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Vats V, Kulkarni V, Shafique MA, Haseeb A, Arain M, Armaghan M, Arshad F, Maryam A, Shojai Rahnama B, Moradi I, Ahuja K, Kamal A, Salameh Z, Ahmed M, Mehmood D. Analyzing the impact of sleep duration on atrial fibrillation risk: a comprehensive systematic review and meta-analysis. Ir J Med Sci 2024; 193:1787-1795. [PMID: 38526766 DOI: 10.1007/s11845-024-03669-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Recent studies have suggested an association between sleep duration and cardiovascular diseases; however, the link to AF is inconclusive. This study aimed to explore the relationship between sleep duration and AF by conducting a systematic review and meta-analysis of primary studies to provide evidence of the link between insufficient sleep and AF. METHODS A review of the existing literature was conducted to identify the primary studies that examined the association between AF and sleep duration. The inquiry spanned databases, including PubMed, Embase, MEDLINE, and Google Scholar, from their inception through October 2023. RESULTS Meta-analysis revealed a statistically significant association (p < 0.01) between shorter sleep duration and the incidence of AF (hazard ratio (HR), 1.18; 95% CI, 1.03-1.34; I2 = 89%). Conversely, longer sleep duration did not exhibit a statistically significant association with the incidence of AF (HR, 1.03; 95% CI, 0.92-1.14; I2 = 66%, p = 0.02). The sensitivity analysis demonstrated reduced heterogeneity after excluding specific studies. CONCLUSION Insufficient sleep duration was associated with an increased risk of AF, whereas a longer sleep duration did not show a significant correlation. Standardized methods for sleep assessment and AF diagnosis as well as adjustments for confounding factors are suggested for future studies to improve the clarity and understanding of these associations.
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Affiliation(s)
- Vaibhav Vats
- Department of Medicine, Smt. Kashibai Navale Medical College & General Hospital, Pune, India
| | - Vrunda Kulkarni
- Department of Medicine, Smt. Kashibai Navale Medical College & General Hospital, Pune, India
| | | | - Abdul Haseeb
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Mustafa Arain
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Faraz Arshad
- Department of Medicine, Shaikh Zayed Hospital, Lahore, Pakistan
| | | | | | - Iman Moradi
- Saint George's University, True Blue, Grenada
| | | | | | | | - Mahlail Ahmed
- Jinnah Medical and Dental College, Karachi, Pakistan
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Ogieuhi IJ, Ugiomoh OMA, Awe M, Khan M, Kwape JM, Akpo D, Thiyagarajan B, Nnekachi NP. Exploring the bidirectional relationship between sleep disorders and atrial fibrillation: implications for risk stratification and management. Egypt Heart J 2024; 76:95. [PMID: 39080107 PMCID: PMC11289190 DOI: 10.1186/s43044-024-00524-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 07/11/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is characterized by the absence of p-waves on ECG and irregular rhythm. It often presents with palpitations either palpitations may occur acutely over a short period or intermittently over several years. Other cardinal symptoms of atrial fibrillation include fatigue, dyspnea, and lightheadedness; it is important however to note that most affected individuals are asymptomatic. Concurrently, sleep disorders such as obstructive sleep apnea (OSA), insomnia, narcolepsy, and circadian rhythm disorders which are a group of conditions associated with the body's internal clock that affect the timing of sleep and alertness, are raising concerns due to their potential associations to arrhythmias. This review explores the bidirectional relationship between AF and sleep disorders, highlighting their implications for risk stratification and management strategies. MAIN BODY The narrative approach of this review synthesizes evidence from numerous studies obtained through meticulous literature searches. Specific sleep disorders with a bidirectional relationship with AF are the focus, with scrutiny on the prevalence of this connection. The examination delves into the pathophysiology of sleep-related autonomic dysregulation and inflammation, emphasizing potential management modalities. Various meta-analysis cohorts have highlighted a strong connection between sleep disorders and atrial fibrillation (AF). Patients with sleep disorders, especially OSA, have a higher likelihood of developing AF, and conversely, those with AF are more prone to sleep disorders. This impact is not limited to development, as sleep disorders also contribute to the progression of AF, with AF, in turn, negatively impacting sleep duration and quality. Sleep disorders may play an important role in atrial remodeling as well as electrophysiological abnormalities, rendering the atrial tissue more susceptible to arrhythmogenesis. The narrative review suggests that treating sleep disorders could not only improve sleep quality but also reduce risk factors associated with atrial fibrillation. The effective management of sleep disorders emerges as a potential challenge in preventing and treating atrial fibrillation. CONCLUSION In conclusion, this narrative study highlights the bidirectional relationship between sleep disorders and atrial fibrillation. There is a positive correlation, affecting the development, progression, and management of atrial fibrillation. The detrimental impact of sleep disorders on atrial remodeling and electrophysiological abnormalities underscores the significance of their diagnosis and treatment. Education about the importance of sleep and the benefits of sleep disorder treatment becomes imperative for patients with AF and sleep disorders.
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Affiliation(s)
| | | | - Mishael Awe
- Medical Academy Named After S I Georgievskiy Crimean Federal University Named After V I Vernadsky, Simferopol, Russia
| | - Maham Khan
- Fatima Jinnah Medical University, Lahore, Pakistan
| | | | - Deborah Akpo
- State Neuropsychiatric Hospital, Nawfia, Anambra State, Nigeria
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Chen S, Liu Z, Yan S, Du Z, Cheng W. Increased susceptibility to new-onset atrial fibrillation in diabetic women with poor sleep behaviour traits: findings from the prospective cohort study in the UK Biobank. Diabetol Metab Syndr 2024; 16:51. [PMID: 38414084 PMCID: PMC10898144 DOI: 10.1186/s13098-024-01292-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/13/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Diabetic individuals often encounter various sleep-related challenges. Although the association between sleep duration and atrial fibrillation (AF) have been explored, the association of other sleep traits with the incidence of AF remains unclear. A comprehensive understanding of these traits is essential for a more accurate assessment of sleep conditions in patients with diabetes and the development of novel AF prevention strategies. METHODS This study involved 23,785 patients with diabetes without any pre-existing cardiovascular disease, drawn from the UK Biobank. Sleep behaviour traits examined encompassed sleep duration, chronotype, insomnia, snoring and daytime sleepiness. Sleep duration was categorised into three groups: low (≤ 5 h), proper (6-8 h) and long (≥ 9 h). We assessed associations using multivariate Cox proportional risk regression models. Furthermore, four poor sleep behaviours were constructed to evaluate their impact on the risk of new-onset AF. RESULTS Over a mean follow-up period of 166 months, 2221 (9.3%) new cases of AF were identified. Short (hazard ratio (HR), 1.28; 95% confidence interval (CI) 1.10-1.50) and long sleep durations (HR 1.16; 95% CI 1.03-1.32) consistently exhibited an elevated risk of AF compared to optimal sleep duration. Early chronotype, infrequent insomnia and daytime sleepiness were associated with 11% (HR 0.89; 95% CI 0.82-0.97), 15% (HR 0.85; 95% CI 0.77-0.95) and 12% (HR 0.88; 95% CI 0.81-0.96) reduced risk of new-onset AF, respectively. However, no significant association was found between snoring and the incidence of AF (HR 0.99; 95% CI 0.91-1.07). CONCLUSIONS In diabetic populations, sleep duration, chronotype, insomnia and daytime sleepiness are strongly associated with AF incidence. An optimal sleep duration of 6-8 h presents the lowest AF risk compared to short or long sleep duration. Additionally, poor sleep patterns present a greater risk of new-onset AF in women than in men.
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Affiliation(s)
- Siwei Chen
- Department of Cardiovascular Medicine, Nanchang People's Hospital (The Third Hospital of Nanchang), Jiangxi, China
| | - Zhou Liu
- Department of Geriatric Medicine, The Fifth People's Hospital of Huai'an, The Affiliated Huai'an Hospital of Yangzhou University, Huai'an, China
- Department of Cardiology, The Fifth People's Hospital of Huai'an, The Affiliated Huai'an Hospital of Yangzhou University, Huai'an, China
| | - Shaohua Yan
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhongyan Du
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China.
- Key Laboratory of Blood-stasis-toxin Syndrome of Zhejiang Province, Zhejiang Engineering Research Center for "Preventive Treatment" Smart Health of Traditional Chinese Medicine, Hangzhou, 310053, China.
| | - Wenke Cheng
- Medical Faculty, University of Leipzig, Liebigstr 27, 04103, Leipzig, Germany.
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 124] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Kumar A, Iqbal K, Shariff M, Stulak JM, Kowlgi NG, Somers VK, Anavekar N, Deshmukh A. Association of sleep duration with atrial fibrillation/flutter mortality in the United States: a cross-sectional analysis. J Interv Card Electrophysiol 2024; 67:157-164. [PMID: 37316764 DOI: 10.1007/s10840-023-01593-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/08/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND The association between sleep duration and atrial fibrillation risk is poorly understood, with inconsistent findings reported by several studies. We sought to assess the association between long sleep duration and mortality due to atrial fibrillation/atrial flutter (AF/AFL). METHODS The 2016-2020 Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research dataset was used to identify death records secondary to AF/AFL in the United States population. We used the 2018 Behavioral Risk Factor Surveillance System (BRFSS) dataset of sleep duration at the county level. All counties were grouped into quartiles based on the percentage of their population with long sleep duration (i.e., ≥ 7 h), Q1 being the lowest and Q4 the highest quartile. Age-adjusted mortality rates (AAMR) were calculated for each quartile. County Health Rankings for Texas were used to adjust the AAMR for comorbidities using linear regression. RESULTS Overall, the AAMR for AF/AFL were highest in Q4 (65.9 [95% CI, 65.5-66.2] per 100,000 person-years) and lowest in Q1 (52.3 [95% CI, 52.1-52.5] per 100,000 person-years). The AAMR for AF/AFL increased stepwise from the lowest to highest quartiles of the percentage population with long sleep duration. After adjustment for the county health ranks of Texas, long sleep duration remained associated with a significantly higher AAMR (coefficient 220.6 (95% CI, 21.53-419.72, p-value = 0.03). CONCLUSIONS Long sleep duration was associated with higher AF/AFL mortality. Increased focus on risk reduction for AF, public awareness about the importance of optimal sleep duration, and further research to elucidate a potential causal relationship between sleep duration and AF are warranted.
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Affiliation(s)
- Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Kinza Iqbal
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Mariam Shariff
- Department of Surgery, Mayo Clinic, Rochester, Minneapolis, MN, USA
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Narayan G Kowlgi
- Department of Cardiovascular Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Nandan Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
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Gaffey AE, Rosman L, Lampert R, Yaggi HK, Haskell SG, Brandt CA, Enriquez AD, Mazzella AJ, Skanderson M, Burg MM. Insomnia and Early Incident Atrial Fibrillation: A 16-Year Cohort Study of Younger Men and Women Veterans. J Am Heart Assoc 2023; 12:e030331. [PMID: 37791503 PMCID: PMC10757545 DOI: 10.1161/jaha.123.030331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/24/2023] [Indexed: 10/05/2023]
Abstract
Background There is growing consideration of sleep disturbances and disorders in early cardiovascular risk, including atrial fibrillation (AF). Obstructive sleep apnea confers risk for AF but is highly comorbid with insomnia, another common sleep disorder. We sought to first determine the association of insomnia and early incident AF risk, and second, to determine if AF onset is earlier among those with insomnia. Methods and Results This retrospective analysis used electronic health records from a cohort study of US veterans who were discharged from military service since October 1, 2001 (ie, post-9/11) and received Veterans Health Administration care, 2001 to 2017. Time-varying, multivariate Cox proportional hazard models were used to examine the independent contribution of insomnia diagnosis to AF incidence while serially adjusting for demographics, lifestyle factors, clinical comorbidities including obstructive sleep apnea and psychiatric disorders, and health care utilization. Overall, 1 063 723 post-9/11 veterans (Mean age=28.2 years, 14% women) were followed for 10 years on average. There were 4168 cases of AF (0.42/1000 person-years). Insomnia was associated with a 32% greater adjusted risk of AF (95% CI, 1.21-1.43), and veterans with insomnia showed AF onset up to 2 years earlier. Insomnia-AF associations were similar after accounting for health care utilization (adjusted hazard ratio [aHR], 1.27 [95% CI, 1.17-1.39]), excluding veterans with obstructive sleep apnea (aHR, 1.38 [95% CI, 1.24-1.53]), and among those with a sleep study (aHR, 1.26 [95% CI, 1.07-1.50]). Conclusions In younger adults, insomnia was independently associated with incident AF. Additional studies should determine if this association differs by sex and if behavioral or pharmacological treatment for insomnia attenuates AF risk.
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Affiliation(s)
- Allison E. Gaffey
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (Cardiovascular Medicine)Yale School of MedicineNew HavenCTUSA
| | - Lindsey Rosman
- Division of Cardiology, Department of MedicineUniversity of North Carolina, Chapel HillChapel HillNCUSA
| | - Rachel Lampert
- Department of Internal Medicine (Cardiovascular Medicine)Yale School of MedicineNew HavenCTUSA
| | - Henry K. Yaggi
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (Pulmonary, Critical Care & Sleep Medicine)Yale School of MedicineCTNew HavenUSA
| | - Sally G. Haskell
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (General Medicine)Yale School of MedicineNew HavenCTUSA
| | - Cynthia A. Brandt
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Emergency MedicineYale School of MedicineNew HavenCTUSA
- Yale Center for Medical InformaticsYale School of MedicineNew HavenCTUSA
| | - Alan D. Enriquez
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (Cardiovascular Medicine)Yale School of MedicineNew HavenCTUSA
| | - Anthony J. Mazzella
- Division of Cardiology, Department of MedicineUniversity of North Carolina, Chapel HillChapel HillNCUSA
| | | | - Matthew M. Burg
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (Cardiovascular Medicine)Yale School of MedicineNew HavenCTUSA
- Department of AnesthesiologyYale School of MedicineNew HavenCTUSA
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Chen J, Li F, Wang Y, Cai D, Chen Y, Mei Z, Chen L. Short sleep duration and atrial fibrillation risk: A comprehensive analysis of observational cohort studies and genetic study. Eur J Intern Med 2023; 114:84-92. [PMID: 37183080 DOI: 10.1016/j.ejim.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/18/2023] [Accepted: 05/02/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Previous observational studies are inconclusive on whether an association exists between short sleep duration and the high risk of developing atrial fibrillation (AF). Understanding their potential association would be of great clinical significance. Thus, in this study, we aimed to explore their causal relationship. METHODS AND RESULTS We meta-analyzed the association between short sleep duration and the risk of developing AF by including six observational studies. Based on genetic susceptibility analysis using the mendelian randomization (MR) method, we identified 16 genetic loci that might link short sleep duration and the high risk of developing AF. Meta-analysis showed a significant association between short sleep duration and a higher risk of developing AF (RR = 1.06, 95% CI 1.02-1.11, P = 0.005). However, the fixed-effect and random-effect inverse variance weighted (IVW) models using the MR method showed a non-obvious effect of short sleep duration on the risk of developing AF (OR, 0.979; 95% CI, 0.880-1.089, P = 0.693; OR, 0.979; 95% CI, 0.857-1.117, P = 0.750, respectively). Other models, also showed no statistical difference. No heterogeneity or asymmetry was observed, as Cochran's Q test showed. The leave-one-out sensitivity analysis demonstrated good robust results, which were not subject to directional pleiotropy. CONCLUSION Meta-analysis and MR analysis demonstrated inconsistent results on the relationship between short sleep duration and a high risk of developing AF. Specifically, while meta-analysis confirmed that short sleep duration increases the risk of developing AF, MR analysis did not support a causal association between genetically determined short sleep and risk of AF.
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Affiliation(s)
- Jun Chen
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310000, China
| | - Fuhao Li
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310000, China
| | - Yucheng Wang
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Medical College of Fudan University, Shanghai, China
| | - Dongsheng Cai
- Zhejiang University of Medical College, Hangzhou, Zhejiang 310000, China
| | - Yijie Chen
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310000, China
| | - Ziwei Mei
- Lishui Municipal Central Hospital, the Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China.
| | - Lei Chen
- Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang 318000, China.
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Cai C, Atanasov S. Long Sleep Duration and Stroke-Highly Linked, Poorly Understood. Neurol Int 2023; 15:764-777. [PMID: 37489354 PMCID: PMC10366725 DOI: 10.3390/neurolint15030048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/26/2023] Open
Abstract
Stroke is one of the leading causes of disability and mortality. Both short and long sleep durations are associated with adverse health outcomes. Cross-sectional studies have shown an increased prevalence of stroke in long sleepers. Long sleep duration increases stroke incidence and mortality in prospective epidemiological studies. Accumulating evidence suggests that the magnitude of the association between sleep and stroke appears to be stronger for longer sleep than shorter sleep, yielding a J-shaped curve. Potential links between long sleep duration and stroke include increased incidence of diabetes and atrial fibrillation, elevated levels of inflammation, arterial stiffness, and blood pressure variability. Long sleep duration is a strong marker and a plausible risk factor for stroke and should be considered in future scoring for risk stratification and stroke prevention.
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Affiliation(s)
- Chumeng Cai
- Department of Neuroscience, College of Natural Sciences, The University of Texas at Austin, Austin, TX 78712-0805, USA
| | - Strahil Atanasov
- Division of Pulmonary Critical Care & Sleep Medicine, University of Texas Medical Branch, Galveston, TX 77555-0561, USA
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Arafa A, Kashima R, Kokubo Y, Teramoto M, Sakai Y, Nosaka S, Kawachi H, Shimamoto K, Matsumoto C, Gao Q, Izumi C. Alcohol consumption and the risk of heart failure: the Suita Study and meta-analysis of prospective cohort studies. Environ Health Prev Med 2023; 28:26. [PMID: 37150604 DOI: 10.1265/ehpm.22-00231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Alcohol consumption is a modifiable lifestyle, but its role in heart failure (HF) development is controversial. Herein, we investigated the prospective association between alcohol consumption and HF risk. METHODS A total of 2,712 participants (1,149 men and 1,563 women) from the Suita Study were followed up every two years. Cox regression was applied to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of HF risk for heavy drinking (≥46 g/day in men or ≥23 g/day in women) and never drinking compared to light drinking (<23 g/day in men or <11.5 g/day in women). Then, we combined the results of the Suita Study with those from other eligible prospective cohort studies in a meta-analysis using the random-effects model. RESULTS In the Suita Study, within a median follow-up period of 8 years, 319 HF cases (162 in men and 157 in women) were detected. In men, but not women, never and heavy drinking carried a higher risk of HF than light drinking: HRs (95% CIs) = 1.65 (1.00, 2.73) and 2.14 (1.26, 3.66), respectively. Alike, the meta-analysis showed a higher risk of HF among heavy drinkers: HR (95% CI) = 1.37 (1.15, 1.62) and abstainers: HR (95% CI) = 1.18 (1.02, 1.37). CONCLUSION We indicated a J-shaped association between alcohol consumption and HF risk among Japanese men. The results of the meta-analysis came in line with the Suita Study. Heavy-drinking men should be targeted for lifestyle modification interventions.
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Affiliation(s)
- Ahmed Arafa
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
- Department of Public Health, Faculty of Medicine, Beni-Suef University
| | - Rena Kashima
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Pathophysiology and Therapeutics, Graduate School of Medicine, Osaka University
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Masayuki Teramoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Yukie Sakai
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Saya Nosaka
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Haruna Kawachi
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
- Department of Environmental Medicine and Population Sciences, Graduate School of Medicine, Osaka University
| | - Keiko Shimamoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Chisa Matsumoto
- Department of Cardiology, Center for Health Surveillance and Preventive Medicine, Tokyo Medical University Hospital
| | - Qi Gao
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Chisato Izumi
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center
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10
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Arafa A, Kokubo Y, Kashima R, Teramoto M, Sakai Y, Nosaka S, Shimamoto K, Kawachi H, Matsumoto C, Kusano K. Association Between White Blood Cell Count and Atrial Fibrillation Risk - A Population-Based Prospective Cohort Study. Circ J 2022; 87:41-49. [PMID: 36288949 DOI: 10.1253/circj.cj-22-0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The incidence and prevalence of atrial fibrillation (AF) are increasing. The white blood cell (WBC) count is an indicator of systemic inflammation and is related to increased cardiovascular disease risk. Using data from the Suita Study, we investigated the association between WBC count and AF risk in the general Japanese population.Methods and Results: This prospective cohort study included 6,884 people, aged 30-84 years, with no baseline AF. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for AF incidence by WBC count quintile. Within a median follow-up period of 14.6 years, 312 AF cases were diagnosed. Compared with the lowest WBC count quintile, the highest quintile was associated with an increased AF risk (HR 1.57; 95% CI 1.07-2.29). The association was more pronounced among women than men (HR 2.16 [95% CI 1.10-4.26] and 1.55 [95% CI 0.99-2.44], respectively; P interaction=0.07), and among current than non-smokers (HR 4.66 [95% CI 1.89-11.50] and 1.61 [95% CI 1.01-2.57], respectively; P interaction=0.20). For each 1.0×109-cells/L increment in WBC count, AF risk increased by 9% in men (9% in non-smokers, 10% in current smokers) and 20% in women (13% in non-smokers, 32% in current smokers). CONCLUSIONS A higher WBC count was positively associated with an elevated AF risk in the general Japanese population, especially in women who smoked.
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Affiliation(s)
- Ahmed Arafa
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.,Department of Public Health, Faculty of Medicine, Beni-Suef University
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Rena Kashima
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.,Department of Cardiovascular Pathophysiology and Therapeutics, Graduate School of Medicine, Osaka University
| | - Masayuki Teramoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Yukie Sakai
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Saya Nosaka
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Keiko Shimamoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Haruna Kawachi
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.,Department of Environmental Medicine and Population Sciences, Graduate School of Medicine, Osaka University
| | - Chisa Matsumoto
- Department of Cardiology, Center for Health Surveillance and Preventive Medicine, Tokyo Medical University Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Arafa A, Kokubo Y, Kobayashi T, Honda-Kohmo K, Kashima R, Sheerah HA, Kusano K. QRS transitional zone rotations and the risk of atrial fibrillation: the Suita Study. Heart Vessels 2022; 37:1914-1920. [PMID: 35622128 DOI: 10.1007/s00380-022-02101-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/11/2022] [Indexed: 11/29/2022]
Abstract
ECG screening can detect people at risk of developing atrial fibrillation (AF). Recent literature indicated that QRS transitional zone rotations could predict several cardiovascular events. Herein, we investigated the association between QRS transitional zone rotations and the future risk of AF. This prospective cohort study included 6794 participants (3178 men and 3616 women), aged 30-84 years, from the urban Japanese city of Suita. QRS transitional zone rotations were diagnosed by ECG during baseline, while AF was diagnosed by ECG, hospital records, and checkups during follow-up. The Cox regression was used to compute the sex-specified hazard ratios (HRs) and 95% confidence intervals (CIs) of incident AF for participants with counterclockwise and clockwise QRS transitional zone rotations compared to those with normal rotation. Within a median follow-up period of 14.6 years, 311 participants (206 men and 105 women) developed AF. Counterclockwise rotation was associated with the reduced risk of AF among men, but not women, in the age-adjusted model: HR (95% CI) = 0.66 (0.44, 0.98) and the multivariable-adjusted model: HR (95% CI) = 0.65 (0.43, 0.97). Clockwise rotation was not associated with AF risk in either sex. To the best of our knowledge, this is the first study to indicate that counterclockwise rotation could be associated with the reduced risk of AF in men. More studies are needed to confirm our findings and elucidate possible mechanisms.
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Affiliation(s)
- Ahmed Arafa
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan. .,Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan. .,Department of Public Health, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Takashi Kobayashi
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Kyoko Honda-Kohmo
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Rena Kashima
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan.,Public Health Division, Ibaraki Public Health Center, Osaka Prefectural Government, Ibaraki, Japan
| | - Haytham A Sheerah
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan.,Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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