Risk of Dementia Associated With Atrial Cardiopathy: The ARIC Study.
Risk of Dementia Associated With Atrial Cardiopathy: The ARIC Study.
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DOI：
10.1161/jaha.121.025646
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发表时间：
2022-08-16
影响因子：
5.4
通讯作者：
Chen, Lin Yee
中科院分区：
文献类型：
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作者：
Johansen, Michelle C.;Wang, Wendy;Zhang, Michael;Knopman, David S.;Ndumele, Chiadi;Mosley, Thomas H.;Selvin, Elizabeth;Shah, Amil M.;Solomon, Scott D.;Gottesman, Rebecca F.;Chen, Lin Yee
心房性心脏病对痴呆风险的影响尚不明确。我们的目的是评估心房性心脏病与痴呆事件的关系以及房颤和卒中的潜在介导作用。我们对参加ARIC（社区动脉粥样硬化风险）研究访视5（2011-2013）的参与者进行了前瞻性队列分析。我们使用考克斯回归来确定心房性心脏病和痴呆风险之间的关系。使用结构方程建模方法确定房颤和/或卒中的潜在介导作用。如果访视5时≥1项以下情况，则定义为心房性心脏病：ECG导联V1的P波终末力>5000 mV·ms，NT-proBNP（N-末端脑钠肽前体）>250 pg/mL或经胸超声心动图显示的左心房容积指数≥34 mL/m2。我们重复了我们的分析，需要≥2个标志物来定义房性心脏病。在5078名参与者中，心房性心脏病的患病率为34%（平均年龄75岁，59%为女性，21%为黑人成年人），763名参与者发展为痴呆症。心房性心脏病与痴呆显著相关（校正的HR，1.35 [95% CI，1.16-1.58]），当需要≥2种生物标志物时，效应估计值加强（校正的HR，1.54 [95% CI，1.25-1.89]）。排除AF（校正HR，1.31 [95% CI，1.12-1.55]）或卒中（校正HR，1.28 [95% CI，1.09-1.52]）患者后，患有心房性心脏病的患者中痴呆的风险增加。AF介导的效应比例为4%（P=0.005），卒中介导的效应比例为9%（P=0.048）。心房性心脏病与痴呆风险增加显著相关，AF或中风仅占很小比例。
The contribution of atrial cardiopathy to dementia risk is uncharacterized. We aimed to evaluate the association of atrial cardiopathy with incident dementia and potential mediation by atrial fibrillation (AF) and stroke. We conducted a prospective cohort analysis of participants in the ARIC (Atherosclerosis Risk in Communities) study attending visit 5 (2011–2013). We used Cox regression to determine the association between atrial cardiopathy and risk of dementia. Structural equation modeling methods were used to determine potential mediation by AF and/or stroke. Atrial cardiopathy was defined if ≥1 of the following at visit 5: P‐wave terminal force >5000 mV·ms in ECG lead V1, NT‐proBNP (N‐terminal pro–brain natriuretic peptide) >250 pg/mL or left atrial volume index ≥34 mL/m2 by transthoracic echocardiography. We repeated our analysis necessitating ≥2 markers to define atrial cardiopathy. The prevalence of atrial cardiopathy was 34% in the 5078 participants (mean age 75 years, 59% female, 21% Black adults), with 763 participants developing dementia. Atrial cardiopathy was significantly associated with dementia (adjusted HR, 1.35 [95% CI, 1.16–1.58]), with strengthening of the effect estimate when necessitating ≥2 biomarkers (adjusted HR, 1.54 [95% CI, 1.25–1.89]). There was an increased risk of dementia among those with atrial cardiopathy when excluding those with AF (adjusted HR, 1.31 [95% CI, 1.12–1.55]) or stroke (adjusted HR, 1.28 [95% CI, 1.09–1.52]). The proportion of the effect mediated by AF was 4% (P=0.005), and 9% was mediated by stroke (P=0.048). Atrial cardiopathy was significantly associated with an increased risk of dementia, with only a small percent mediation of the effect by AF or stroke.