Keeping to the rhythm of cardiovascular health.
Keeping to the rhythm of cardiovascular health.
复制标题
保持心血管健康的节奏。
DOI：
10.1093/eurjpc/zwad410
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发表时间：
2024
影响因子：
8.3
通讯作者：
Khurshid,Shaan
中科院分区：
文献类型：
--
作者：
Kany,Shinwan;Khurshid,Shaan
心血管疾病是全世界死亡人数过多的主要原因。因此，最近一直强调优化心血管健康（CVH）指标，以减少动脉粥样硬化性心血管疾病和心力衰竭的公共卫生负担。相对而言，很少有人关注心律失常，这是与大量的发病率和死亡率。来自英国生物样本库（一项超过50万名参与者的前瞻性队列研究）的研究表明，在55岁以下人群中有10.1%的人和65岁或以上人群中有10.5%的人普遍存在心律失常。房颤（AF）是目前最常见的心律失常，发生率为3.1/1000人-年，而室上性心律失常（1.1/1000人-年）和室性心律失常（0.5/1000人-年）相对不常见。1有充分的理由支持CVH指标的优化可能对心律失常风险产生有益影响的观点。研究得最好的例子是AF，其中心脏代谢因素如高血压和肥胖似乎有助于心房纤维化、左心房扩大和传导系统的变化，这些变化易导致心律失常的发生和维持。2此外，心脏代谢参数的改善似乎对AF发病率和负担具有有益影响。例如，体重减轻> 10%的AF患者已被证明左心房容量和AF负担减少，而体力活动（PA）几乎以剂量依赖性方式与AF事件相关。3-5因此，最近发布的2023年ACC/AHA/ACCP/HRS房颤诊断和管理指南将肥胖和PA等风险因素的优化归类为房颤治疗的支柱。[6]但是其他重要的心律失常，如室性心律失常或缓慢性心律失常，情况又如何呢？我们是否可以使用复合指南支持的框架（例如AHA认可的CVH指标，有时称为“Life's Simple 7”）来全面了解CVH的影响，而不是调查单个风险因素？7在本期《欧洲预防心脏病学杂志》中，Cheng等人8在基于人群的社区动脉粥样硬化风险（ARIC）研究中调查了CVH与心律失常事件的相关性，该研究是一项社区队列研究，在1987年至1989年期间从美国的四个社区招募了15000多人。个体接受心血管危险因素的标准化评估，并返回进行四次随访。心血管健康是使用Life's Simple 7系统定义的，它包括CVH的七个领域。这七个领域包括四个健康行为：饮食质量，PA，吸烟和体重，以及三个健康指标：空腹血糖，总胆固醇和血压（BP）。根据AHA的建议，使用先前定义的阈值将每个领域分类为较差，中等或理想。7心律失常结局分为三个主要组：AF、室性心律失常和缓慢性心律失常，然后使用研究访视时进行的心电图、住院记录和死亡证明来确定。在排除了普遍存在心律失常的个体后，他们分析了13078名参与者的CVH与AF事件、室性心律失常和缓慢性心律失常之间的关系，使用单独的考克斯回归模型对多个基线临床因素进行了调整。在中位数为23年的随访中，共有2548例AF事件，1363例AF事件。
Cardiovascular disease is the leading cause of excess deaths worldwide. As a result, there has been recent emphasis on the optimization of cardiovascular health (CVH) metrics as a means to reduce the public health burden of atherosclerotic cardiovascular disease and heart failure. Comparably little attention has been paid to cardiac rhythm disorders, which are associated with substantial morbidity and mortality. Studies from the UK Biobank, a prospective cohort of over 500 000 participants, have shown that prevalent arrhythmias are found in∼ 1% of the population under 55 years of age and in∼ 5% of those aged 65 years or older. Atrial fibrillation (AF) is by far the most common arrhythmia and occurs with an incidence rate of 3.1 per 1000 person-years, while supraventricular arrhythmias (1.1 per 1000 person-years) and ventricular arrhythmias (0.5 per 1000 person-years) are relatively less common. 1 There is solid rationale to support the notion that the optimization of CVH metrics may have beneficial effects on arrhythmia risk. The best studied example is AF, where cardiometabolic factors such as hypertension and obesity appear to contribute to atrial fibrosis, left atrial enlargement, and changes to the conduction system that predispose to the initiation and maintenance of arrhythmia. 2 Furthermore, improvement in cardiometabolic parameters appears to have beneficial effects on AF incidence and burden. For example, people with AF who achieve weight loss of> 10% have been shown to have decreases in left atrial volume and AF burden, while physical activity (PA) has been associated with incident AF in an almost dose-dependent manner. 3–5 Consequently, the recently published 2023 ACC/AHA/ACCP/HRS guidelines for the diagnosis and management of AF categorize the optimization of risk factors such as obesity and PA as pillars of AF treatment. 6 But what about other important rhythm disorders such as ventricular arrhythmias or bradyarrhythmias? And rather than investigating individual risk factors, can we gain insight into the effects of CVH holistically using a composite guideline-supported framework, such as the AHA-endorsed CVH metric, sometimes called ‘Life’s Simple 7’? 7 In this issue of the European Journal of Preventive Cardiology, Cheng et al. 8 investigated the association of CVH with incident arrhythmias in the population-based Atherosclerosis Risk in Communities (ARIC) study, a community cohort recruiting over 15 000 people from four communities in the USA between 1987 and 1989. Individuals underwent standardized evaluation of cardiovascular risk factors, and returned for four follow-up visits. Cardiovascular health was defined systematically using Life’s Simple 7, which comprises seven domains of CVH. The seven domains comprise four health behaviours: dietary quality, PA, smoking, and weight, and three health measures: fasting blood glucose, total cholesterol, and blood pressure (BP). As recommended by the AHA, each domain was categorized as poor, intermediate, or ideal using previously defined thresholds. 7 Arrhythmia outcomes were classified into three main groups: AF, ventricular arrhythmias, and bradyarrhythmias, and then ascertained using electrocardiograms performed at study visits, hospitalization records, and death certificates. After excluding individuals with prevalent rhythm disorders, they analysed 13 078 participants for associations between CVH and incident AF, ventricular arrhythmias, and bradyarrhythmias, using separate Cox regression models adjusted for multiple baseline clinical factors. Over a median of 23 years of follow-up, there were a total of 2548 incident AF, 1363 incident …