背景:体重增加(WG)对房颤(AF)患者心血管结局的长期影响尚不清楚。
结果:我们研究了62871(平均年龄,72±12,43%的女性)成人房颤患者在2010年1月1日至2021年5月13日之间在匹兹堡大学医学中心进行了评估。连续体重指数,危险因素,合并症,随后的死亡和住院被确定并根据百分比WG(≥0%至<5%,≥5%至<10%,且≥10%)。超过4.9±3.19年的随访,27114例(43%)患者体重增加(61%,≥0%至<5%;23%,≥5%至<10%;16%,≥10%)。进行性WG患者的年龄逐渐年轻(P<0.001),女性(40%,42%,和47%),家庭收入中位数较低(P=0.002)和积极吸烟(8%,13%和13%),他们不太可能服用非维生素K口服抗凝剂(39%,37%,和32%)。WG与房颤住院风险显著增加相关(≥10%WG;风险比[HR],1.2[95%CI,1.2-1.3];P<0.0001),心力衰竭(≥10%WG;HR,1.44[95%CI,1.3-1.6];P<0.001;≥5%至<10%WG;HR,1.17[95%CI,1.1-1.2];P<0.001),心肌梗死(≥10%WG;HR,1.2[95%CI,1.3-1.6];P<0.001)和全因卒中(4.2%,4.3%,和5.6%),尽管平均CHADS2Vasc评分显着降低(2.9±1.7、2.7±1.6和2.7±1.7)。WG较多的患者更有可能接受心脏和电生理干预。
结论:在房颤患者中,WG与心血管原因的住院率增加有关,尤其是心力衰竭,中风,心肌梗塞,和AF。
BACKGROUND: The long-term impact of weight gain (WG) on cardiovascular outcomes among patients with atrial fibrillation (AF) is unclear.
RESULTS: We studied 62 871 (mean age, 72±12, 43% women) adult patients with AF evaluated at the University of Pittsburgh Medical Center between January 1, 2010, and May 13, 2021. Serial body mass index, risk factors, comorbidities, and subsequent death and hospitalization were ascertained and stratified according to percentage WG (≥0% to <5%, ≥5% to <10%, and ≥10%). Over 4.9±3.19 years of follow-up, 27 114 (43%) patients gained weight (61%, ≥0% to <5%; 23%, ≥5% to <10%; 16%, ≥10%). Patients with progressive WG were incrementally younger (P<0.001) women (40%, 42%, and 47%) with lower median household income (P=0.002) and active smoking (8%, 13% and 13%), and they were less likely to be on a non-vitamin K oral anticoagulant (39%, 37%, and 32%). WG was incrementally associated with a significant increase in risk of hospitalization for AF (≥10% WG; hazard ratio [HR], 1.2 [95% CI, 1.2-1.3]; P<0.0001), heart failure (≥10% WG; HR, 1.44 [95% CI, 1.3-1.6]; P<0.001; ≥5% to <10% WG; HR, 1.17 [95% CI, 1.1-1.2]; P<0.001), myocardial infarction (≥10% WG; HR, 1.2 [95% CI, 1.3-1.6]; P<0.001) and all-cause stroke (4.2%, 4.3%, and 5.6%) despite significantly lower mean CHADS2Vasc score (2.9±1.7, 2.7±1.6, and 2.7±1.7). Patients with more WG were significantly more likely to receive cardiac and electrophysiologic interventions.
CONCLUSIONS: Among patients with AF, WG is incrementally associated with increased hospitalization for cardiovascular causes, particularly heart failure, stroke, myocardial infarction, and AF.