Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, College of Medicine, Dankook University, Cheonan, Republic of Korea.
BMC Med. 2024 May 13;22(1):194. doi: 10.1186/s12916-024-03400-4.
The reason for higher incidence of atrial fibrillation (AF) in Europe compared with East Asia is unclear. We aimed to investigate the association between modifiable lifestyle factors and lifetime risk of AF in Europe and East Asia, along with race/ethnic similarities and disparities.
1:1 propensity score matched pairs of 242,763 East Asians and 242,763 White Europeans without AF were analyzed. Modifiable lifestyle factors considered were blood pressure, body mass index, cigarette smoking, diabetes, alcohol consumption, and physical activity, categorized as non-adverse or adverse levels. Lifetime risk of AF was estimated from the index age of 45 years to the attained age of 85 years, accounting for the competing risk of death.
The overall lifetime risk of AF was higher in White Europeans than East Asians (20.9% vs 15.4%, p < 0.001). The lifetime risk of AF was similar between the two races in individuals with non-adverse lifestyle factor profiles (13.4% vs 12.9%, p = 0.575), whereas it was higher in White Europeans with adverse lifestyle factor profiles (22.1% vs 15.8%, p < 0.001). The difference in the lifetime risk of AF between the two races increased as the burden of adverse lifestyle factors worsened (1 adverse lifestyle factor; 4.3% to ≥ 3 adverse lifestyle factors; 11.2%). Compared with East Asians, the relative risk of AF in White Europeans was 23% and 62% higher for one (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.16-1.29) and ≥ 3 adverse lifestyle factors (HR 1.62, 95% CI 1.51-1.75), respectively.
The overall higher lifetime risk of AF in White Europeans compared with East Asians might be attributable to adverse lifestyle factors. Adherence to healthy lifestyle factors was associated with the lifetime risk of AF of about 1 in 8 regardless of race/ethnicity.
欧洲心房颤动（AF）的发病率高于东亚，但其原因尚不清楚。本研究旨在调查欧洲和东亚人群中可改变的生活方式因素与 AF 终生风险之间的关系，并探讨其与种族/民族的相似性和差异性。
将 242763 名无 AF 的东亚人和 242763 名白人欧洲人进行 1:1 倾向评分匹配，共匹配出 485526 对。考虑的可改变的生活方式因素包括血压、体重指数、吸烟、糖尿病、饮酒和体力活动，分为非不良和不良水平。从 45 岁的索引年龄到 85 岁的实际年龄，估计 AF 的终生风险，同时考虑死亡的竞争风险。
白人欧洲人总体 AF 终生风险高于东亚人（20.9%比 15.4%，p<0.001）。在生活方式因素非不良的个体中，两种人群的 AF 终生风险相似（13.4%比 12.9%，p=0.575），而在生活方式因素不良的个体中，白人欧洲人的 AF 终生风险更高（22.1%比 15.8%，p<0.001）。随着不良生活方式因素负担的加重，两种人群的 AF 终生风险差异增大（1 种不良生活方式因素，4.3%；≥3 种不良生活方式因素，11.2%）。与东亚人相比，白人欧洲人发生 AF 的相对风险分别高出 23%和 62%，风险比（HR）分别为 1.23（95%置信区间[CI] 1.16-1.29）和 1.62（95%CI 1.51-1.75）。
与东亚人相比，白人欧洲人 AF 的终生风险较高，可能与不良生活方式因素有关。无论种族/民族如何，坚持健康的生活方式因素与大约 1/8 的 AF 终生风险相关。
