scholarly journals Risk factor modification reduced incidence of atrial fibrillation in an 18-year prospective cohort study: a time-updated analysis

Author(s):  
Mi Kyoung Son ◽  
Dae Sub Song ◽  
Kyoungho Lee ◽  
Hyun-Young Park

Abstract Background Although atrial fibrillation (AF) is an increasing health burden worldwide, strategies for AF prevention are lacking. This study aimed to identify modifiable risk factors (MRF) for and estimate their impact on AF risk in the midlife general population. Methods We assessed 9,049 participants who were free of prevalent AF at baseline from the Korean Genome and Epidemiology Study. Cox models with time-varying assessment of risk factors were used to identify significant MRF for incident AF. The MRF burden was defined as the proportion of times presented MRF during follow-up, based on the number of visits. Results Over a median follow-up of 13.1 years, 182 (2.01%) participants developed AF. In time-updated multivariable models accounting for changes in risk factors, three MRF including systolic blood pressure (SBP) more than 140 mmHg, obesity with central obesity, and an inactive lifestyle were significantly associated with incident AF. Compared to subjects with three MRF, those with one or no MRF had a decreased risk of AF (hazard ratio [95% CI] for one MRF, 0.483 [0.256–0.914]; and for no MRF, 0.291 [0.145–0.583]). A decreasing MRF burden was associated with reduced AF risk (hazard ratio [95% CI] per 10% decrease in SBP more than 140 mmHg, 0.937 [0.880–0.997]; in obesity with central obesity, 0.942 [0.907–0.978]; in inactivity, 0.926 [0.882–0.973]). Conclusions Maintenance or achievement of optimal MRF control was associated with decreased AF risk, suggesting that minimizing the burden of MRF might help prevent AF.

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001092
Author(s):  
Jorge A Wong ◽  
David Conen ◽  
Jeff S Healey ◽  
Linda S B Johnson

ObjectiveHeart failure (HF) frequently complicates atrial fibrillation (AF) and significantly increases mortality risk. Limited data exist on the modifiable risk factors associated with development of HF in AF patients.MethodsWe examined two large, prospective, population-based cohorts without prior AF or HF at baseline: Malmö Preventive Project (MPP, n=32 625) and Malmö Diet and Cancer Study (MDCS, n=27 695). Using Lunn-McNeil competing risks, multivariable Cox models were constructed to determine hazard ratios (HR) and 95% confidence intervals (CI) of risk factors for incident HF with AF, and AF alone.ResultsMean follow-up in MPP and MDCS was 27.6±8.4 and 17.7±5.3 years. In MPP, body mass index (HR 1.11, 95% CI 1.09 to 1.13 vs HR 1.05, 95% CI 1.04 to 1.06 per kg/m2), systolic blood pressure (HR 1.20, 95% CI 1.24 to 1.26 vs HR 1.08, 95% CI 1.06 to 1.10 per 10 mm Hg) and current cigarette smoking (HR 1.73, 95% CI 1.54 to 1.95 vs HR 1.23, 95% CI 1.15 to 1.32) had stronger associations with incident AF with HF compared with AF alone (all p for difference <0.0001). Similar results were observed in MDCS (all p for difference <0.009). These three risk factors and diabetes accounted for 51.8% and 54.1% of the population attributable risk (PAR) for AF with HF in MPP and MDCS, respectively, compared with 20.1% and 27.0% for AF alone.ConclusionsObesity, hypertension and active smoking preferentially associated with AF with HF, compared with AF alone, and accounted for >50% of the PAR. Randomised trials are needed to assess whether risk factor modification can reduce the incidence of AF with HF and reduce mortality.


2018 ◽  
Vol 16 (4) ◽  
pp. 435-444 ◽  
Author(s):  
Isaac Josh Abecassis ◽  
Rajeev D Sen ◽  
Jason Barber ◽  
Rakshith Shetty ◽  
Cory M Kelly ◽  
...  

Abstract BACKGROUND Endovascular treatment of intracranial aneurysms is associated with higher rates of recurrence and retreatment, though contemporary rates and risk factors for basilar tip aneurysms (BTAs) are less well-described. OBJECTIVE To characterize progression, retreatement, and retreated progression of BTAs treated with microsurgical or endovascular interventions. METHODS We retrospectively reviewed records for 141 consecutive BTA patients. We included 158 anterior communicating artery (ACoA) and 118 middle cerebral artery (MCA) aneurysms as controls. Univariate and multivariate analyses were used to calculate rates of progression (recurrence of previously obliterated aneurysms and progression of known residual aneurysm dome or neck), retreatment, and retreated progression. Kaplan–Meier analysis was used to characterize 24-mo event rates for primary outcome prediction. RESULTS Of 141 BTA patients, 62.4% were ruptured and 37.6% were unruptured. Average radiographical follow-up was 33 mo. Among ruptured aneurysms treated with clipping, there were 2 rehemorrhages due to recurrence (6.1%), and none in any other cohorts. Overall rates of progression (28.9%), retreatment (28.9%), and retreated progression (24.7%) were not significantly different between surgical and endovascular subgroups, though ruptured aneurysms had higher event rates. Multivariate modeling confirmed rupture status (P = .003, hazard ratio = 0.14) and aneurysm dome width (P = .005, hazard ratio = 1.23) as independent predictors of progression requiring retreatment. In a separate multivariate analysis with ACoA and MCA aneurysms, basilar tip location was an independent predictor of progression, retreatment, and retreated progression. CONCLUSION BTAs have higher rates of progression and retreated progression than other aneurysm locations, independent of treatment modality. Rupture status and dome width are risk factors for progression requiring retreatment.


2018 ◽  
Vol 25 (15) ◽  
pp. 1646-1652 ◽  
Author(s):  
Lars E Garnvik ◽  
Vegard Malmo ◽  
Imre Janszky ◽  
Ulrik Wisløff ◽  
Jan P Loennechen ◽  
...  

Background Atrial fibrillation is the most common heart rhythm disorder, and high body mass index is a well-established risk factor for atrial fibrillation. The objective of this study was to examine the associations of physical activity and body mass index and risk of atrial fibrillation, and the modifying role of physical activity on the association between body mass index and atrial fibrillation. Design The design was a prospective cohort study. Methods This study followed 43,602 men and women from the HUNT3 study in 2006–2008 until first atrial fibrillation diagnosis or end of follow-up in 2015. Atrial fibrillation diagnoses were collected from hospital registers and validated by medical doctors. Cox proportional hazard regression analysis was performed to assess the association between physical activity, body mass index and atrial fibrillation. Results During a mean follow-up of 8.1 years (352,770 person-years), 1459 cases of atrial fibrillation were detected (4.1 events per 1000 person-years). Increasing levels of physical activity were associated with gradually lower risk of atrial fibrillation ( p trend 0.069). Overweight and obesity were associated with an 18% (hazard ratio 1.18, 95% confidence interval 1.03–1.35) and 59% (hazard ratio 1.59, 95% confidence interval 1.37–1.84) increased risk of atrial fibrillation, respectively. High levels of physical activity attenuated some of the higher atrial fibrillation risk in obese individuals (hazard ratio 1.53, 95% confidence interval 1.03–2.28 in active and 1.96, 95% confidence interval 1.44–2.67 in inactive) compared to normal weight active individuals. Conclusion Overweight and obesity were associated with increased risk of atrial fibrillation. Physical activity offsets some, but not all, atrial fibrillation risk associated with obesity.


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Caroline Goode ◽  
Jinying Zhao ◽  
Richard B Devereux ◽  
Santosh Murthy ◽  
Alexander E Merkler ◽  
...  

Introduction: Leukocyte telomere length (LTL) is a potential biomarker of aging and associated with several age-related diseases. Current research on an association between LTL and incident stroke has had inconclusive results. We hypothesized that LTL is associated with incident stroke among American Indians (AI) in the Strong Heart Family Study (SHFS). Methods: The SHFS is a population-based cohort study of cardiovascular disease (CVD) and its risk factors. Participants (n=2,769) recruited from regions in Arizona, Oklahoma and the Dakotas were assessed for LTL and CVD risk factors during a clinic visit between 2001 and 2003. Incident stroke events were identified through the end of 2018 (mean follow-up: 16.4 years). We assessed the association between LTL and incident stroke using frailty models based on the proportional hazards, accounting for family relatedness and established stroke risk factors that include sex, geographical location, education, smoking, atrial fibrillation, diabetes mellitus, and hypertension. Results: Among 2,769 participants, the mean age was 40.6±17.2 and 41.4% were male. During follow-up, there were 79 (2.9%) incident stroke cases. In the primary model, which adjusted for demographic variables (sex, location and education), the hazard ratios (HR) for stroke in participants in the first and second LTL quartiles were significantly higher than those in the highest (longest) LTL quartile, with HRs of 3.1 (95%CI: 1.4 - 6.6) and 3.5 (95%CI: 1.7 - 7.5), respectively. After adjusting for smoking, atrial fibrillation, diabetes mellitus, and hypertension, the association between LTL and stroke was attenuated, but remained significant when comparing the second shortest LTL quartile to the longest LTL quartile, HR: 2.3 (95% CI: 1.1 – 5.0). Conclusions: In summary, LTL was associated with incident stroke among SHFS participants. Those with shorter LTL have higher risk of stroke. Longer follow-up time may add more power to data analyses since the SHFS is relatively young, with an average baseline age of 40 years. If results are confirmed in other populations, LTL may serve as a biomarker identifying high risk individuals for the purpose of stroke prevention.


2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Utibe R Essien ◽  
Megan McCabe ◽  
Sadiya S Khan

Introduction: Atrial fibrillation (AF) is a leading cause of cardiovascular morbidity and mortality. Disparities in AF outcomes have been related to individual-level social determinants of health, including race/ethnicity and socioeconomic status. While neighborhood-level factors, such as poverty, have been related to prevalence of key risk factors (e.g. obesity, hypertension), the association between neighborhood poverty and incident AF has not been previously examined. Methods: Using the Northwestern Medicine Enterprise Data Warehouse, we identified adults free of cardiovascular disease, with at least 5 years of follow-up from January 1, 2005 - December 31, 2013. Residential addresses were geocoded and matched to census tract level poverty estimates from the American Community Survey. Neighborhood poverty was defined as the proportion of residents in the census tract living below the US-defined poverty threshold. We categorized neighborhood poverty levels into tertiles. Generalized linear mixed effects models were used to examine the association between tertiles of neighborhood poverty and incident AF, adjusting for demographic (age, sex, race/ethnicity, insurance type) and AF risk factors (hypertension, diabetes, obesity and smoking status). Results: The cohort comprised 29,069 adults with a mean (SD) age of 51.4 (11.3) years, which included 58% women and 10% non-Hispanic Blacks. Higher rates of obesity, diabetes, hypertension, and smoking were observed in higher poverty groups. Approximately, 3.4% of patients developed incident AF over a follow-up of 5 years. The adjusted odds of incident AF were higher for the medium poverty compared to the low poverty group (adjusted odds ratio, aOR 1.30 (95% CI 1.05-1.56). The aOR of incident AF was similarly higher in the high poverty compared to low poverty group though not statistically significant (Table). Conclusions: In a cohort of adults free of cardiovascular disease at baseline, we found that residence in a more deprived neighborhood was associated with higher rates of incident AF, even after adjustment for traditional risk factors. Understanding how neighborhood and individual-level clinical factors interact to increase the incidence of AF is critical to developing equitable prevention strategies in this increasingly common condition.


2019 ◽  
Vol 30 (3) ◽  
pp. 525-532
Author(s):  
Laura Morales-Fernández ◽  
José María Martínez-de-la-Casa ◽  
Blanca Benito-Pascual ◽  
Federico Saénz-Francés ◽  
Enrique Santos-Bueso ◽  
...  

Objective: To assess incidence and risk factors of cataract extraction in patients with primary congenital glaucoma, surgical outcome, and complications. Material and method: Retrospective cohort study, in which 108 patients with primary congenital glaucoma were included. Data collected were need for cataract extraction and at what age, intraocular pressure at diagnosis of primary congenital glaucoma, required antiglaucomatous surgeries, possible mutation in the CYP1B1 gene, and final visual acuity. Among the patients who required cataract extraction were visual acuity, intraocular pressure, and complications, evaluated preoperatively and postoperatively. The data were analysed with STATA. Results: A total of 198 eyes of 108 patients were included, with a median follow-up of 8 years (range: 5–53). In all, 32 eyes (16.2%) of 24 patients (22%) required cataract extraction. The median age for cataract extraction was 12.94 years (interquartile range: 2.42–22). The main identified risk factors associated with cataract extraction were antiglaucomatous surgeries (hazard ratio 1.48, p < 0.001) and valvular implant (hazard ratio 2.78, p < 0.001). Lens was implanted in 30/32 eyes and the main complications were intraocular pressure decontrol ( n = 13), capsular fibrosis ( n = 7), corneal decompensation ( n = 4), lens subluxation ( n = 4), and endophthalmitis ( n = 1). Visual acuity improvement was observed after cataract extraction in 66.67% of eyes. Conclusions: There is a high incidence of cataract surgery in patients with primary congenital glaucoma, but generally outside of pediatric age. A greater risk of cataract extraction was identified in those patients with a greater number of antiglaucomatous surgeries, especially after valvular implantation. Despite the high rate of complications related to cataract extraction in primary congenital glaucoma, good visual improvement was observed after surgery.


2020 ◽  
Vol 15 (12) ◽  
pp. 1749-1761
Author(s):  
Dorey A. Glenn ◽  
Candace D. Henderson ◽  
Michelle O’Shaughnessy ◽  
Yichun Hu ◽  
Andrew Bomback ◽  
...  

Background and objectivesInfections contribute to patient morbidity and mortality in glomerular disease. We sought to describe the incidence of, and identify risk factors for, infection-related acute care events among Cure Glomerulonephropathy Network (CureGN) study participants.Design, setting, participants, & measurementsCureGN is a prospective, multicenter, cohort study of children and adults with biopsy sample–proven minimal change disease, FSGS, membranous nephropathy, or IgA nephropathy/vasculitis. Risk factors for time to first infection-related acute care events (hospitalization or emergency department visit) were identified using multivariable Cox proportional hazards regression.ResultsOf 1741 participants (43% female, 41% <18 years, 68% White), 163 (9%) experienced infection-related acute care events over a median follow-up of 17 months (interquartile range, 9–26 months). Unadjusted incidence rates of infection-related acute care events were 13.2 and 6.2 events per 100 person-years among pediatric and adult participants, respectively. Among participants with versus without corticosteroid exposure at enrollment, unadjusted incidence rates were 50.6 and 28.6 per 100 person-years, respectively, during the first year of follow-up (adjusted hazard ratio for time to first infection, 1.31; 95% CI, 0.89 to 1.93), and 4.1 and 1.1 per 100 person-years, respectively, after 1 year of follow-up (hazard ratio, 2.99; 95% CI, 1.54 to 5.79). Hypoalbuminemia combined with nephrotic-range proteinuria (serum albumin ≤2.5 g/dl and urinary protein-creatinine ratio >3.5 mg/mg), compared with serum albumin >2.5 g/dl and urinary protein-creatinine ratio ≤3.5 mg/mg, was associated with higher risk of time to first infection (adjusted hazard ratio, 2.49; 95% CI, 1.51 to 4.12).ConclusionsAmong CureGN participants, infection-related acute care events were common and associated with younger age, corticosteroid exposure, and hypoalbuminemia with proteinuria.


2020 ◽  
Vol 21 (4) ◽  
pp. 1247 ◽  
Author(s):  
Yann Nguyen ◽  
Jérôme Stirnemann ◽  
Florent Lautredoux ◽  
Bérengère Cador ◽  
Monia Bengherbia ◽  
...  

Gaucher disease (GD) is a rare lysosomal autosomal-recessive disorder due to deficiency of glucocerebrosidase; polyclonal gammopathy (PG) and/or monoclonal gammopathy (MG) can occur in this disease. We aimed to describe these immunoglobulin abnormalities in a large cohort of GD patients and to study the risk factors, clinical significance, and evolution. Data for patients enrolled in the French GD Registry were studied retrospectively. The risk factors of PG and/or MG developing and their association with clinical bone events and severe thrombocytopenia, two markers of GD severity, were assessed with multivariable Cox models and the effect of GD treatment on gammaglobulin levels with linear/logarithmic mixed models. Regression of MG and the occurrence of hematological malignancies were described. The 278 patients included (132 males, 47.5%) were followed up during a mean (SD) of 19 (14) years after GD diagnosis. PG occurred in 112/235 (47.7%) patients at GD diagnosis or during follow-up and MG in 59/187 (31.6%). Multivariable analysis retained age at GD diagnosis as the only independent risk factor for MG (> 30 vs. ≤30 years, HR 4.71, 95%CI [2.40–9.27]; p < 0.001). Risk of bone events or severe thrombocytopenia was not significantly associated with PG or MG. During follow-up, non-Hodgkin lymphoma developed in five patients and multiple myeloma in one. MG was observed in almost one third of patients with GD. Immunoglobulin abnormalities were not associated with the disease severity. However, prolonged surveillance of patients with GD is needed because hematologic malignancies may occur.


BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e029759 ◽  
Author(s):  
Prabhdeep Kaur ◽  
Sudha Ramachandra Rao ◽  
Ramachandran Venkatachalam ◽  
Boopathi Kangusamy ◽  
Ezhil Radhakrishnan ◽  
...  

Background and objectivesCardiovascular diseases (CVD) accounted for one-third of the deaths in India. We conducted a cohort study to estimate the incidence of CVD and the association of established risk factors with the incident CVD in a rural population in South India.Design, setting and participantsWe conducted a community-based cohort study among 6026 adults aged 25–64 years in five villages in Tiruvallur, Tamil Nadu. We did baseline (2005–2007) and two follow-up surveys in 2008–2009 and 2013–2015. Risk factors studied were tobacco, alcohol, hypertension, self-reported diabetes and central obesity.Outcome measuresOutcome measures were fatal or non-fatal ischaemic heart disease or cerebrovascular event. We estimated HRs for the risk factors and population attributable fraction (PAF).ResultsWe followed up 5641 (94.4%) subjects, and follow-up duration was 33 371 person years. The overall incidence of cardiovascular event or death was 4.6 per 1000 person years. Current smoking (HR 1.6, 95% CI 1.1 to 2.6) and hypertension (HR 2.2, 95% CI 1.5 to 3.4) were the risk factors among men and accounted for 47% of the PAF. Among women, hypertension (HR 1.8, 95% CI 1.0 to 3.4), self-reported diabetes (HR 4.3, 95% CI 2.2 to 8.1) and central obesity (HR 2.2, 95% CI 1.2 to 4.0) were associated with CVD and accounted for more than half of the PAF.ConclusionsWe described the high burden of fatal CVD and identified the role of CVD risk factors such as hypertension, self-reported diabetes, smoking and central obesity. There is an urgent need to implement low-cost interventions such as smoking cessation and treat hypertension and diabetes in primary care settings.


2019 ◽  
Vol 47 (9) ◽  
pp. 1359-1365 ◽  
Author(s):  
Sarah K. Chen ◽  
Medha Barbhaiya ◽  
Daniel H. Solomon ◽  
Hongshu Guan ◽  
Kazuki Yoshida ◽  
...  

Objective.Systemic lupus erythematosus (SLE) is a multisystem chronic inflammatory autoimmune disease with high prevalence of several risk factors for atrial fibrillation/flutter (AF). However, the incidence and risk of AF in SLE have not been well quantified.Methods.We used the United States Medicaid Analytic eXtract from 2007 to 2010 to identify beneficiaries aged 18–65 years, with prevalent SLE, each matched by age and sex to 4 non-SLE general Medicaid recipients. We estimated the incidence rates (IR) per 1000 person-years (PY) for AF hospitalizations and used multivariable Cox regression to estimate the HR for AF hospitalization.Results.We identified 46,876 US Medicaid recipients with SLE, and 187,504 age- and sex-matched non-SLE controls (93% female; mean age 41.5 ± 12.2 yrs). Known AF risk factors such as hypertension (HTN), cardiovascular disease (CVD), and kidney disease were more prevalent in patients with SLE. During a mean followup of 1.9 ± 1.1 years for SLE, and 1.8 ± 1.1 years for controls, the IR per 1000 PY for AF was 1.4 (95% CI 1.1–1.6) among patients with SLE and 0.7 (95% CI 0.6–0.8) among non-SLE controls. In age- and sex-matched and race-adjusted Cox models, the HR for AF was 1.79 (95% CI 1.43–2.24); after adjustment for baseline HTN and CVD, the adjusted HR was reduced to 1.17 (95% CI 0.92–1.48).Conclusion.SLE was associated with a doubled rate of hospitalization for AF compared to age- and sex-matched general Medicaid patients. In a race-adjusted model, the risk was 80% higher. However, the AF risk factors HTN and CVD were more prevalent among patients with SLE and accounted for the excess risk.


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