Atrial Fibrillation: Incidence, Risk Factors, and Genetics

心房颤动（AF）是一种常见的心律失常，随着人口老龄化，其公共卫生重要性日益增加。本项目的总体目标是确定新发房颤的新风险因素，并评价其自然史和血栓性并发症。 血栓形成，特别是缺血性卒中，是AF最具破坏性的并发症，也是AF患者死亡和残疾的主要原因。关于短暂性AF（单次AF发作或AF持续7天或更短时间）患者卒中风险的知识有限。需要信息来指导短暂性房颤患者的抗凝治疗决策，特别是在开发新型抗血栓药物时。拟议的更新项目将在Group Health的AF患者初始队列中研究AF的预后。在约750例一过性AF患者中，将研究进展为阵发性和永久性AF的风险因素。将比较一过性AF患者与无AF患者的卒中风险。 随着认识到AF在同一家族成员中发生的频率增加，遗传因素可能对AF风险有贡献。AF的全基因组关联研究正在进行中。来自Group Health研究中AF病例和对照组的数据将用于复制正在进行的AF全基因组关联研究的结果。此外，该项目将识别早发性AF患者，早发性AF定义为65岁或以下且无基础结构性心脏病的AF患者。目前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检测到。将在新发现的早发性AF患者中进行全基因组扫描，并将结果与其他研究的结果结合起来，进行全基因组与早发性AF相关性的荟萃分析。 本研究的最终目标是增加对房颤危险因素和预后的了解，加强预防工作，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.