Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the Atherosclerosis Risk in Communities (ARIC) study.
Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the Atherosclerosis Risk in Communities (ARIC) study.
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DOI：
10.1161/circulationaha.110.009035
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发表时间：
2011-04-12
期刊：
影响因子：
37.8
通讯作者：
Alonso A
中科院分区：
文献类型：
--
作者：
Huxley RR;Lopez FL;Folsom AR;Agarwal SK;Loehr LR;Soliman EZ;Maclehose R;Konety S;Alonso A
房颤（AF）是卒中和总死亡率的重要危险因素，但关于房颤可预防负担的信息缺乏。本研究的目的是确定非裔美国人和白人房颤负担的比例，理论上可以通过维持最佳风险概况来避免。这项研究包括14598名中年社区动脉粥样硬化风险研究队列成员。先前确定的房颤风险因素，即高血压、体重指数升高、糖尿病、吸烟和既往心脏病，被分为“最佳”、“边缘”和“升高”水平。根据他们的风险因素水平，个人被分为这三组之一。非最佳风险概况导致房颤的人群归因比例分别对非裔美国人和白人男性和女性进行了估计。在平均17.1年的随访中，发现1520例AF。年龄调整后的发病率在白人男性中最高，在非裔美国女性中最低（分别为7.45和3.67 / 1000人年）。最佳风险概况的总体患病率为5.4%，但这一比例因种族和性别而异：白人女性为10%，非裔美国男性为1.6%。总体而言，56.5%的房颤病例可以通过具有≥1个高危因素来解释，其中血压升高是最重要的因素。与其他形式的心血管疾病一样，通过优化心血管危险因素水平，半数以上的房颤负担是有可能避免的。
Atrial fibrillation (AF) is an important risk factor for stroke and overall mortality but information about the preventable burden of AF is lacking. The aim of this study was to determine what proportion of the burden of AF in African-Americans and whites could theoretically be avoided by the maintenance of an optimal risk profile. This study included 14,598 middle-aged, Atherosclerosis Risk in Communities Study cohort members. Previously established AF risk factors, namely high blood pressure, elevated body mass index, diabetes, cigarette smoking and prior cardiac disease were categorized into ‘optimal’, ‘borderline’ and ‘elevated’ levels. Based on their risk factor levels, individuals were classified into one of these three groups. The population attributable fraction of AF due to having a non-optimal risk profile was estimated separately for African-American and white men and women. During a mean follow-up of 17.1 years, 1520 cases of incident AF were identified. The age-adjusted incidence rates were highest in white men and lowest in African-American women (7.45 and 3.67 per 1000 person-years, respectively). The overall prevalence of an optimal risk profile was 5.4% but this varied according to race and gender: 10% in white women versus 1.6% in African-American men. Overall, 56.5% of AF cases could be explained by having ≥ 1 elevated risk factors, of which elevated blood pressure was the most important contributor. As with other forms of cardiovascular disease, more than half of the AF burden is potentially avoidable through the optimization of cardiovascular risk factors levels.