Atrial fibrillation and the risk of myocardial infarction.
Atrial fibrillation and the risk of myocardial infarction.
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DOI：
10.1001/jamainternmed.2013.11912
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发表时间：
2014-01
影响因子：
39
通讯作者：
Cushman, Mary
中科院分区：
文献类型：
--
作者：
Soliman, Elsayed Z.;Safford, Monika M.;Muntner, Paul;Khodneva, Yulia;Dawood, Farah Z.;Zakai, Neil A.;Thacker, Evan L.;Judd, Suzanne;Howard, Virginia J.;Howard, George;Herrington, David M.;Cushman, Mary
心肌梗死（MI）是房颤（AF）的既定危险因素。然而，尚未研究AF作为MI风险因素的程度。为研究房颤相关的心肌梗死事件风险，2003年至2007年期间，从卒中地理和种族差异原因（REGARDS）队列中招募了23928名居住在美国大陆且基线时无冠心病的前瞻性队列参与者，随访至2009年12月。专家裁定的总MI事件（致死性和非致死性）。超过6.9年的随访（中位数4.5年），发生了648起MI事件。在社会人口统计学校正模型中，AF与MI风险增加约2倍相关（风险比[HR]，1.96 [95% CI，1.52-2.52]）。这种联系仍然很重要（HR，1.70 [95% CI，1.26-2.30]）进一步校正总胆固醇、高密度脂蛋白胆固醇、吸烟状态、收缩压、降压药物、体重指数、糖尿病、华法林使用、阿司匹林使用、他汀类药物使用、卒中和血管疾病史、估计肾小球滤过率、白蛋白/肌酐比值后，和C反应蛋白水平在亚组分析中，女性房颤相关心肌梗死的风险显著较高（HR，2.16 [95% CI，1.41-3.31]）（HR，1.39 [95% CI，0.91-2.10]）和黑人（HR，2.53 [95% CI，1.67-3.86]）比白人（HR，1.26 [95% CI，0.83-1.93]）;对于相互作用，P = 0.03和P = 0.02。另一方面，老年（≥75岁）与年轻（<75岁）受试者中与AF相关的MI风险无显著差异（分别为HR，2.00 [95% CI，1.16-3.35]和HR，1.60 [95% CI，1.11-2.30]）;对于相互作用，P = 0.44。房颤与心肌梗死风险增加独立相关，尤其是在女性和黑人中。这些发现增加了对AF作为公共卫生负担的严重性的日益关注：除了是众所周知的卒中风险因素外，AF还与MI风险增加相关。
Myocardial infarction (MI) is an established risk factor for atrial fibrillation (AF). However, the extent to which AF is a risk factor for MI has not been investigated. To examine the risk of incident MI associated with AF. A prospective cohort of 23 928 participants residing in the continental United States and without coronary heart disease at baseline were enrolled from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort between 2003 and 2007, with follow-up through December 2009. Expert-adjudicated total MI events (fatal and nonfatal). Over 6.9 years of follow-up (median 4.5 years), 648 incident MI events occurred. In a sociodemographic-adjusted model, AF was associated with about 2-fold increased risk of MI (hazard ratio [HR], 1.96 [95% CI, 1.52–2.52]). This association remained significant (HR, 1.70 [95% CI, 1.26–2.30]) after further adjustment for total cholesterol, high-density lipoprotein cholesterol, smoking status, systolic blood pressure, blood pressure–lowering drugs, body mass index, diabetes, warfarin use, aspirin use, statin use, history of stroke and vascular disease, estimated glomerular filtration rate, albumin to creatinine ratio, and C-reactive protein level. In subgroup analysis, the risk of MI associated with AF was significantly higher in women (HR, 2.16 [95% CI, 1.41–3.31]) than in men (HR, 1.39 [95% CI, 0.91–2.10]) and in blacks (HR, 2.53 [95% CI, 1.67–3.86]) than in whites (HR, 1.26 [95% CI, 0.83–1.93]); for interactions, P = .03 and P = .02, respectively. On the other hand, there were no significant differences in the risk of MI associated with AF in older (≥75 years) vs younger (<75 years) participants (HR, 2.00 [95% CI, 1.16–3.35] and HR, 1.60 [95% CI, 1.11–2.30], respectively); for interaction, P = .44. AF is independently associated with an increased risk of incident MI, especially in women and blacks. These findings add to the growing concerns of the seriousness of AF as a public health burden: in addition to being a well-known risk factor for stroke, AF is also associated with increased risk of MI.
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2
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