADS-VASc scores, age, sex, and area. Overall, 1.2% had AF, 13.6% had left ventricular hypertrophy (LVH), and 28.1% had ischaemia (two-thirds of AF cases also had ischaemia or LVH). The prevalence of AF increased with age, prior CVD, and levels of CHA₂DS₂-VASc scores (0.5%, 1.3%, 2.1%, 2.9%, and 4.4% for scores <2, 2, 3, 4, and ≥5, respectively). Atrial fibrillation was associated with two-fold higher hazard ratios (HR) for CVD (2.15; 95% CI, 1.71-2.69) and stroke (1.88; 1.44-2.47) and a four-fold higher HR for HF (3.79; 2.21-6.49). The 5-year cumulative incidence of CVD was comparable for AF, prior CVD, and CHA₂DS₂-VASc scores ≥ 2 (36.7% vs. 36.2% vs. 37.7%, respectively) but was two-fold greater than for ischaemia (19.4%), LVH (18.0%), or normal ECG (14.1%), respectively.
CONCLUSION
The findings highlight the importance of screening for AF together with estimation of CHA₂DS₂-VASc scores for prevention of CVD in Chinese adults.
目的
心房颤动（AF）的患病率与既往心血管疾病（CVD）及CVD危险因素呈正相关，但尽管中国成年人的CVD负担较重，其AF患病率却低于欧洲人。我们在中国嘉道理生物银行中研究了AF及其他心电图（ECG）异常的患病率和预后情况。
方法与结果
2013年至2014年，对25239名成年人（平均年龄59.5岁，62%为女性）的随机样本进行了12导联ECG记录，并使用Mortara VERITAS™算法进行解读。对参与者进行了5年的随访，以观察新发中风、缺血性心脏病、心力衰竭（HF）及所有CVD情况，总体及按CHADS-VASc评分、年龄、性别和地区进行分析。总体而言，1.2%的人患有AF，13.6%的人有左心室肥厚（LVH），28.1%的人有缺血（三分之二的AF病例同时有缺血或LVH）。AF的患病率随年龄、既往CVD及CHA₂DS₂-VASc评分水平的升高而增加（评分<2、2、3、4及≥5时，患病率分别为0.5%、1.3%、2.1%、2.9%及4.4%）。AF与CVD（风险比[HR]为2.15；95%置信区间[CI]，1.71 - 2.69）和中风（HR为1.88；1.44 - 2.47）的HR高出两倍相关，与HF的HR高出四倍相关（3.79；2.21 - 6.49）。AF、既往CVD及CHA₂DS₂-VASc评分≥2时，5年CVD累积发病率相当（分别为36.7%、36.2%及37.7%），但分别是缺血（19.4%）、LVH（18.0%）或正常ECG（14.1%）的两倍。
结论
研究结果凸显了在中国成年人中筛查AF并评估CHA₂DS₂-VASc评分以预防CVD的重要性。
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