累积血压暴露对新发心房颤动的预测价值
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摘要
目的探讨累积血压暴露(cumBP)对新发心房颤动(AF)的预测价值。方法本研究采用前瞻性队列研究的方法,观察对象为唐山开滦集团员工,自2006年开始每隔2年进行1次体检,截止至2015年底,共进行了5次体检。前3次体检均参加且血压等基线资料完整的研究对象为57927例。排除既往AF病史者、随访时心电图资料缺失者,最终纳入统计学分析的观察对象为40727例。根据累积收缩压暴露(cumSBP)进行四分位数分组:第一分位组:cumSBP<464 mmHg·year;第二分位组:464 mmHg·year≤cumSBP<512 mmHg·year;第三分位组:512 mmHg·year≤cumSBP<569 mmHg·year;第四分位组:cumSBP≥569 mmHg·year。比较不同cumSBP组新发AF的情况。COX比例风险模型分析cumBP对新发AF的预测价值。结果 (1)40727例观察对象,平均年龄51.81±11.54岁,其中男性30693例(75.4%),女性10034例(24.6%)。(2)结果表明,男性比例和年龄、体质指数、空腹血糖、总胆固醇和尿酸水平均随cumSBP的增加而增加,各组间差异有统计学意义(P<0.05)。(3)平均随访4.97±0.37年,影响新发AF事件的多因素COX比例风险模型分析显示:校正其他混杂因素后,cumSBP每增加10 mmHg·year,发生新发AF的HR值为1.034(95%CI 1.012～1.057);累积舒张压暴露每增加5 mmHg·year,发生新发AF的HR值为1.026(95%CI 1.008～1.044)。结论 cumBP对新发AF具有预测价值。
Aim To explore the predictive value of cumulative blood pressure exposure(cumBP) for new-onset atrial fibrillation(AF). Methods A prospective cohort study was used in this study. The people of Kailuan Group, Tangshan, were observed every two years since 2006. By the end of 2015, five examinations were carried out. The number of participants in the first three physical examinations with complete blood pressure and other baseline data was 57927. 40727 subjects were included in the final statistical analysis, excluding the patients with previous AF history and missing electrocardiogram data during follow-up. According to cumulative systolic blood pressure exposure(cumSBP), four quantiles grouping was performed: first quartile group: cumSBP<464 mmHg·year; second quartile group: 464 mmHg·year≤cumSBP<512 mmHg·year; third quartile group: 512 mmHg·year≤cumSBP<569 mmHg·year; fourth quartile group: cumSBP≥569 mmHg·year. The status of new-onset AF was compared in different cumSBP groups. COX proportional hazard model was used to analyze the predictive value of cumBP for new-onset AF. Results(1)In 40727 cases, the average age was 51.81±11.54 years old, among them, there were 30693 males(75.4%) and 10034 females(24.6%).(2)The results showed that the proportion of men and the levels of age, body mass index, fasting blood glucose, total cholesterol and uric acid increased with the increase of cumSBP, and the differences among the groups were statistically significant(P<0.05).(3)The average follow-up period was 4.97±0.37 years. The analysis of the multivariate COX proportional hazard model affecting the new-onset AF showed that, after correcting other confounding factors, the HR value of new-onset AF was 1.034(95%CI 1.012-1.057) for every 10 mmHg·year increase in cumSBP, and HR value was 1.026(95%CI 1.008-1.044) for every 5 mmHg·year increase in cumulative diastolic pressure exposure. Conclusion Cumulative blood pressure exposure has predictive value for new-onset atrial fibrillation.
Aim To explore the predictive value of cumulative blood pressure exposure(cumBP) for new-onset atrial fibrillation(AF). Methods A prospective cohort study was used in this study. The people of Kailuan Group, Tangshan, were observed every two years since 2006. By the end of 2015, five examinations were carried out. The number of participants in the first three physical examinations with complete blood pressure and other baseline data was 57927. 40727 subjects were included in the final statistical analysis, excluding the patients with previous AF history and missing electrocardiogram data during follow-up. According to cumulative systolic blood pressure exposure(cumSBP), four quantiles grouping was performed: first quartile group: cumSBP<464 mmHg·year; second quartile group: 464 mmHg·year≤cumSBP<512 mmHg·year; third quartile group: 512 mmHg·year≤cumSBP<569 mmHg·year; fourth quartile group: cumSBP≥569 mmHg·year. The status of new-onset AF was compared in different cumSBP groups. COX proportional hazard model was used to analyze the predictive value of cumBP for new-onset AF. Results(1)In 40727 cases, the average age was 51.81±11.54 years old, among them, there were 30693 males(75.4%) and 10034 females(24.6%).(2)The results showed that the proportion of men and the levels of age, body mass index, fasting blood glucose, total cholesterol and uric acid increased with the increase of cumSBP, and the differences among the groups were statistically significant(P<0.05).(3)The average follow-up period was 4.97±0.37 years. The analysis of the multivariate COX proportional hazard model affecting the new-onset AF showed that, after correcting other confounding factors, the HR value of new-onset AF was 1.034(95%CI 1.012-1.057) for every 10 mmHg·year increase in cumSBP, and HR value was 1.026(95%CI 1.008-1.044) for every 5 mmHg·year increase in cumulative diastolic pressure exposure. Conclusion Cumulative blood pressure exposure has predictive value for new-onset atrial fibrillation.
引文
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[13] Tremblay-Gravel M,White M,Roy D,et al.Blood pressure and atrial fibrillation:a combined AF-CHF and AFFIRM analysis[J].J Cardiovasc Electrophysiol,2015,26(5):509-514.
[14] Patel N,O'Neal WT,Whalen SP,et al.Electrocardiographic left ventricular hypertrophy predicts atrial fibrillation independent of left ventricular mass[J].Ann Noninvasive Electrocardiol,2017,22(3):1-5.
[15] Mayyas F,Alzoubi KH,Van Wagoner DR.Impact of aldosterone antagonists on the substrate for atrial fibrillation:aldosterone promotes oxidative stress and atrial structural/electrical remodeling[J].Int J Cardiol,2013,168(6):5135-5142.
[2] Hart RG,Halperin JL.Atrial fibrillation and thromboembolism:a decade of progress in stroke prevention[J].Ann Intern Med,1999,131(9):688-695.
[3] Wang YX,Song L,Xing AJ,et al.Predictive value of cumulative blood pressure for all-cause mortality and cardiovascular events[J].Sci Rep,2017,7:41969.
[4] Zemaitis P,Liu K,Jacobs DR Jr,et al.Cumulative systolic BP and changes in urine albumin-to-creatinine ratios in nondiabetic participants of the multi-ethnic study of atherosclerosis[J].Clin J Am Soc Nephrol,2014,9(11):1922-1929.
[5] Rahman F,Yin X,Larson MG,et al.Trajectories of risk factors and risk of new-onset atrial fibrillation in the Framingham Heart Study[J].Hypertension,2016,68(3):597-605.
[6] Grundvold I,Skretteberg PT,Liest?l K,et al.Upper normal blood pressures predict incident atrial fibrillation in healthy middle-aged men:a 35-year follow-up study[J].Hypertension,2012,59(2):198-204.
[7] Vaziri SM,Larson MG,Benjamin EJ,et al.Echocardiographic predictors of non-rheumatic atrial fibrillation:the Framingham Heart Study[J].Circulation,1994,89(2):724-730.
[8] Tsang TS,Barnes ME,Bailey KR,et al.Left atrial volume:important riskmarker of incident atrial fibillation in 1655 older men and women[J].Mayo Clin Proc,2001,76(5):467-475.
[9] Lantelme P,Laurent S,Besnard C,et al.Arterial stiffness is associated with left atrial size in hypertensive patients[J].Arch Cardiovasc Dis,2008,101(1):35-40.
[10] Mitchell GF.Arterial stiffness and hypertension[J].Hypertension,2014,64(1):13-18.
[11] Chen LY,Leening MJ,Norby FL,et al.Carotid intima-media thickness and arterial stiffness and the risk of atrial fibrillation:the atherosclerosis risk in communities (ARIC) study,multi-ethnic study of atherosclerosis (MESA),and the rotterdam study[J].J Am Heart Assoc,2016,5(5):e002907.
[12] Shaikh AY,Wang N,Yin X,et al.Relations of arterial stiffness and brachial flow-mediated dilation with new-onset atrial fibrillation:The Framingham Heart Study[J].Hypertension,2016,68(3):590-596.
[13] Tremblay-Gravel M,White M,Roy D,et al.Blood pressure and atrial fibrillation:a combined AF-CHF and AFFIRM analysis[J].J Cardiovasc Electrophysiol,2015,26(5):509-514.
[14] Patel N,O'Neal WT,Whalen SP,et al.Electrocardiographic left ventricular hypertrophy predicts atrial fibrillation independent of left ventricular mass[J].Ann Noninvasive Electrocardiol,2017,22(3):1-5.
[15] Mayyas F,Alzoubi KH,Van Wagoner DR.Impact of aldosterone antagonists on the substrate for atrial fibrillation:aldosterone promotes oxidative stress and atrial structural/electrical remodeling[J].Int J Cardiol,2013,168(6):5135-5142.