心房颤动患者心脏代谢合并症与死亡率之间的关联。

Association between cardiometabolic comorbidity and mortality in patients with atrial fibrillation.

作者信息

Dong Zhaojie, Jiang Chao, He Liu, Gao Mingyang, Tang Ribo, Liu Nian, Zhou Ning, Sang Caihua, Long Deyong, Du Xin, Dong Jianzeng, Ma Changsheng

机构信息

Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.

Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.

出版信息

BMC Cardiovasc Disord. 2025 Apr 30;25(1):344. doi: 10.1186/s12872-025-04784-8.

DOI:10.1186/s12872-025-04784-8

PMID:40307689

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12044800/

Abstract

BACKGROUND

Patients with atrial fibrillation (AF) often suffer from cardiometabolic comorbidities, but the impact of the type and number of cardiometabolic comorbidities on the prognosis of AF patients remain unclear.

METHODS

From August 2011 to December 2018, 23,838 AF patients from the Chinese Atrial Fibrillation Registry (China-AF) Study were enrolled in this study. The all-cause and cardiovascular-cause mortality was described. The Cox proportional hazard model was employed to explore the associations of the type and number of cardiometabolic comorbidities with all-cause and cardiovascular-cause mortality.

RESULTS

During an average follow-up of 4.07 ± 1.96 years, 2,140 (8.98%) deaths were identified. The mortality in AF patients with cardiometabolic conditions was significantly higher than that in AF patients without cardiometabolic conditions. Cardiovascular events contributed the most to the death of AF patients, particularly heart failure. AF complicated with heart failure was associated with the highest risk of all-cause mortality [hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.74-2.13], followed by thromboembolism, diabetes mellitus, and vascular diseases. Whereas, the presence of co-morbid hypertension did not have a significant association with all-cause mortality (HR 0.97, 95%CI 0.86-1.09). The adjusted HRs for all-cause mortality in AF patients were 1.21 (95%CI 0.99-1.47), 1.71 (95%CI 1.40-2.08), 2.55 (95%CI 2.07-3.13), and 3.39 (95%CI 2.71-4.24) for 1, 2, 3, and ≥ 4 cardiometabolic comorbidities, respectively.

CONCLUSION

The increase in the number of cardiometabolic comorbidities is associated with mortality in AF patients. Hence, strengthening the management of cardiometabolic comorbidities is critical to reducing the mortality of patients with AF.

TRIAL REGISTRATION

URL: http://www.chictr.org.cn/showproj.aspx?proj=5831 .

REGISTRATION NUMBER

ChiCTR-OCH-13003729. Date of the registration is October 22, 2013.

摘要

背景

心房颤动（AF）患者常伴有心脏代谢合并症，但心脏代谢合并症的类型和数量对AF患者预后的影响尚不清楚。

方法

2011年8月至2018年12月，本研究纳入了中国心房颤动注册研究（China-AF）中的23838例AF患者。描述了全因死亡率和心血管疾病导致的死亡率。采用Cox比例风险模型探讨心脏代谢合并症的类型和数量与全因死亡率和心血管疾病导致的死亡率之间的关联。

结果

在平均4.07±1.96年的随访期间，共确定2140例（8.98%）死亡。患有心脏代谢疾病的AF患者的死亡率显著高于无心脏代谢疾病的AF患者。心血管事件是AF患者死亡的主要原因，尤其是心力衰竭。AF合并心力衰竭与全因死亡率风险最高相关[风险比（HR）1.92，95%置信区间（CI）1.74-2.13]，其次是血栓栓塞、糖尿病和血管疾病。而合并高血压与全因死亡率无显著关联（HR 0.97，95%CI 0.86-1.09）。AF患者中，合并1、2、3和≥4种心脏代谢合并症时，全因死亡率的校正HR分别为1.21（95%CI 0.99-1.47）、1.71（95%CI 1.40-2.08）、2.55（95%CI 2.07-3.13）和3.39（95%CI 2.71-4.24）。