PDF(Pubmed)
Abstract：
Sustained forms of atrial fibrillation (AF) are associated with lower treatment success rates and poorer prognosis compared with paroxysmal AF. Yet, little is known about risk factors that predispose to persistent AF on initial presentation. Our objective was to define risk factors associated with new-onset persistent AF.
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.
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.
摘要：
■与阵发性房颤相比，持续性房颤（AF）的治疗成功率较低，预后较差。然而，对初次出现持续性房颤易感的危险因素知之甚少.我们的目的是确定与新发持续性房颤相关的危险因素。
■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.
■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.
