Tian Feng, Yu Genfeng, Yang Mengyuan, Sun Ying, Gui Zihao, Zhao Xiaoyu, Wang Ningjian, Wan Heng, Peng Xuetao
Health Management Division, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong, China.
Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong, China.
Environ Health. 2025 Mar 14;24(1):9. doi: 10.1186/s12940-025-01166-7.
The study aimed to investigate the association between domestic water hardness and the incidence of AF and the interaction effects between water hardness and genetic susceptibility to incident AF risk. As a secondary objective, its associations with incident heart failure (HF), coronary heart disease (CHD), and stroke were measured.
The UK Biobank is a prospective cohort study comprising over 500,000 participants recruited in the United Kingdom between 2006 and 2010, aged 37 to 73 years. A total of 447,950 participants did not have prevalent AF, and 423,946 participants who were free of HF, CHD, and stroke at baseline were included. Water hardness was assessed by CaCO concentration. The genetic risk score for AF was based on the standard polygenic risk score. Cox proportional hazards regression models and restricted cubic spline (RCS) analysis were conducted.
During a median follow-up of 13.74 years, 30,726 (6.86%) individuals were diagnosed with AF for the first time. Compared with those with water hardness ≤ 60 mg/L, individuals with domestic water hardness 121-180 mg/L had a 17% lower risk of developing AF (HR 0.83, 95% CI 0.79-0.87), but water hardness of 61-120 mg/L and > 180 mg/L was associated with a higher risk of incident AF (both 1.04, 1.01-1.07). A non-linear relationship between water hardness and incident AF (P for non-linear = 0.001) was found. Individuals with water hardness 121-180 mg/L were also significantly associated with a lower risk of incident HF (HR 0.82, 95% CI 0.75-0.89), CHD (HR 0.80, 95% CI 0.76-0.84) and stroke (HR 0.88, 95% CI 0.81-0.95). There were no significant interaction effects between water hardness level and genetic susceptibility to AF, HF, CHD, and stroke risk (all P for interaction > 0.05).
Potential U-shaped associations between domestic water hardness and incident AF across varying levels of genetic risk were found. Hard water (121-180 mg/L) may offer the most benefits compared to soft water when considering overall cardiovascular health, including AF, HF, CHD, and stroke.
本研究旨在调查生活用水硬度与房颤发病率之间的关联，以及水硬度与房颤发病风险的遗传易感性之间的交互作用。作为次要目标，还测量了其与心力衰竭（HF）、冠心病（CHD）和中风的关联。
英国生物银行是一项前瞻性队列研究，纳入了2006年至2010年在英国招募的50多万名参与者，年龄在37至73岁之间。共有447950名参与者无房颤病史，纳入了423946名在基线时无HF、CHD和中风的参与者。通过碳酸钙浓度评估水硬度。房颤的遗传风险评分基于标准多基因风险评分。进行了Cox比例风险回归模型和受限立方样条（RCS）分析。
在中位随访13.74年期间，30726名（6.86%）个体首次被诊断为房颤。与生活用水硬度≤60mg/L的个体相比，生活用水硬度为121 - 180mg/L的个体发生房颤的风险降低17%（HR 0.83，95%CI 0.79 - 0.87），但水硬度为61 - 120mg/L和>180mg/L与房颤发病风险较高相关（均为1.04，1.01 - 1.07）。发现水硬度与房颤发病之间存在非线性关系（非线性P = 0.001）。生活用水硬度为121 - 180mg/L的个体也与HF（HR 0.82，95%CI 0.75 - 0.89）、CHD（HR 0.80，95%CI 0.76 - 0.84）和中风（HR 0.88，95%CI 0.81 - 0.95）的发病风险较低显著相关。水硬度水平与房颤、HF、CHD和中风风险的遗传易感性之间无显著交互作用（所有交互作用P>0.05）。
发现生活用水硬度与不同遗传风险水平下的房颤发病之间存在潜在的U型关联。在考虑包括房颤、HF、CHD和中风在内的整体心血管健康时，与软水相比，硬水（121 - 180mg/L）可能带来的益处最大。
