Predictors of incident atrial fibrillation and influence of medications: a retrospective case-control study
Predictors of incident atrial fibrillation and influence of medications: a retrospective case-control study
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DOI：
10.3399/bjgp11x578034
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发表时间：
2011-06-01
影响因子：
5.9
通讯作者：
Hobbs, F. D. Richard
中科院分区：
文献类型：
--
作者：
Hodgkinson, James A.;Taylor, Clare J.;Hobbs, F. D. Richard
背景：心房颤动（AF）是一种常见疾病，与死亡率和主要发病率的风险增加，并预计将增加由于人口老龄化。目的：更新早期研究的AF预测因子使用UK data.Design和设置：病例对照分析的成年人年龄18岁及以上的诊断AF的做法注册与全科医学研究数据库（GPRD）在英国。方法：使用GPRD，病例对照分析进行了使用逻辑回归比较55 412事件AF病例216 400对照，病史和既往使用的药物。使用样条回归分析总结了自诊断或药物使用开始的时间与AF风险之间的关系。（风险比[RR] 2.91 [95% CI = 2.59 - 3.27]）;缺血性心脏病（IHD）（RR 2.00 [95% CI = 1.78 - 2.24]）;高血压（RR 2.60 [95% CI = 2.32 - 2.92]）;甲状腺功能亢进（RR 1.56 [95% CI = 1.39 - 1.75]）;酗酒（RR 1.43 [95% CI = 1.27 - 1.60]）;脑血管意外（RR 1.48 [95%CI = 1.32至1.66]）;和肥胖（体重指数>= 30 kg/m2 RR 1.29 [95%CI = 1.15至1.45]）。目前使用口服糖皮质激素（RR 1.62 [95% CI = 1.44 - 1.82]）和β-2激动剂（RR 1.30 [95% CI = 1.16 - 1.46]）被确定为显著的风险因素，他汀类药物（RR 0.82 [95% CI = 0.73 - 0.92]）被确定为显著的保护因素。目前使用双膦酸盐（RR 0.95 [95% CI = 0.85 - 1.07]）、肾素-血管紧张素-醛固酮系统（RAAS）药物（RR 1.04 [95% CI = 0.93 - 1.17]）或黄嘌呤衍生物（RR 1.09 [95% CI = 0.97 - 1.22]）未发现影响。样条回归分析发现，心力衰竭，IHD，使用口服糖皮质激素，并使用他汀类药物对发展中国家AF的可能性的影响是持续了数years.Conclusion：这些研究结果更新的风险因素，与AF，并确认他汀类药物的保护性能和β-2受体激动剂在发展中国家AF的风险，但不是假设的保护质量的糖皮质激素和RAAS剂。
Background:Atrial fibrillation (AF) is a common condition, associated with raised mortality and risk of major morbidity, and is predicted to increase due to an aging population.Aim:To update earlier research of AF predictors using UK data.Design and setting:Case-control analysis of adults aged 18 years and older with a diagnosis of AF in practices registered with the General Practice Research Database (GPRD) in the UK.Method:Using the GPRD, a case-control analysis was performed using logistic regression to compare 55 412 incident AF cases to 216 400 controls, for medical history and prior use of drugs. The association between time since start of diagnosis or drug use and AF risk was summarised using Spline regression.Results:The following were confirmed as risk factors for AF: heart failure (risk ratio [RR] 2.91 [95% CI = 2.59 to 3.27]); ischaemic heart disease (IHD) (RR 2.00 [95% CI = 1.78 to 2.24]); hypertension (RR 2.60 [95% CI = 2.32 to 2.92]); hyperthyroidism (RR 1.56 [95% CI = 1.39 to 1.75]); being a heavy drinker (RR 1.43 [95% CI = 1.27 to 1.60]); cerebrovascular accident (RR 1.48 [95% CI = 1.32 to 1.66]); and obesity (body mass index >= 30 kg/m2 RR 1.29 [95% CI = 1.15 to 1.45]). Current use of oral glucocorticoids (RR 1.62 [95% CI = 1.44 to 1.82]) and of beta-2 agonists (RR 1.30 [95% CI = 1.16 to 1.46]) were identified as significant risk factors, and statins (RR 0.82 [95% CI = 0.73 to 0.92]) as a significant protective factor. No effect was found for current use of bisphosphonates (RR 0.95 [95% CI = 0.85 to 1.07]), renin-angiotensin-aldosterone system (RAAS) agents (RR 1.04 [95% CI = 0.93 to 1.17]), or xanthine derivatives (RR 1.09 [95% CI = 0.97 to 1.22]). Spline regression analysis found the effect of heart failure, IHD, use of oral glucocorticoids, and use of statins on the likelihood of developing AF was sustained over a number of years.Conclusion:These findings update the risk factors that are associated with AF, and confirm the protective properties of statins and the risks of beta-2 agonists in developing AF, but not the supposed protective qualities of glucocorticoids and RAAS agents.