Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: Population-based estimates
Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: Population-based estimates
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DOI：
10.1016/s0002-9149(98)00583-9
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发表时间：
1998-10-16
影响因子：
2.8
通讯作者：
Levy, D
中科院分区：
文献类型：
--
作者：
Kannel, WB;Wolf, PA;Levy, D
心房纤颤（AF）是最常见的严重心律失常，是导致普通人群发病率和死亡率较高的原因。其患病率随着年龄的增长而增加一倍，从50-59岁的0.5%增加到80-89岁的近9%。它也变得越来越普遍，在65-84岁的男子中从1968-1970年的3.2%增加到1987-1989年的9.1%。男性的统计学显著增加不能用队列中年龄、瓣膜疾病或心肌梗死的增加来解释。新发房颤的发病率也随着年龄的增长而增加一倍，与已知诱发疾病的患病率增加无关。根据Frachial研究的38年随访数据，在调整年龄和易感条件后，男性发生AF的风险是女性的1.5倍。在心血管危险因素中，只有高血压和糖尿病是AF的重要独立预测因素，并对年龄和其他易感条件进行了调整。吸烟是一个显着的危险因素，在妇女调整年龄（OR = 1.4），但只是短的意义上调整她的危险因素。肥胖和酒精摄入均与两种性别的房颤发病率无关。在调整其他相关疾病后，对于男性和女性来说，糖尿病的风险分别为1.4倍和1.6倍，高血压的风险分别为1.5倍和1.4倍。由于人群中的高患病率，高血压是导致人群中AF的原因（14%），而不是任何其他风险因素。内在的显性心脏疾病造成了相当高的风险。调整其他相关条件后，心力衰竭与AF的风险分别为男性和女性的4.5倍和5.9倍，瓣膜性心脏病与AF的风险分别为1.8倍和3.4倍。仅在男性中，心肌梗死使AF的风险因素调整可能性显着增加了40%。非风湿性房颤的超声心动图预测因子包括左心房增大（每增加5 mm风险增加39%）、左心室短轴缩短率（每减少5%风险增加34%）和左心室壁厚（每增加4 mm风险增加28%）。这些超声心动图特征为AF提供了超出传统临床风险因素的预后信息。心电图左心室肥大仅调整年龄后，房颤风险增加3-4倍，但调整相关疾病后，该风险比降至1.4。房颤的主要危害是中风，其风险增加4-5倍。由于其在高龄人群中的高患病率，AF作为卒中的危险因素具有重要意义，并在90岁时成为主导因素。与AF相关的卒中归因风险从50-59岁的1.5%急剧增加到80-89岁的23.5%。AF与两种性别的死亡率加倍相关，在调整相关心血管疾病后，死亡率降低至1.5-1.9倍。与AF相关的生存率降低发生在广泛的年龄范围内。(C)1998年，Excerpta Medica，Inc.
Atrial fibrillation (AF) is the most common of the serious cardiac rhythm disturbances and is responsible for substantial morbidity and mortality in the general population. Its prevalence doubles with each advancing decade of age, from 0.5% at age 50-59 years to almost 9% at age 80-89 years. It is also becoming more prevalent, increasing in men aged 65-84 years From 3.2% in 1968-1970 to 9.1% in 1987-1989. This statistically significant increase in men was not explained by an increase in age, valve disease, or myocardial infarctions in the cohort. The incidence of new onset of AF also doubled with each decade of age, independent of the increasing prevalence of known predisposing conditions. Based on 38-year follow-up data from the Framingham Study, men had a 1.5-fold greater risk of developing AF than women after adjustment for age and predisposing conditions. Of the cardiovascular risk factors, only hypertension and diabetes were significant independent predictors of AF, adjusting for age and other predisposing conditions. Cigarette smoking was a significant risk factor in women adjusting only for age (OR = 1.4), but was just short of significance on adjustment for of her risk factors. Neither obesity nor alcohol intake was associated with AF incidence in either sex. For men and women, respectively, diabetes conferred a 1.4- and 1.6-fold risk, and hypertension a 1.5- and 1.4-fold risk, after adjusting For other associated conditions. Because of ifs high prevalence in the population, hypertension was responsible for more AF in the population (14%) than any other risk factor. Intrinsic overt cardiac conditions imposed a substantially higher risk. Adjusting for other relevant conditions, heart failure was associated with a 4.5- and 5.9-fold risk, and valvular heart disease a 1.8- and 3.4-fold risk for AF in men and women, respectively. Myocardial infarction significantly increased the risk factor-adjusted likelihood of AF by 40% in men only. Echocardiographic predictors of nonrheumatic AF include left atrial enlargement (39% increase in risk per 5-mm increment), left ventricular fractional shortening (34% per 5% decrement), and left ventricular wall thickness (28% per 4-mm increment). These echocardiographic features offer prognostic information for AF beyond the traditional clinical risk factors. Electrocardiographic left ventricular hypertrophy increased risk of AF 3-4-fold after adjusting only for age, but this risk ratio is decreased to 1.4 after adjustment for the of her associated conditions. The chief hazard of AF is stroke, the risk of which is increased 4-5-fold. Because of its high prevalence in advanced age, AF assumes great importance as a risk factor for stroke and by the ninth decade becomes a dominant factor. The attributable risk far stroke associated with AF increases steeply from 1.5% at age 50-59 years to 23.5% at age 80-89 years. AF is associated with a doubling of mortality in both sexes, which is decreased to 1.5-1.9-fold after adjusting for associated cardiovascular conditions. Decreased survival associated with AF occurs across a wide range of ages. (C) 1998 by Excerpta Medica, Inc.