Risk of death and cardiovascular events in initially healthy women with new-onset atrial fibrillation.
Risk of death and cardiovascular events in initially healthy women with new-onset atrial fibrillation.
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DOI：
10.1001/jama.2011.659
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发表时间：
2011-05-25
影响因子：
120.7
通讯作者：
Albert, Christine M.
中科院分区：
文献类型：
--
作者：
Conen, David;Chae, Claudia U.;Glynn, Robert J.;Tedrow, Usha B.;Everett, Brendan M.;Buring, Julie E.;Albert, Christine M.
在中年妇女和低合并症负担人群中，与新发房颤相关的风险定义不清。研究初始健康女性房颤发生率与死亡率之间的关系，并评估相关心血管合并症对风险的影响。1993年至2010年3月16日期间，34722名妇女参加了妇女健康研究，并进行了前瞻性随访。参与者（95%为白人）年龄为45岁(中位数（四分位数间距）53岁（49-59岁），基线时无房颤和心血管疾病。采用具有时变协变量的Cox比例风险模型来确定偶发性房颤女性的事件风险。对阵发性房颤女性进行二次分析。主要结局包括总死亡率、心血管死亡率和非心血管死亡率。次要结局包括中风、充血性心力衰竭和心肌梗死。在15.4（14.7-15.8）年的中位（四分位数范围）随访期间，1011名女性发生房颤。患有和未患有房颤的女性每1000人年的发病率（95%置信区间（ci））分别为：全因死亡率10.8（8.1-13.5）和3.1(2.9-3.2)，心血管死亡率4.3（2.6-6.0）和0.57(0.5-0.6)，非心血管死亡率6.5（4.4-8.6）和2.5（2.4-2.6）。在多变量模型中，新发房颤的全因死亡率、心血管死亡率和非心血管死亡率的风险比（hr） （95% ci）分别为2.14（1.64-2.77）、4.18（2.69-6.51）和1.66（1.19-2.30）。对可能导致死亡的非致死性心血管事件进行调整，降低了这些风险，但AF事件仍然与所有死亡率组成部分相关（HR 1.70（1.30-2.22）、2.57（1.63-4.07）和1.42(1.02-1.98)）。在患有阵发性房颤的女性（n=656）中，死亡风险的增加仅限于心血管原因（HR 2.94(1.55-5.59)）。在一组健康女性中，新发房颤与心血管、非心血管和全因死亡率独立相关，其中一些风险可能由非致死性心血管事件解释。
The risks associated with new-onset AF among middle-aged women and populations with a low co-morbidity burden are poorly defined. To examine the association between incident AF and mortality in initially healthy women, and to evaluate the influence of associated cardiovascular co-morbidities on risk. Between 1993 and March 16, 2010, 34722 women participating in the Women's Health Study underwent prospective follow-up. Participants (95% white) were >45 years (median (interquartile range) 53 (49–59) years) and free of AF and cardiovascular disease at baseline. Cox proportional-hazards models with time-varying covariates were utilized to determine the risk of events among women with incident AF. Secondary analyses were performed among women with paroxysmal AF. Primary outcomes included total, cardiovascular, and non-cardiovascular mortality. Secondary outcomes included stroke, congestive heart failure and myocardial infarction. During a median (interquartile range) follow-up of 15.4 (14.7–15.8) years, 1011 women developed AF. Incidence rates (95% confidence intervals (CIs)) per 1000 person-years among women with and without AF were 10.8 (8.1–13.5) and 3.1 (2.9–3.2) for all-cause, 4.3 (2.6–6.0) and 0.57 (0.5–0.6) for cardiovascular and 6.5 (4.4–8.6) and 2.5 (2.4–2.6) for non-cardiovascular mortality, respectively. In multivariable models, hazard ratios (HRs) (95% CIs) of new-onset AF for all-cause, cardiovascular and non-cardiovascular mortality were 2.14 (1.64–2.77), 4.18 (2.69–6.51) and 1.66 (1.19–2.30), respectively. Adjustment for non-fatal cardiovascular events potentially on the causal pathway to death attenuated these risks, but incident AF remained associated with all mortality components (HR 1.70 (1.30–2.22)), 2.57 (1.63–4.07) and 1.42 (1.02–1.98)). Among women with paroxysmal AF (n=656), the increase in mortality risk was limited to cardiovascular causes (HR 2.94 (1.55–5.59)). Among a group of healthy women, new-onset AF was independently associated with cardiovascular, non-cardiovascular and all-cause mortality, with some of the risk potentially explained by non-fatal cardiovascular events.
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影响因子：
37.8
作者：
Conen D;Tedrow UB;Koplan BA;Glynn RJ;Buring JE;Albert CM
通讯作者：
Albert CM
影响因子：
37.8
作者：
Jahangir, Arshad;Lee, Victor;Gersh, Bernard J.
通讯作者：
Gersh, Bernard J.
影响因子：
5.9
作者：
Vidaillet, H;Granada, JF;Hayes, J
通讯作者：
Hayes, J
影响因子：
37.8
作者：
Mukamal, KJ;Tolstrup, JS;Gronbæk, M
通讯作者：
Gronbæk, M
影响因子：
37.8
作者：
Wang, TJ;Larson, MG;Benjamin, EJ
通讯作者：
Benjamin, EJ