心房颤动是否会增加新发心肌梗死发病风险?

Does Atrial Fibrillation Increase the Risk of New Onset Myocardial Infarction?

背景心房颤动是医疗实践中症状最为明显的心律失常,心房颤动已经列入自1990年以来发病率增长最快的八大死亡原因之一。流行病学调查显示,65岁以上人群心房颤动的发生率最高可达9%,80岁以上人群最高可达17%;高血压患者到60岁以后将会有60%以上发生心房颤动。心房颤动增加了缺血性卒中、心力衰竭、慢性肾脏病、认知功能障碍及痴呆等疾病的发病风险,但是否会增加新发心肌梗死发病风险,尚不明确。目的探讨心房颤动是否会增加新发心肌梗死的发病风险。方法选取2006年6月至2007年10月河北省唐山市开滦集团职工健康查体人群(开滦研究人群)96750例,其中心房颤动患者458例(心房颤动组),无心房颤动者96292例(非心房颤动组)。记录受试者的一般资料,包括年龄、性别、个人史(吸烟史、饮酒史)、既往病史(高血压、冠心病、糖尿病、血脂异常),人体测量指标(体质量、身高、血压等);收集总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)。每2年随访1次,即分别在2008—2009年、2010—2011年、2012—2013年、2014—2015年和2016—2017年随访,中位随访时间为10年,随访终点事件为新发心肌梗死。采用多因素Cox回归模型分析探讨心房颤动对新发心肌梗死的影响。结果(1)心房颤动组和非心房颤动组年龄、体质指数(BMI)、收缩压(SBP)、LDL-C、FPG、糖尿病发生率、吸烟率、饮酒率、新发心肌梗死发生率比较,差异有统计学意义(P<0.05);(2)多因素Cox回归模型分析结果显示:心房颤动较非心房颤动增加新发心肌梗死发病风险〔RR=1.841,95%CI(1.118,2.869),P<0.05〕,校正年龄、性别(男性)后,心房颤动较非心房颤动增加新发心肌梗死发病风险〔RR=1.635,95%CI(1.049,2.547),P<0.05〕,进一步校正BMI、SBP、LDL-C、FPG、吸烟、饮酒后,心房颤动较非心房颤动增加新发心肌梗死发病风险〔RR=1.381,95%CI(1.087,1.573),P<0.05〕;饮酒为新发心肌梗死的保护因素〔RR=0.664,95%CI(0.572,0.770),P<0.05〕。结论心房颤动是新发心肌梗死发病的独立危险因素。

Background Atrial fibrillation is the most obvious arrhythmia in medical practice.Atrial fibrillation has been listed as one of the eight fastest-growing causes of death since 1990.Epidemiological investigation shows that the highest incidence of atrial fibrillation is 9%in people over 65 years old and 17%in people over 80 years old;more than 60%of patients with hypertension will develop atrial fibrillation after the age of 60.Atrial fibrillation increases the risk of ischemic stroke,heart failure,chronic kidney disease,cognitive impairment and dementia,but it is unclear whether it increases the risk of new onset myocardial infarction.Objective To investigate whether atrial fibrillation increases the risk of new onset myocardial infarction.Methods From June 2006 to October 2007,96750 employees of Kailuan Group in Tangshan,Hebei Province(Kailuan population)were selected for the study,including 458 patients with atrial fibrillation(atrial fibrillation group)and 96292 patients without atrial fibrillation(non atrial fibrillation group).The general information of patients was recorded,including age,gender,personal history(smoking history,drinking history),past medical history(hypertension,coronary heart disease,diabetes,dyslipidemia),anthropometric parameters(weight,height,blood pressure,etc.).Total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)and fasting blood glucose(FPG)were collected.The patients were followed up every 2 years,respectively,that was from 2008 to 2009,2010 to 2011,2012 to 2013,2014 to 2015,and 2016 to 2017.The median follow-up was 10 years,and the end point was new onset myocardial infarction.Multivariate Cox regression model was used to analyze the effect of atrial fibrillation on new onset myocardial infarction.Results(1)There were significant differences in age,body mass index(BMI),systolic blood pressure(SBP),LDL-C,FPG,diabetes,smoking,drinking and new onset myocardial infarction between atrial fibrillation group and non atrial fibrillation group(P<0.05).(2)Multivariate Cox regression analysis showed that atrial fibrillation increased the risk of new onset myocardial infarction compared with non atrial fibrillation〔RR=1.841,95%CI(1.118,2.869),P<0.05〕.After adjusting for age and gender(male),atrial fibrillation increased the risk of new onset myocardial infarction compared with non atrial fibrillation〔RR=1.635,95%CI(1.049,2.547),P<0.05〕,after further adjustment for BMI,SBP,LDL-C,FPG,smoking and drinking,atrial fibrillation increased the risk of new onset myocardial infarction compared with non atrial fibrillation〔RR=1.381,95%CI(1.087,1.573),P<0.05〕;drinking was the protective factor of new onset myocardial infarction〔RR=0.664,95%CI(0.572,0.770),P<0.05〕.Conclusion Atrial fibrillation is an independent risk factor of new onset myocardial infarction.