Atrial Fibrillation: Incidence, Risk Factors, and Genetics

房颤(房颤)是一种常见的心律失常，随着人口老龄化，其对公众健康的重要性日益增加。本项目的总体目标是确定发生房颤的新危险因素，并评估其自然病史和血栓并发症。 血栓形成，尤其是缺血性中风，是房颤最具破坏性的并发症，也是房颤患者死亡和残疾的主要原因。有关短暂性房颤(单发房颤或房颤持续7天或更短时间)患者中风风险的知识有限。需要信息来指导一过性房颤患者的抗凝决策，特别是随着新的抗血栓药物的开发。拟议的更新项目将在Group Health的房颤患者初始队列中调查房颤的预后。在大约750名短暂性房颤患者中，将研究进展为阵发性和永久性房颤的危险因素。短暂性房颤患者的卒中风险将与无房颤患者的风险进行比较。 随着人们认识到房颤在同一家庭成员中发生的频率增加，基因可能对房颤的风险有贡献。房颤的全基因组关联研究正在进行中。集团健康研究中来自房颤病例和对照的数据将被用于复制正在进行的房颤全基因组关联研究的结果。此外，该项目将确定早发性房颤患者，即发生在65岁或以下且没有潜在结构性心脏病的患者。现代关于早发性房颤的流行病学研究很少，在没有临床心血管疾病作为病因的人群中，房颤的遗传易感性可能最容易被检测到。全基因组扫描将在新发现的早发性房颤患者中进行，结果将与其他研究的结果结合起来，进行全基因组与早发性房颤相关性的荟萃分析。 这项研究的最终目标是增加对房颤危险因素和预后的了解，并加强预防措施和改善对房颤患者的护理。

Atrial fibrillation (AF) is a common arrhythmia and is assuming increased public health importance as the population ages. The overall objective of this project is to identify novel risk factors for the development of incident AF and to evaluate its natural history and thrombotic complications. Thrombosis, and in particular ischemic stroke, is the most devastating complication of AF, and is a leading cause of death and disability in patients with AF. Knowledge about the risk of stroke in patients with transitory AF (a single episode of AF or AF lasting 7 days or less) is limited. Information is needed to guide anticoagulation decisions for patients with transitory AF, particularly as novel antithrombotic agents are developed. The proposed renewal project will investigate the prognosis of AF in an inception cohort of AF patients at Group Health. Among approximately 750 patients with transitory AF, risk factors will be studied for progression to paroxysmal and permanent AF. Stroke risk in patients with transitory AF will be compared to risk in those with no AF. With the recognition that AF occurs with increased frequency among members of the same family, a genetic contribution to AF risk is likely. Genome-wide association studies of AF are under way. Data from AF cases and controls in the Group Health study will be used to replicate findings from ongoing genome-wide association studies of AF. In addition, this project will identify patients with early-onset AF, defined as AF occurring in a person 65 years of age or younger and without underlying structural heart disease. There are few contemporary epidemiologic studies of early-onset AF, and genetic predisposition to AF may be most easily detected among people without clinical cardiovascular disease as an etiologic factor. Genome-wide scans will be performed in newly-identified patients with early-onset AF, and results will be combined with those from other studies in a meta-analysis of genome-wide associations with early-onset AF. The ultimate goal of this research is to increase knowledge about AF risk factors and prognosis and to enhance prevention efforts and improve care for patients with AF.