Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
BMJ Open. 2024 Nov 27;14(11):e091175. doi: 10.1136/bmjopen-2024-091175.
Uric acid (UA) and obesity are significant risk factors for new-onset atrial fibrillation (AF). Based on the pathogenesis mechanisms of new-onset AF involving obesity and UA, it is possible that UA and weight gain may interact with each other. We investigated the impact of UA and weight gain on new-onset AF using a simple measure of weight change over time, 'weight gain of ≥10 kg after age 20'.
A retrospective cohort study.
We retrospectively analysed 16 444 Japanese aged over 30 without AF from a cohort of employees undergoing annual health check-up from 2 April 2013 to 30 April 2022. We conducted a landmark survival analysis to assess the impact of longitudinal changes in UA and obesity on new-onset AF. Weight gain was defined as 'weight gain of≥10 kg after age 20' using a standardised self-administered questionnaire.
Subjects were diagnosed with AF when AF was present in the electrocardiogram or when indicated in a patient interview.
During a median follow-up period of 3.91 years, 69 new-onset AF occurred (incidence; 1.12/1000 person-years). UA levels were 5.76 (±1.37) in the weight gain group and 4.87 (±1.31) in the no weight gain group, both within normal limits. A multivariable landmark survival analysis including interaction term showed that new-onset AF was significantly associated with age, sex, baseline systolic blood pressure, baseline UA and the interaction term between UA change and weight gain. The interaction term between weight gain and UA change indicates that HR for every UA 1 mg/dL increase was 1.96 (95% CI 1.38 to 2.77) in subjects with weight gain and 0.95 (95% CI 0.61 to 1.48) in those without.
Even if UA levels are within the normal range, subsequent UA change and weight gain in adulthood have an interactive effect on new-onset AF.
尿酸（UA）和肥胖是新发心房颤动（AF）的重要危险因素。基于涉及肥胖和 UA 的新发 AF 的发病机制，UA 和体重增加可能相互作用。我们通过衡量随时间推移的体重变化的简单指标“20 岁后体重增加≥10kg”，研究 UA 和体重增加对新发 AF 的影响。
回顾性队列研究。
我们对 2022 年 4 月 2 日至 4 月 30 日期间接受年度健康检查的员工队列中年龄超过 30 岁且无 AF 的 16444 名日本人进行了回顾性分析。我们进行了 landmark 生存分析，以评估 UA 和肥胖的纵向变化对新发 AF 的影响。体重增加是通过标准的自我管理问卷定义的“20 岁后体重增加≥10kg”。
当心电图出现 AF 或患者访谈中出现 AF 时，诊断为 AF。
在中位数为 3.91 年的随访期间，有 69 例新发 AF（发生率为 1.12/1000 人年）。体重增加组的 UA 水平为 5.76（±1.37），无体重增加组为 4.87（±1.31），均在正常范围内。包括交互项的多变量 landmark 生存分析显示，新发 AF 与年龄、性别、基线收缩压、基线 UA 和 UA 变化与体重增加之间的交互项显著相关。UA 变化与体重增加之间的交互项表明，体重增加的受试者中，UA 每增加 1mg/dL，HR 为 1.96（95%CI 1.38 至 2.77），而无体重增加的受试者中，HR 为 0.95（95%CI 0.61 至 1.48）。
即使 UA 水平在正常范围内，成年后 UA 的变化和体重增加对新发 AF 仍具有交互作用。
