Espnes Hilde, Wilsgaard Tom, Ball Jocasta, Løchen Maja-Lisa, Njølstad Inger, Schnabel Renate B, Gerdts Eva, Sharashova Ekaterina
Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
JACC Adv. 2025 Jan 10;4(2):101556. doi: 10.1016/j.jacadv.2024.101556. eCollection 2025 Feb.
Atrial fibrillation (AF) and heart failure (HF) often coexist and impact morbidity and mortality. There is limited knowledge on the association of AF subtypes with HF according to sex.
The purpose of this study was to explore sex-specific associations between AF subtypes and subsequent HF, identifying HF risk factors in participants with AF, and exploring the combined impact on mortality.
14,790 women and 13,181 men from the Tromsø Study were enrolled between 1994 and 2008 and followed for incident AF and HF through 2016. Cox regression was conducted to provide HRs and 95% CIs.
Those with AF had higher risk of subsequent HF in both sexes compared to those without AF. Women with permanent AF had higher relative risk of HF than men (HR: 10.52; 95% CI: 8.72-12.70, and HR: 7.65; 95% CI: 6.40-9.15, respectively). Risk factors for HF in participants with AF included smoking in all, higher diastolic blood pressure and hypertension in women, underweight, obesity, and low alcohol consumption in men. All-cause mortality was higher in women with both subtypes (paroxysmal/persistent: HR: 2.10; 95% CI: 1.78-2.48, permanent: HR: 1.40, 95% CI: 1.14-1.72) and in men with paroxysmal/persistent AF (HR: 1.66; 95% CI: 1.40-1.96). Subsequent HF increased risk of mortality in both sexes.
All AF subtypes were associated with increased risk of HF. Smoking was a shared risk factor, while diastolic blood pressure and hypertension were specific to women, and underweight, obesity, and low alcohol intake were specific to men. Subsequent HF increased mortality risk in all.
心房颤动（AF）与心力衰竭（HF）常并存，影响发病率和死亡率。关于AF亚型与HF按性别分类的关联，人们了解有限。
本研究旨在探讨AF亚型与后续HF之间的性别特异性关联，确定AF参与者中的HF危险因素，并探讨对死亡率的综合影响。
1994年至2008年期间，招募了来自特罗姆瑟研究的14790名女性和13181名男性，随访至2016年，观察房颤和心力衰竭的发病情况。采用Cox回归分析得出风险比（HR）和95%置信区间（CI）。
与无AF者相比，AF患者发生后续HF的风险在两性中均更高。永久性AF女性发生HF的相对风险高于男性（HR分别为10.52；95%CI：8.72-12.70和HR：7.65；95%CI：6.40-9.15）。AF参与者发生HF的危险因素包括所有人中的吸烟，女性中的舒张压升高和高血压，男性中的体重过轻、肥胖和低酒精摄入量。两种亚型（阵发性/持续性：HR：2.10；95%CI：1.78-2.48，永久性：HR：1.40，95%CI：1.14-1.72）的女性以及阵发性/持续性AF男性的全因死亡率更高（HR：1.66；95%CI：1.40-1.96）。后续HF增加了两性的死亡风险。
所有AF亚型均与HF风险增加相关。吸烟是共同的危险因素，而舒张压和高血压是女性特有的，体重过轻、肥胖和低酒精摄入量是男性特有的。后续HF增加了所有人的死亡风险。
