Incident Atrial Fibrillation and Risk of Dementia in a Diverse, Community-Based Population.
Incident Atrial Fibrillation and Risk of Dementia in a Diverse, Community-Based Population.
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DOI：
10.1161/jaha.122.028290
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发表时间：
2023-03-21
影响因子：
5.4
通讯作者：
Go, Alan S.
中科院分区：
文献类型：
--
作者：
Bansal, Nisha;Zelnick, Leila R.;An, Jaejin;Harrison, Teresa N.;Lee, Ming-Sum;Singer, Daniel E.;Fan, Dongjie;Go, Alan S.
心房颤动(房颤)是成人最常见的临床相关心律失常，与缺血性中风和过早死亡有关。然而，关于房颤是否与痴呆风险独立相关的数据是相互矛盾的，特别是在不同的人群中。我们确定了2010至2017年间来自两个大型综合医疗保健提供系统的所有成年人，并对发生房颤的事件进行了1：1匹配：按指标日期、性别、估计肾小球滤过率类别和研究地点的年龄没有房颤。随后的痴呆症是通过先前验证的诊断代码确定的。细灰色分布风险模型被用来检验发生房颤(与没有房颤)与偶发痴呆风险的关联，调整了社会人口学和共病，并考虑了竞争性死亡风险。还进行了按年龄、性别、种族、民族和慢性肾脏疾病状况进行的亚组分析。在 968匹配的成年人中，平均(SD)年龄为73.6%(11.3)岁，其中44.8%为女性，72.3%为白人。平均随访3.3年(四分位数范围，1.7-5.4年)的痴呆症发病率(每100人年)在有房颤和无房颤的人群中分别为2.79(95%可信区间，2.72-2.85)和2.04(95%可信区间，1.99-2.08)/100人年。在调整后的模型中，房颤事件与诊断为痴呆症的风险显著增加相关(子分布风险比[SHR]，1.13[95%CI，1.09-1.16])。在对临时卒中事件进行额外调整后，房颤事件与痴呆症的关联仍具有统计学意义(SHR，1.10[95%CI，1.07-1.15])。65岁(自发性高血压，1.65[95%可信区间，1.29-2.12])与≥65岁(自发性高血压，1.07[95%可信区间，1.03-1.10])(交互作用P<；0.001)和非自发性高血压(自发性高血压，1.20[95%可信区间，1.14-1.26])与慢性肾脏疾病(自发性高血压，1.06[95%可信区间，1.01-1.11]；交互作用P<；0.001)的相关性更强。性别、种族或民族方面没有发现有意义的差异。在一个以社区为基础的大型、多样化的队列中，房颤事件与痴呆症风险的适度增加有关，这种风险在年轻患者和没有慢性肾脏疾病的患者中更加突出，但在性别、种族或民族之间没有显著差异。进一步的研究应该描述支持这些发现的机制，这可能会为房颤治疗的使用提供信息。
Atrial fibrillation (AF) is the most common, clinically relevant arrhythmia in adults and associated with ischemic stroke and premature death. However, data are conflicting on whether AF is independently associated with risk of dementia, particularly in diverse populations. We identified all adults from 2 large integrated health care delivery systems between 2010 and 2017 and performed a 1:1 match of incident AF: no AF by age at index date, sex, estimated glomerular filtration rate category, and study site. Subsequent dementia was identified through previously validated diagnosis codes. Fine‐Gray subdistribution hazard models were used to examine the association of incident AF (versus no AF) with risk of incident dementia, adjusting for sociodemographics and comorbidity and accounting for competing risk of death. Subgroup analyses by age, sex, race, ethnicity, and chronic kidney disease status were also performed. Among 196 968 matched adults, mean (SD) age was 73.6 (11.3) years, with 44.8% women, and 72.3% White. Incidence rates (per 100 person‐years) for dementia over a median follow‐up of 3.3 (interquartile range, 1.7–5.4) years were 2.79 (95% CI, 2.72–2.85) and 2.04 (95% CI, 1.99–2.08) per 100 person‐years in persons with versus without incident AF, respectively. In adjusted models, incident AF was associated with a significantly greater risk of diagnosed dementia (subdistribution hazard ratio [sHR], 1.13 [95% CI, 1.09–1.16]). With additional adjustment for interim stroke events, the association of incident AF with dementia remained statistically significant (sHR, 1.10 [95% CI, 1.07–1.15]). Associations were stronger for age <65 (sHR, 1.65 [95% CI, 1.29–2.12]) versus ≥65 (sHR, 1.07 [95% CI, 1.03–1.10]) years (interaction P<0.001); and those without (sHR, 1.20 [95% CI, 1.14–1.26]) versus with chronic kidney disease (sHR, 1.06 [95% CI, 1.01–1.11]; interaction P<0.001). No meaningful differences were seen by sex, race, or ethnicity. In a large, diverse community‐based cohort, incident AF was associated with a modestly increased risk of dementia that was more prominent in younger patients and those without chronic kidney disease but did not substantially vary across sex, race, or ethnicity. Further studies should delineate mechanisms underpinning these findings, which may inform use of AF therapies.
影响因子：
6
作者：
McCauley MD;Hsu JY;Ricardo AC;Darbar D;Kansal M;Kurella Tamura M;Feldman HI;Kusek JW;Taliercio JJ;Rao PS;Shafi T;He J;Wang X;Sha D;Lamar M;Go AS;Yaffe K;Lash JP;CRIC Study Investigators
通讯作者：
CRIC Study Investigators