Pulse pressure and risk of new-onset atrial fibrillation
Pulse pressure and risk of new-onset atrial fibrillation
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DOI：
10.1001/jama.297.7.709
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发表时间：
2007-02-21
影响因子：
120.7
通讯作者：
Benjamin, Emelia J.
中科院分区：
文献类型：
--
作者：
Mitchell, Gary F.;Vasan, Ramachandran S.;Benjamin, Emelia J.
房颤（AF）是导致相当高的发病率和死亡率的原因，因此确定可改变的风险因素是当务之急。脉压增加是主动脉僵硬的反映，增加了心脏负荷，可能增加AF风险。目的研究脉压与AF事件之间的关系。设计、设置和参与者前瞻性、基于社区的观察队列研究，在马萨诸塞州的Fracket进行，包括5331名Fracket心脏研究参与者，年龄在35岁及以上，最初无AF结果698名参与者（13.1%）在脉压评估后平均12年发生AF。脉压≤ 40 mm Hg（第25百分位数）和脉压> 61 mm Hg（第75百分位数）的累积20年AF发生率分别为5.6%和23.3%。在针对年龄、性别、平均动脉压的基线和时间依赖性变化以及AF的临床风险因素校正的模型中（体重指数、吸烟、瓣膜病、糖尿病、心电图左心室肥大、高血压治疗和普遍的心肌梗死或心力衰竭），脉压与房颤风险增加相关（校正的危险比[HR]，每20 mm Hg增量1.26; 95%置信区间[CI]，1.12-1.43; P <0.001）。相比之下，平均动脉压与AF事件无关（校正HR，每10 mm Hg增量0.96; 95% CI，0.88-1.05; P = 0.39）。收缩压与房颤有关（HR，每20 mm Hg增量1.14; 95% CI，1.04-1.25; P = .006）;然而，如果增加舒张压，模型拟合改善，舒张相关性为反比（校正HR，每10 mm Hg增量0.87; 95% CI，0.78-0.96; P = 0.01），与脉压效应一致。在具有可解释的超声心动图图像的患者中，在校正了基线左心房尺寸、左心室质量和左心室短轴缩短率的模型中，脉压与AF之间的相关性持续存在（校正HR，1.23; 95%CI，1.09-1.39; P = .001）。需要进一步的研究来确定降低脉压的干预措施是否会限制AF发病率的增长。
Context Atrial fibrillation (AF) is responsible for considerable morbidity and mortality, making identification of modifiable risk factors a priority. Increased pulse pressure, a reflection of aortic stiffness, increases cardiac load and may increase AF risk.Objective To examine relations between pulse pressure and incident AF.Design, Setting, and Participants Prospective, community-based observational cohort in Framingham, Mass, including 5331 Framingham Heart Study participants aged 35 years and older and initially free from AF (median age, 57 years; 55% women).Main Outcome Measures Incident AF.Results AF developed in 698 participants (13.1%) a median of 12 years after pulse pressure assessment. Cumulative 20-year AF incidence rates were 5.6% for pulse pressure of 40 mm Hg or less (25th percentile) and 23.3% for pulse pressure greater than 61 mm Hg (75th percentile). In models adjusted for age, sex, baseline and time-dependent change in mean arterial pressure, and clinical risk factors for AF (body mass index, smoking, valvular disease, diabetes, electrocardiographic left ventricular hypertrophy, hypertension treatment, and prevalent myocardial infarction or heart failure), pulse pressure was associated with increased risk for AF (adjusted hazard ratio [HR], 1.26 per 20-mm Hg increment; 95% confidence interval [CI], 1.12-1.43; P < .001). In contrast, mean arterial pressure was unrelated to incident AF (adjusted HR, 0.96 per 10-mm Hg increment; 95% CI, 0.88-1.05; P = .39). Systolic pressure was related to AF (HR, 1.14 per 20-mm Hg increment; 95% CI, 1.04-1.25; P = .006); however, if diastolic pressure was added, model fit improved and the diastolic relation was inverse (adjusted HR, 0.87 per 10-mm Hg increment; 95% CI, 0.78-0.96; P = .01), consistent with a pulse pressure effect. Among patients with interpretable echocardiographic images, the association between pulse pressure and AF persisted in models that adjusted for baseline left atrial dimension, left ventricular mass, and left ventricular fractional shortening (adjusted HR, 1.23; 95% CI, 1.09-1.39; P = .001).Conclusion Pulse pressure is an important risk factor for incident AF in a community-based sample. Further research is needed to determine whether interventions that reduce pulse pressure will limit the growing incidence of AF.