We prospectively examined the differential associations between lifestyle, clinical, and socioeconomic risk factors and AF pattern (persistent versus paroxysmal) at the time of diagnosis among 25 119 participants without a history of cardiovascular disease, AF, or cancer in the VITAL rhythm study (Vitamin D and Omega-3).
During a median follow-up of 5.3 years, 900 participants developed AF and 346 (38.4%) were classified as persistent at the time of diagnosis. In multivariable competing risk models, increasing age, male sex, White race, height, weight, body mass index ≥30 kg/m2, hypertension, current or past smoking, alcohol intake ≥2 drinks/day, postcollege education, and randomized treatment with vitamin D were significantly associated with incident persistent AF. Compared with paroxysmal AF, increasing age, male sex, weight, body mass index ≥30 kg/m2, and postcollege education were more strongly associated with persistent AF in multivariable models regardless of whether interim cardiovascular disease and heart failure events were censored.
In a prospective cohort without baseline AF or cardiovascular disease, over one-third of AF at the time of diagnosis is persistent. Older age, male sex, postcollege education, and obesity were preferentially associated with persistent AF and represent a high-risk AF subset for population-based intervention.
■我们前瞻性地研究了生活方式之间的不同关联,临床,在25119名无心血管疾病史的参与者中,诊断时的社会经济风险因素和房颤模式(持续性与阵发性)。AF,或VITAL节律研究中的癌症(维生素D和Omega-3)。
■在5.3年的中位随访期间,900名参与者在诊断时发展为房颤,346名(38.4%)被分类为持续性。在多变量竞争风险模型中,年龄越来越大,男性,白人种族,高度,体重,体重指数≥30kg/m2,高血压,当前或过去吸烟,酒精摄入量≥2杯/天,大学后教育,维生素D的随机治疗与持续性房颤的发生显著相关.与阵发性房颤相比,年龄越来越大,男性,体重,在多变量模型中,体重指数≥30kg/m2和大学后教育与持续性房颤的相关性更强,无论是否对临时心血管疾病和心力衰竭事件进行审查.
■在没有基线房颤或心血管疾病的前瞻性队列中,诊断时超过三分之一的房颤持续存在.年纪大了,男性,大学后教育,肥胖优先与持续性房颤相关,代表人群干预的高危房颤亚组.