Psaty B M, Manolio T A, Kuller L H, Kronmal R A, Cushman M, Fried L P, White R, Furberg C D, Rautaharju P M
Department of Medicine, University of Washington, Seattle, USA.
Circulation. 1997 Oct 7;96(7):2455-61. doi: 10.1161/01.cir.96.7.2455.
This study aimed to describe the incidence of atrial fibrillation (AF) among older adults during 3 years of follow-up.
In this cohort study, 5201 adults > or = 65 years old were examined annually on four occasions between June 1989 and May 1993. At baseline, participants answered questionnaires and underwent a detailed examination that included carotid ultrasound, pulmonary function tests, ECG, and echocardiography. Subjects with a pacemaker or AF at baseline (n=357) were excluded. New cases of AF were identified from three sources: (1) annual self-reports, (2) annual ECGs, and (3) hospital discharge diagnoses. Cox proportional-hazards models were used to assess baseline risk factors as predictors of incident AF. Among 4844 participants, 304 developed a first episode of AF during an average follow-up of 3.28 years, for an incidence of 19.2 per 1000 person-years. The onset was strongly associated with age, male sex, and the presence of clinical cardiovascular disease. For men 65 to 74 and 75 to 84 years old, the incidences were 17.6 and 42.7, respectively, and for women, 10.1 and 21.6 events per 1000 person-years. In stepwise models, the use of diuretics, a history of valvular heart disease, coronary disease, advancing age, higher levels of systolic blood pressure, height, glucose, and left atrial size were all associated with an increased risk of AF. The use of beta-blockers and high levels of alcohol use, cholesterol, and forced expiratory volume in 1 second were associated with a reduced risk of AF.
The incidence of AF in older adults may be higher than estimated by previous population studies. Left atrial size appears to be an important risk factor, and the control of blood pressure and glucose may be important in preventing the development of AF.
本研究旨在描述老年人在3年随访期间心房颤动（AF）的发生率。
在这项队列研究中，1989年6月至1993年5月期间，每年对5201名年龄≥65岁的成年人进行4次检查。基线时，参与者回答问卷并接受详细检查，包括颈动脉超声、肺功能测试、心电图和超声心动图。排除基线时患有起搏器或房颤的受试者（n = 357）。房颤新病例通过三种来源确定：（1）年度自我报告，（2）年度心电图，以及（3）医院出院诊断。使用Cox比例风险模型评估基线风险因素作为房颤发生的预测指标。在4844名参与者中，304人在平均3.28年的随访期间首次发生房颤，发病率为每1000人年19.2例。发病与年龄、男性性别以及临床心血管疾病的存在密切相关。对于65至74岁和75至84岁的男性，发病率分别为每1000人年17.6例和42.7例，对于女性，分别为每1000人年10.1例和21.6例。在逐步模型中，使用利尿剂、瓣膜性心脏病史、冠心病、年龄增长、收缩压水平升高、身高、血糖和左心房大小均与房颤风险增加相关。使用β受体阻滞剂以及高水平饮酒、胆固醇和1秒用力呼气量与房颤风险降低相关。
老年人房颤的发生率可能高于以往人群研究的估计。左心房大小似乎是一个重要的风险因素，控制血压和血糖对于预防房颤的发生可能很重要。
