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Mei Y, Huang L, Gong C, Zhao W, Gui M, Qiu Q, Wang Z, Chen Y, Xie Y, Cai X, Yuan YS, Zheng ZF, Xue Y, Deng H, Liu X. Leisure-time physical activity and the incidence of atrial fibrillation in senior adults: a prospective cohort study. Age Ageing 2024; 53:afae142. [PMID: 38984694 DOI: 10.1093/ageing/afae142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/21/2024] [Indexed: 07/11/2024] Open
Abstract
OBJECTIVE Whether physical activity could reduce the risk of atrial fibrillation (AF) remains unclear. This study was to investigate the relationship of leisure-time physical activity (LTPA) with AF incidence among Chinese older adults. METHODS A total of 3253 participants aged ≥60 years from the Guangzhou Heart Study were successfully followed between March 2018 and September 2019. LTPA was assessed using a modified Global Physical Activity Questionnaire. AF was ascertained by 12-lead electrocardiograms, 24-hour single-lead Holter and clinical examination. The Cox proportional hazards model was used to the estimate hazard ratio (HR) and 95% confidence interval (CI) after adjustment for confounders, and the population-attributable fraction (PAF) was estimated. RESULTS A total of 76 (2.34%) new-onset cases of AF were identified during a median of 31.13 months of follow-up. After adjustment for confounders, subjects who had LTPA at least 10.0 metabolic equivalent (MET)-hours/week had a 55% lower risk of developing AF (HR: 0.45, 95%CI: 0.25-0.81), and at least 20 MET-hours/week reduced the risk by 45% (HR: 0.55, 95%CI: 0.34-0.92). At least 11% (PAF: 11%, 95%CI: 0%-20%) or 14% (PAF: 14%, 95%CI: 0%-26%) of AF cases could be avoided, respectively, if the subjects do LTPA at least 10 MET-hours/week or 20 MET-hours/week. A significant exposure-response trend was also observed between LTPA and AF risk (Plinear-trend = 0.002). For a specific LTPA, doing housework was associated with a 43% reduced risk, while engaging in ball games was associated with an increased risk. CONCLUSION This prospective cohort study indicated that a higher LTPA volume was associated with a lower AF risk in Chinese older adults.
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Affiliation(s)
- Yunting Mei
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China
| | - Li Huang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China
| | - Cong Gong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Southern Medical University, Guangzhou 510080, China
| | - Wenjing Zhao
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen 518055, China
| | - Ming Gui
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China
| | - Quan Qiu
- Department of Administrative Affairs, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430 China
| | - Zhiwei Wang
- Department of 12320 Health Hotline, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Yufeng Chen
- Department of Community Health, Guangzhou Yuexiu District Center for Disease Control and Prevention, Guangzhou 510080, China
| | - Yuanling Xie
- Department of Community Health, Guangzhou Baiyun Street Community Health Service Center, Guangzhou 510080, China
| | - Xueqing Cai
- Department of Community Health, Guangzhou Dadong Street Community Health Service Center, Guangzhou 510080, China
| | - Yue-Shuang Yuan
- Department of Community Health, Guangzhou Xinzao Town Community Health Service Center, Guangzhou 511442, China
| | - Zhen-Feng Zheng
- Department of Community Health, Guangzhou Nancun Town Community Health Service Center, Guangzhou 511442, China
| | - Yumei Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Southern Medical University, Guangzhou 510080, China
| | - Hai Deng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Southern Medical University, Guangzhou 510080, China
| | - Xudong Liu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China
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2
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Kamada H, Kawasoe S, Kubozono T, Ninomiya Y, Enokizono K, Yoshimoto I, Iriki Y, Ikeda Y, Miyata M, Miyahara H, Tokushige K, Ohishi M. Simple risk scoring using sinus rhythm electrocardiograms predicts the incidence of atrial fibrillation in the general population. Sci Rep 2024; 14:9628. [PMID: 38671212 PMCID: PMC11053076 DOI: 10.1038/s41598-024-60219-y] [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: 09/06/2023] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Atrial fibrillation (AF) is an arrhythmic disease. Prediction of AF development in healthy individuals is important before serious complications occur. We aimed to develop a risk prediction score for future AF using participants' data, including electrocardiogram (ECG) measurements and information such as age and sex. We included 88,907 Japanese participants, aged 30-69 years, who were randomly assigned to derivation and validation cohorts in a ratio of 1:1. We performed multivariate logistic regression analysis and obtained the standardised beta coefficient of relevant factors and assigned scores to them. We created a score based on prognostic factors for AF to predict its occurrence after five years and applied it to validation cohorts to assess its reproducibility. The risk score ranged from 0 to 17, consisting of age, sex, PR prolongation, QT corrected for heart rate prolongation, left ventricular hypertrophy, premature atrial contraction, and left axis deviation. The area under the curve was 0.75 for the derivation cohort and 0.73 for the validation cohort. The incidence of new-onset AF reached over 2% at 10 points of the risk score in both cohorts. Thus, in this study, we showed the possibility of predicting new-onset AF using ECG findings and simple information.
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Affiliation(s)
- Hiroyuki Kamada
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Shin Kawasoe
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
| | - Yuichi Ninomiya
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Kei Enokizono
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Issei Yoshimoto
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yasuhisa Iriki
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Masaaki Miyata
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | | | | | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
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3
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01771-5. [PMID: 38609733 DOI: 10.1007/s10840-024-01771-5] [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: 04/14/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
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Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | - Gregory F Michaud
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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4
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)00261-3. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [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] [Received: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society.
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece.
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil; Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France; Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain; Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Case Western Reserve University, Cleveland, OH, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA; Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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5
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024; 26:euae043. [PMID: 38587017 PMCID: PMC11000153 DOI: 10.1093/europace/euae043] [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: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O’Neill
- Cardiovascular Directorate, St. Thomas’ Hospital and King’s College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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6
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Pan J, Liu M, Huang J, Chen L, Xu Y. Impact of anemia on clinical outcomes in patients with acute heart failure: A systematic review and meta-analysis. Clin Cardiol 2024; 47:e24228. [PMID: 38402548 PMCID: PMC10823545 DOI: 10.1002/clc.24228] [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: 10/26/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 02/26/2024] Open
Abstract
Anemia and acute heart failure (AHF) frequently coexist. Several published studies have investigated the association of anemia with all-cause mortality and all-cause heart failure events in AHF patients, but their findings remain controversial. This study is intended to evaluate the relationship between anemia and AHF. We systematically searched PubMed, Medline, the Cochrane Library, Embase, and Elsevier's ScienceDirect databases until July 30, 2023, and selected prospective or retrospective cohort studies to evaluate anemia for AHF. A total of nine trials involving 29 587 AHF patients were eventually included. Pooled analyses demonstrated anemia is associated with a higher risk of all-cause heart failure event rate (OR: 1.82, 95% CI: 1.58-2.10, p < .01) and all-cause mortality, both for short-term (30 days) all-cause mortality (OR: 1.91, 95% CI: 1.31-2.79, p < .01) and long-term (1 year) all-cause mortality (OR: 1.72, 95% CI: 1.27-2.32, p < .01). The evidence from this meta-analysis suggested that anemia may be an independent risk factor for all-cause mortality and all-cause heart failure events in patients with AHF and might emphasize the importance of anemia correction before discharge.
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Affiliation(s)
- Jiahui Pan
- Department of Cardiology, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouZhejiangPeople's Republic of China
| | - Meijun Liu
- Department of CardiologyHangzhou First People's HospitalHangzhouZhejiangPeople's Republic of China
| | - Jiamin Huang
- Department of the Fourth School of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouZhejiangPeople's Republic of China
| | - Liuying Chen
- Department of CardiologyHangzhou First People's HospitalHangzhouZhejiangPeople's Republic of China
| | - Yizhou Xu
- Department of CardiologyHangzhou First People's HospitalHangzhouZhejiangPeople's Republic of China
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7
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Mohammadi S, Paryad E, Khanghah AG, Leili EK, Noveiri MJS. Investigate the relationship between obstructive sleep apnea and cardiac arrhythmia after CABG surgery. BMC Cardiovasc Disord 2024; 24:64. [PMID: 38263001 PMCID: PMC10804646 DOI: 10.1186/s12872-023-03694-x] [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: 09/15/2023] [Accepted: 12/26/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Heart rhythm disorder is one of the most common problems after coronary artery bypass graft surgery. Various factors, such as the history of sleep apnoea before the operation, may aggravate the occurrence of this disorder. The present study was conducted to determine the relationship between sleep apnoea before surgery and heart rhythm disorder after surgery in patients undergoing coronary Artery Bypass Grafting in 2019. METHODS This analytical cross-sectional study was conducted on 192 patients who were selected by sequential sampling. The research tool included demographic information, a checklist of heart rhythm disorders, and the Berlin sleep apnoea questionnaire. Descriptive statistics and the Chi-square test, Fisher's exact test, Mann-Whitney's U-test, and logistic regression were used to analyze the data. RESULTS A total of 71.35% of the samples were male, and the mean age of the participants was 57.8 ± 7.5 years. Also, 46.0% of the samples had sleep pane and 21.35% had rhythm disorder. The most frequent heart rhythm disorder in patients with obstructive sleep apnoea was atrial fibrillation. There was a significant relationship between the occurrence of rhythm disorder and a history of smoking (P = 0.021), and the regression model showed that a history of smoking is the only variable related to the occurrence of rhythm disorder after coronary Artery Bypass Grafting (P = 0.005, CI 95%: 6.566-1.386, OR = 3.017). CONCLUSIONS The results showed that there is no statistically significant relationship between sleep apnea and rhythm disorder after coronary artery bypass surgery.
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Affiliation(s)
- Somayeh Mohammadi
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Ezzat Paryad
- Department of Nursing, GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Atefeh Ghanbari Khanghah
- Department of Nursing, Social Determinants of Health Research Center (SDHRC), Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnezhad Leili
- Department of Biostatics, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Marzieh Jahani Sayad Noveiri
- Department of Medical Surgery, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.
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8
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Schlueter DJ, Sulieman L, Mo H, Keaton JM, Ferrara TM, Williams A, Qian J, Stubblefield O, Zeng C, Tran TC, Bastarache L, Dai J, Babbar A, Ramirez A, Goleva SB, Denny JC. Systematic replication of smoking disease associations using survey responses and EHR data in the All of Us Research Program. J Am Med Inform Assoc 2023; 31:139-153. [PMID: 37885303 PMCID: PMC10746325 DOI: 10.1093/jamia/ocad205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/04/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE The All of Us Research Program (All of Us) aims to recruit over a million participants to further precision medicine. Essential to the verification of biobanks is a replication of known associations to establish validity. Here, we evaluated how well All of Us data replicated known cigarette smoking associations. MATERIALS AND METHODS We defined smoking exposure as follows: (1) an EHR Smoking exposure that used International Classification of Disease codes; (2) participant provided information (PPI) Ever Smoking; and, (3) PPI Current Smoking, both from the lifestyle survey. We performed a phenome-wide association study (PheWAS) for each smoking exposure measurement type. For each, we compared the effect sizes derived from the PheWAS to published meta-analyses that studied cigarette smoking from PubMed. We defined two levels of replication of meta-analyses: (1) nominally replicated: which required agreement of direction of effect size, and (2) fully replicated: which required overlap of confidence intervals. RESULTS PheWASes with EHR Smoking, PPI Ever Smoking, and PPI Current Smoking revealed 736, 492, and 639 phenome-wide significant associations, respectively. We identified 165 meta-analyses representing 99 distinct phenotypes that could be matched to EHR phenotypes. At P < .05, 74 were nominally replicated and 55 were fully replicated. At P < 2.68 × 10-5 (Bonferroni threshold), 58 were nominally replicated and 40 were fully replicated. DISCUSSION Most phenotypes found in published meta-analyses associated with smoking were nominally replicated in All of Us. Both survey and EHR definitions for smoking produced similar results. CONCLUSION This study demonstrated the feasibility of studying common exposures using All of Us data.
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Affiliation(s)
- David J Schlueter
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
- Department of Health and Society, University of Toronto, Scarborough, Toronto, ON, Canada
| | - Lina Sulieman
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Huan Mo
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
- The Cohort Analytics Core (CAC), Center for Precision Health Research, National Human Genome Research Institute, Bethesda, MD, USA
| | - Jacob M Keaton
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Tracey M Ferrara
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Ariel Williams
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Jun Qian
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Onajia Stubblefield
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Chenjie Zeng
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Tam C Tran
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
- The Cohort Analytics Core (CAC), Center for Precision Health Research, National Human Genome Research Institute, Bethesda, MD, USA
| | - Lisa Bastarache
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jian Dai
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Anav Babbar
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Andrea Ramirez
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Slavina B Goleva
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Joshua C Denny
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
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9
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Jones CA, Wallace MJ, Bandaru P, Woodbury ED, Mohler PJ, Wold LE. E-cigarettes and arrhythmogenesis: a comprehensive review of pre-clinical studies and their clinical implications. Cardiovasc Res 2023; 119:2157-2164. [PMID: 37517059 PMCID: PMC10578912 DOI: 10.1093/cvr/cvad113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/21/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Electronic cigarette use has grown exponentially in recent years, and while their popularity has increased, the long-term effects on the heart are yet to be fully studied and understood. Originally designed as devices to assist with those trying to quit traditional combustible cigarette use, their popularity has attracted use by teens and adolescents who traditionally have not smoked combustible cigarettes. Acute effects on the heart have been shown to be similar to traditional combustible cigarettes, including increased heart rate and blood pressure. The main components of electronic cigarettes that contribute to these arrhythmic effects are found in the e-liquid that is aerosolized and inhaled, comprised of nicotine, flavourings, and a combination of vegetable glycerin (VG) and propylene glycol (PG). Nicotine can potentially induce both ventricular and atrial arrhythmogenesis, with both the atrial and ventricular effects resulting from the interactions of nicotine and the catecholamines they release via potassium channels. Atrial arrhythmogenesis, more specifically atrial fibrillation, can also occur due to structural alterations, which happens because of nicotine downregulating microRNAs 133 and 590, both post-transcriptional growth factor repressors. Liquid flavourings and the combination of PG and VG can possibly lead to arrhythmic events by exposing users to acrolein, an aldehyde that stimulates TRPA1 that in turn causes a change towards sympathetic activation and autonomic imbalance. The design of these electronic delivery devices is constantly changing; therefore, it has proven extremely difficult to study the long-term effects on the heart caused by electronic cigarettes but will be important to understand given their rising popularity. The arrhythmic effects of electronic cigarettes appear similar to traditional cigarettes as well; however, a comprehensive review has not been compiled and is the focus of this article.
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Affiliation(s)
- Carson A Jones
- Dorothy M. Davis Heart and Lung Research Institute, Wexner Medical Center, The Ohio State University, 473 W 12th Avenue, Columbus, OH 43210, USA
| | - Michael J Wallace
- Dorothy M. Davis Heart and Lung Research Institute, Wexner Medical Center, The Ohio State University, 473 W 12th Avenue, Columbus, OH 43210, USA
| | - Priya Bandaru
- Dorothy M. Davis Heart and Lung Research Institute, Wexner Medical Center, The Ohio State University, 473 W 12th Avenue, Columbus, OH 43210, USA
| | - Emerson D Woodbury
- Dorothy M. Davis Heart and Lung Research Institute, Wexner Medical Center, The Ohio State University, 473 W 12th Avenue, Columbus, OH 43210, USA
| | - Peter J Mohler
- Dorothy M. Davis Heart and Lung Research Institute, Wexner Medical Center, The Ohio State University, 473 W 12th Avenue, Columbus, OH 43210, USA
- Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Loren E Wold
- Dorothy M. Davis Heart and Lung Research Institute, Wexner Medical Center, The Ohio State University, 473 W 12th Avenue, Columbus, OH 43210, USA
- Division of Cardiac Surgery, Department of Surgery, Wexner Medical Center, The Ohio State University, 473 W 12th Avenue, Room 603, Columbus, OH 43210, USA
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10
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Wu G, Wu J, Lu Q, Cheng Y, Mei W. Association between cardiovascular risk factors and atrial fibrillation. Front Cardiovasc Med 2023; 10:1110424. [PMID: 37753167 PMCID: PMC10518410 DOI: 10.3389/fcvm.2023.1110424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
Background The most prevalent sustained arrhythmia in medical practice, atrial fibrillation (AF) is closely associated with a high risk of cardiovascular disease. Nevertheless, the risk of AF associated with cardiovascular risk factors has not been well elucidated. We pooled all published studies to provide a better depiction of the relationship among cardiovascular risk factors with AF. Methods Studies were searched in the MEDLINE, Web of Science, and EMBASE databases since initiation until January 15, 2022. Prospective cohort studies assessing the relationship a minimum of single cardiovascular risk factors to AF incidence were included if they contained adequate data for obtaining relative risks (RR) and 95% confidence intervals (CI). Random-effects models were utilized to perform independent meta-analyses on each cardiovascular risk factor. PROSPERO registry number: CRD42022310882. Results A total of 17,098,955 individuals and 738,843 incident cases were reported for data from 101 studies included in the analysis. In all, the risk of AF was 1.39 (95% CI, 1.30-1.49) for obesity, 1.27 (95% CI, 1.22-1.32) per 5 kg/m2 for increase in body mass index, 1.19 (95% CI, 1.10-1.28) for former smokers, 1.23 (95% CI, 1.09-1.38) for current smokers, 1.31 (95% CI, 1.23-1.39) for diabetes mellitus, 1.68 (95% CI, 1.51-1.87) for hypertension, and 1.12 (95% CI, 0.95-1.32) for dyslipidemia. Interpretation Adverse cardiovascular risk factors correlate with an increased risk of AF, yet dyslipidemia does not increase the risk of AF in the general population, potentially providing new insights for AF screening strategies among patients with these risk factors. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, PROSPERO identifier (CRD42022310882).
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Affiliation(s)
- Guohao Wu
- Department of General Practice, Huadu District People's Hospital, Southern Medical University, Guangzhou, China
| | - Jingguo Wu
- Department of Emergency Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qin Lu
- Department of General Practice, The First Affiliated Hospital, Sun Yat-Sen University,Guangzhou, China
| | - Yunjiu Cheng
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University,Guangzhou, China
| | - Weiyi Mei
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University,Guangzhou, China
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11
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Lip GYH, Proietti M, Potpara T, Mansour M, Savelieva I, Tse HF, Goette A, Camm AJ, Blomstrom-Lundqvist C, Gupta D, Boriani G. Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal. Europace 2023; 25:euad226. [PMID: 37622590 PMCID: PMC10451006 DOI: 10.1093/europace/euad226] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/26/2023] Open
Abstract
Stroke prevention in patients with atrial fibrillation (AF) is one pillar of the management of this common arrhythmia. Substantial advances in the epidemiology and associated pathophysiology underlying AF-related stroke and thrombo-embolism are evident. Furthermore, the introduction of the non-vitamin K antagonist oral anticoagulants (also called direct oral anticoagulants) has clearly changed our approach to stroke prevention in AF, such that the default should be to offer oral anticoagulation for stroke prevention, unless the patient is at low risk. A strategy of early rhythm control is also beneficial in reducing strokes in selected patients with recent onset AF, when compared to rate control. Cardiovascular risk factor management, with optimization of comorbidities and attention to lifestyle factors, and the patient's psychological morbidity are also essential. Finally, in selected patients with absolute contraindications to long-term oral anticoagulation, left atrial appendage occlusion or exclusion may be considered. The aim of this state-of-the-art review article is to provide an overview of the current status of AF-related stroke and prevention strategies. A holistic or integrated care approach to AF management is recommended to minimize the risk of stroke in patients with AF, based on the evidence-based Atrial fibrillation Better Care (ABC) pathway, as follows: A: Avoid stroke with Anticoagulation; B: Better patient-centred, symptom-directed decisions on rate or rhythm control; C: Cardiovascular risk factor and comorbidity optimization, including lifestyle changes.
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Affiliation(s)
- Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marco Proietti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Tatjana Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia
- Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Irina Savelieva
- Clinical Academic Group, Molecular and Clinical Sciences Institute, St. George’s University of London, Cranmer Terrace London SW17 0RE, UK
| | - Hung Fat Tse
- Cardiology Division, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Andreas Goette
- Medizinische Klinik II: Kardiologie und Intensivmedizin, St. Vincenz-Krankenhaus Paderborn, Am Busdorf 2, 33098 Paderborn, Germany
| | - A John Camm
- Clinical Academic Group, Molecular and Clinical Sciences Institute, St. George’s University of London, Cranmer Terrace London SW17 0RE, UK
| | - Carina Blomstrom-Lundqvist
- Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, via del Pozzo 71, 41125 Modena, Italy
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12
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Masoudkabir F, Mohammadifard N, Mani A, Ignaszewski A, Davis MK, Vaseghi G, Mansourian M, Franco C, Gotay C, Sarrafzadegan N. Shared Lifestyle-Related Risk Factors of Cardiovascular Disease and Cancer: Evidence for Joint Prevention. ScientificWorldJournal 2023; 2023:2404806. [PMID: 37520844 PMCID: PMC10386903 DOI: 10.1155/2023/2404806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 02/25/2023] [Accepted: 06/09/2023] [Indexed: 08/01/2023] Open
Abstract
Cardiovascular disease (CVD) and cancer are leading causes of mortality and morbidity worldwide and are the major focus of the World Health Organization's joint prevention programs. While, diverse diseases, CVD and cancer, have many similarities. These include common lifestyle-related risk factors and shared environmental, metabolic, cellular, inflammatory, and genetic pathways. In this review, we will discuss the shared lifestyle-related and environmental risk factors central to both diseases and how the strategies commonly used to prevent atherosclerotic vascular disease can be applied to cancer prevention.
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Affiliation(s)
- Farzad Masoudkabir
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Mohammadifard
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arya Mani
- Yale Cardiovascular Genetics Program, Yale Cardiovascular Research Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew Ignaszewski
- Division of Cardiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Margot K. Davis
- Division of Cardiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Golnaz Vaseghi
- Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Epidemiology and Biostatistics Department, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Christopher Franco
- Division of Cardiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carolyn Gotay
- School of Population & Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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13
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Akboga MK, Inanc IH, Keskin M, Sabanoglu C, Gorenek B. Current Evidence on Prevention of Atrial Fibrillation: Modifiable Risk Factors and the Effects of Risk Factor Intervention. Cardiol Rev 2023; 31:70-79. [PMID: 36735576 DOI: 10.1097/crd.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Atrial fibrillation (AF) is one of the most encountered arrhythmias in clinical practice. It is also estimated that the absolute AF burden may increase by greater than 60% by 2050. It is inevitable that AF will become one of the largest epidemics in the world and may pose a major health problem for countries. Although AF rarely causes mortality in the acute period, it causes a significant increase in mortality and morbidity, including a fivefold increase in the risk of stroke, a twofold increase in dementia, and a twofold increase in myocardial infarction in the chronic period. Despite all the advances in the treatment of AF, it is better understood day by day that preventing AF may play a key role in reducing AF and its related complications. Modification of the main modifiable factors such as quitting smoking, abstaining from alcohol, changing eating habits, and exercise seems to be the first step in preventing AF. The strict adherence to the treatment process of secondary causes predisposing to AF such as DM, hypertension, obesity, and sleep apnea is another step in the prevention of AF. Both an individual approach and global public health campaigns can be highly beneficial to reduce the risk of AF. In this review, we aimed to summarize the current evidence on the relationship between modifiable risk factors and AF, and the impact of possible interventions on these factors in preventing or reducing the AF burden in the light of recently published guidelines and studies.
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Affiliation(s)
- Mehmet Kadri Akboga
- From the Department of Cardiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ibrahim Halil Inanc
- Department of Cardiology, Kirikkale Yuksek Ihtisas Hospital, Kirikkale, Turkey
| | - Muhammed Keskin
- Department of Cardiology, Bahcesehir University Faculty of Medicine, Istanbul, Turkey
| | - Cengiz Sabanoglu
- Department of Cardiology, Kirikkale Yuksek Ihtisas Hospital, Kirikkale, Turkey
| | - Bulent Gorenek
- Department of Cardiology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
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14
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Chen S, Luo X, Zhao J, Liang Z, Gu J. Exploring the causality between ankylosing spondylitis and atrial fibrillation: A two-sample Mendelian randomization study. Front Genet 2022; 13:951893. [PMID: 36468019 PMCID: PMC9708899 DOI: 10.3389/fgene.2022.951893] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/01/2022] [Indexed: 09/22/2023] Open
Abstract
Objective: To study whether ankylosing spondylitis (AS) has a causal effect on the risk of atrial fibrillation (AF) using two-sample Mendelian randomization (MR) analysis. Methods: Single nucleotide polymorphisms (SNPs) were selected as independent instrumental variables (IVs) from a GWAS study of AS. Summary data from a large-scale GWAS meta-analysis of AF was utilized as the outcome dataset. Inverse-variance weighted (IVW) model was used for the primary analysis. Multiple sensitivity and heterogeneity tests were conducted to confirm the robustness of the results. Results: In total, 18 SNPs were identified as IVs for MR analysis. Five MR methods consistently found that ankylosing spondylitis was not causally associated with atrial fibrillation (IVW: OR = 0.983 (0.894, 1.080), p = 0.718; MR-Egger: OR = 1.190 (0.973, 1.456), p = 0.109; Simple mode: OR = 0.888 (0.718, 1.098), p = 0.287; Weighted mode: OR = 0.989 (0.854, 1.147), p = 0.890; Weight median: OR = 0.963 (0.852, 1.088), p = 0.545). Leave-one-out analysis supported the stability of MR results. Both the MR-Egger intercept and MR-PRESSO method revealed the absence of horizontal pleiotropy. Conclusion: The two-sample MR analysis did not support a causal relationship between AS and the risk of AF.
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Affiliation(s)
- Shuhong Chen
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Clinical Medical Research Center for Immune Diseases of Guangdong Province, Guangzhou, China
| | - Xiqing Luo
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Clinical Medical Research Center for Immune Diseases of Guangdong Province, Guangzhou, China
| | - Jiaoshi Zhao
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Clinical Medical Research Center for Immune Diseases of Guangdong Province, Guangzhou, China
| | - Zhenguo Liang
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Clinical Medical Research Center for Immune Diseases of Guangdong Province, Guangzhou, China
| | - Jieruo Gu
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- The Clinical Medical Research Center for Immune Diseases of Guangdong Province, Guangzhou, China
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15
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Ohlrogge AH, Frost L, Schnabel RB. Harmful Impact of Tobacco Smoking and Alcohol Consumption on the Atrial Myocardium. Cells 2022; 11:cells11162576. [PMID: 36010652 PMCID: PMC9406618 DOI: 10.3390/cells11162576] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
Tobacco smoking and alcohol consumption are widespread exposures that are legal and socially accepted in many societies. Both have been widely recognized as important risk factors for diseases in all vital organ systems including cardiovascular diseases, and with clinical manifestations that are associated with atrial dysfunction, so-called atrial cardiomyopathy, especially atrial fibrillation and stroke. The pathogenesis of atrial cardiomyopathy, atrial fibrillation, and stroke in context with smoking and alcohol consumption is complex and multifactorial, involving pathophysiological mechanisms, environmental, and societal aspects. This narrative review summarizes the current literature regarding alterations in the atrial myocardium that is associated with smoking and alcohol.
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Affiliation(s)
- Amelie H. Ohlrogge
- Department of Cardiology, University Heart and Vascular Centre Hamburg, 20246 Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
| | - Lars Frost
- Diagnostic Centre, University Clinic for Development of Innovative Patient Pathways, Silkeborg Regional Hospital, 8600 Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Renate B. Schnabel
- Department of Cardiology, University Heart and Vascular Centre Hamburg, 20246 Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
- Correspondence:
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16
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External validation and comparison of CHA 2DS 2-VASc-RAF and CHA 2DS 2-VASc-LAF scores for predicting left atrial thrombus and spontaneous echo contrast in patients with non-valvular atrial fibrillation. J Interv Card Electrophysiol 2022; 65:535-542. [PMID: 35831771 DOI: 10.1007/s10840-022-01285-y] [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] [Received: 04/13/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE CHA2DS2-VASc-RAF (R is renal dysfunction, and AF is atrial fibrillation type) and CHA2DS2-VASc-LAF (L is left atrial diameter, and AF is atrial fibrillation type) scores have been developed to estimate the risk of left atrial thrombus (LAT) and spontaneous echo contrast (SEC) in patients with non-valvular atrial fibrillation (NVAF). However, few external validations have been conducted to assess their accuracy. Thus, this study aimed to validate and compare the two modified scores for predicting LAT/SEC in patients with NVAF. METHODS This study included 399 patients with NVAF who underwent transesophageal echocardiography. Risk factors related to LAT/SEC were identified through logistic regression analysis, and predictive value and diagnostic efficiency were evaluated using receiver operating characteristic (ROC) curve. RESULTS Approximately 9.8% (39/399) of the patients with NVAF had LAT/SEC. Multivariate logistic regression analysis showed that history of stroke/transient ischemic attack, congestive heart failure, non-paroxysmal atrial fibrillation, lack of anticoagulation therapy, enlarged left atrial diameter, enlarged left ventricular end diastolic diameter, decreased left ventricular ejection fraction, decreased left atrial appendage emptying velocity, and decreased estimated glomerular filtration rate were independent risk factors for LAT/SEC. The CHA2DS2-VASc-LAF (area under the ROC curve [AUC] = 0.839) and CHA2DS2-VASc-RAF (AUC = 0.829) scores showed larger predictive values than the CHA2DS2-VASc (AUC = 0.737) and CHADS2 (AUC = 0.736) scores. The AUC of the CHA2DS2-VASc-RAF score was similar to that of the CHA2DS2-VASc-LAF score (Z = 0.432; P = 0.666). CONCLUSION This study validated that the CHA2DS2-VASc-RAF and CHA2DS2-VASc-LAF scores are useful prognostic scoring systems for predicting LAT/SEC in patients with NVAF.
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Tsartsalis D, Korela D, Karlsson LO, Foukarakis E, Svensson A, Anastasakis A, Venetsanos D, Aggeli C, Tsioufis C, Braunschweig F, Dragioti E, Charitakis E. Risk and Protective Factors for Sudden Cardiac Death: An Umbrella Review of Meta-Analyses. Front Cardiovasc Med 2022; 9:848021. [PMID: 35783841 PMCID: PMC9246322 DOI: 10.3389/fcvm.2022.848021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSudden cardiac death (SCD) is a global public health issue, accounting for 10–20% of deaths in industrialized countries. Identification of modifiable risk factors may reduce SCD incidence.MethodsThis umbrella review systematically evaluates published meta-analyses of observational and randomized controlled trials (RCT) for the association of modifiable risk and protective factors of SCD.ResultsFifty-five meta-analyses were included in the final analysis, of which 31 analyzed observational studies and 24 analyzed RCTs. Five associations of meta-analyses of observational studies presented convincing evidence, including three risk factors [diabetes mellitus (DM), smoking, and early repolarization pattern (ERP)] and two protective factors [implanted cardiac defibrillator (ICD) and physical activity]. Meta-analyses of RCTs identified five protective factors with a high level of evidence: ICDs, mineralocorticoid receptor antagonist (MRA), beta-blockers, and sodium-glucose cotransporter-2 (SGLT-2) inhibitors in patients with HF. On the contrary, other established, significant protective agents [i.e., amiodarone and statins along with angiotensin-converting enzyme (ACE) inhibitors in heart failure (HF)], did not show credibility. Likewise, risk factors as left ventricular ejection fraction in HF, and left ventricular hypertrophy, non-sustain ventricular tachycardia, history of syncope or aborted SCD in pediatric patients with hypertrophic cardiomyopathy, presented weak or no evidence.ConclusionsLifestyle risk factors (physical activity, smoking), comorbidities like DM, and electrocardiographic features like ERP constitute modifiable risk factors of SCD. Alternatively, the use of MRA, beta-blockers, SGLT-2 inhibitors, and ICD in patients with HF are credible protective factors. Further investigation targeted in specific populations will be important for reducing the burden of SCD.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020216363, PROSPERO CRD42020216363.
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Affiliation(s)
- Dimitrios Tsartsalis
- Department of Emergency Medicine, “Hippokration” Hospital, Athens, Greece
- First Department of Cardiology, “Hippokration” Hospital, University of Athens, Medical School, Athens, Greece
| | - Dafni Korela
- Department of Cardiology, Venizeleio General Hospital, Heraklion, Greece
| | - Lars O. Karlsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | - Anneli Svensson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Aris Anastasakis
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Constantina Aggeli
- First Department of Cardiology, “Hippokration” Hospital, University of Athens, Medical School, Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, “Hippokration” Hospital, University of Athens, Medical School, Athens, Greece
| | | | - Elena Dragioti
- Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Emmanouil Charitakis
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- *Correspondence: Emmanouil Charitakis
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18
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Association of RDW, NLR, and PLR with Atrial Fibrillation in Critical Care Patients: A Retrospective Study Based on Propensity Score Matching. DISEASE MARKERS 2022; 2022:2694499. [PMID: 35669502 PMCID: PMC9166973 DOI: 10.1155/2022/2694499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 04/09/2022] [Accepted: 05/12/2022] [Indexed: 11/18/2022]
Abstract
Objective Previous studies have shown inconsistent results in relation to the red cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) of atrial fibrillation (AF). This retrospective study is aimed at detecting the association of RDW, NLR, and PLR with AF. Methods A total of 4717 critical care patients were screened from the Medical Information Mart for Intensive Care- (MIMIC-) III database. The patients were separated into the non-AF and AF groups. The imbalances between the groups were reduced using propensity score matching (PSM). ROC curves were generated to detect the diagnostic value of RDW, NLR, and PLR. Logistic regression analysis was used to detect the risk factors for AF. Results A total of 991 non-AF patients paired with 991 AF patients were included after PSM in this study. The RDW level in the AF group was significantly higher than that in the non-AF group (15.09 ± 1.93vs. 14.89 ± 1.91, P = 0.017). Neither NLR nor PLR showed any significant difference between the two groups (P > 0.05 for each). According to ROC curve, RDW showed a very low diagnostic value of AF (AUC = 0.5341), and the best cutoff of RDW was 14.1 (ACU = 0.5257, sensitivity = 0.658, specificity = 0.395). Logistic regression analysis showed that an elevated RDW level increased 1.308-fold (95%CI = 1.077-1.588, P = 0.007) risk of AF. Neither elevated NLR nor elevated PLR was a significant risk factor for AF (OR = 0.993, 95%CI = 0.802-1.228, P = 0.945 for NLR; OR = 0.945, 95%CI = 0.763-1.170, P = 0.603 for PLR). Conclusions Elevated RDW level but not NLR or PLR levels is associated with AF. RDW > 14.1 is a risk factor for AF, but its diagnostic capacity for AF is not of great value.
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19
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Arai H, Ueda S, Uchida K, Sakakibara F, Kinjo N, Nezu M, Morimoto T. Effect of current smoking on ischemic events in patients with atrial fibrillation taking vitamin K antagonist. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2022; 14:200135. [PMID: 36703862 PMCID: PMC9871989 DOI: 10.1016/j.ijcrp.2022.200135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 01/29/2023]
Abstract
Purpose We investigated the association between current smoking and clinical outcomes in patients with atrial fibrillation (AF) prescribed vitamin K antagonist (VKA). Methods We conducted a retrospective study at 71 centers in Japan. The inclusion criterion was taking a VKA for AF. Exclusion criteria were mechanical heart valves or history of pulmonary thrombosis or deep vein thrombosis. Consecutive patients were registered in February 2013 and followed until February 2017. The primary outcomes included ischemic events and major bleedings. The secondary outcomes were ischemic stroke, hemorrhagic stroke, and all-cause mortality. Results A total of 7826 patients were included, with a mean age of 73 years; 5274 (67%) were men. The adjusted hazard ratios (HRs; 95% confidence intervals [CIs]) of current smokers relative to non-current smokers for ischemic events and major bleedings were 1.64 (1.05-2.57) and 1.09 (0.72-1.65), respectively. The adjusted HRs (95% CIs) of current smokers relative to non-current smokers for ischemic stroke, hemorrhagic stroke, and all-cause mortality were 1.65 (1.03-2.64), 0.52 (0.12-2.15), and 1.26 (0.83-1.92), respectively. Conclusions There were significant associations between current smoking and ischemic events or ischemic stroke in patients with AF on VKA.
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Affiliation(s)
- Hideki Arai
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan,Department of Internal Medicine, Toyonaka Heisei Hospital, Toyonaka, Japan
| | - Shinichiro Ueda
- Department of Clinical Pharmacology and Therapeutics, University of the Ryukyus, Okinawa, Japan
| | - Kazutaka Uchida
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan,Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Fumihiro Sakakibara
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan,Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Norito Kinjo
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan,Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Mari Nezu
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan,Corresponding author. Professor of Medicine, Department of Clinical Epidemiology, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan.
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20
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Fu Y, Feng S, Xu Y, Yang Y, Chen H, He W, Zhu W, Yin K, Xue Z, Wei B. Association of Depression, Antidepressants With Atrial Fibrillation Risk: A Systemic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:897622. [PMID: 35647056 PMCID: PMC9130653 DOI: 10.3389/fcvm.2022.897622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Depression is a possible influence factor for the increased risk of incident atrial fibrillation (AF). Although several investigations have assessed their association, the results are still controversial. Therefore, we conducted a meta-analysis to evaluate the association between depression or using antidepressants and AF. Methods We systemically performed the literature retrieval from two electronic databases PubMed and EMBASE until March 2022 to extract relevant data. The hazard ratios (HRs) and odds ratios (OR) from included studies with 95% confidence intervals (CIs) were adjusted into the risk ratio (RR) and pooled by using the random-effects model. Results Totally 9 studies about the associations between depression or antidepressants and incident AF risk were included in this meta-analysis. Among them, 5 studies specifically analyzed the impact of antidepressants on the risk of AF. The outcomes of our analysis indicated that depression or depressive symptoms could increase AF risk (RR = 1.15, 95% CI, 1.03–1.27, P < 0.01). In addition, the use of antidepressants can also increase AF risk (RR = 1.16, 95% CI, 1.07–1.25, P < 0.001). These results remained unchanged when we remove the source of heterogeneity or adjust the analysis model into the fixed-effects model. Conclusions Based on existing investigations, both depression and the use of antidepressants are closely related to the increase of incident AF risk.
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Affiliation(s)
- Yonghui Fu
- Department of Psychiatry, Jiangxi Mental Hospital, Affiliated Mental Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Clinical Research Center on Mental Disorders, Nanchang, China
| | - Shenghui Feng
- Department of Medical, Queen Mary School, Nanchang University, Nanchang, China
| | - Yingxiang Xu
- Department of Psychiatry, Jiangxi Mental Hospital, Affiliated Mental Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Clinical Research Center on Mental Disorders, Nanchang, China
| | - Yuanjian Yang
- Department of Psychiatry, Jiangxi Mental Hospital, Affiliated Mental Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Clinical Research Center on Mental Disorders, Nanchang, China
| | - Haibo Chen
- Department of Psychiatry, Jiangxi Mental Hospital, Affiliated Mental Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Clinical Research Center on Mental Disorders, Nanchang, China
| | - Wenfeng He
- Jiangxi Key Laboratory of Molecular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wengen Zhu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kang Yin
- Department of Critial Care Medicine, The First Affiliated Hosptial of Gannan Medical University, Ganzhou, China
| | - Zhengbiao Xue
- Department of Critial Care Medicine, The First Affiliated Hosptial of Gannan Medical University, Ganzhou, China
- *Correspondence: Zhengbiao Xue
| | - Bo Wei
- Department of Psychiatry, Jiangxi Mental Hospital, Affiliated Mental Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Clinical Research Center on Mental Disorders, Nanchang, China
- Bo Wei
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21
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Benowitz NL, Liakoni E. Tobacco use disorder and cardiovascular health. Addiction 2022; 117:1128-1138. [PMID: 34590373 DOI: 10.1111/add.15703] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/01/2021] [Indexed: 12/28/2022]
Abstract
This narrative review examines the impact of cigarette smoking and the use of other tobacco and nicotine products on cardiovascular disease. Smoking increases the incidence of both acute and chronic cardiovascular diseases, and the harmful effects are substantially and relatively quickly reversible after quitting. Recommended cessation treatment includes offering pharmacotherapy, counseling which should emphasize the rapid risk reduction that occurs after quitting and adequate follow-up contacts. Although most research on cardiovascular disease in relation to tobacco use has focused upon cigarette smoking, we also review available data related to other combustible tobacco products, smokeless tobacco, electronic nicotine delivery systems and second-hand smoke. We discuss the implications of smoking on clinical management of patients with heart disease and newer developments with potential relevance to treatment of such patients.
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Affiliation(s)
- Neal L Benowitz
- Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA
| | - Evangelia Liakoni
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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22
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Camen S, Csengeri D, Geelhoed B, Niiranen T, Gianfagna F, Vishram‐Nielsen JK, Costanzo S, Söderberg S, Vartiainen E, Börschel CS, Donati MB, Løchen M, Ojeda FM, Kontto J, Mathiesen EB, Jensen S, Koenig W, Kee F, de Gaetano G, Zeller T, Jørgensen T, Tunstall‐Pedoe H, Blankenberg S, Kuulasmaa K, Linneberg A, Salomaa V, Iacoviello L, Schnabel RB. Risk Factors, Subsequent Disease Onset, and Prognostic Impact of Myocardial Infarction and Atrial Fibrillation. J Am Heart Assoc 2022; 11:e024299. [PMID: 35322680 PMCID: PMC9075452 DOI: 10.1161/jaha.121.024299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Although myocardial infarction (MI) and atrial fibrillation (AF) are frequent comorbidities and share common cardiovascular risk factors, the direction and strength of the association of the risk factors with disease onset, subsequent disease incidence, and mortality are not completely understood. Methods and Results In pooled multivariable Cox regression analyses, we examined temporal relations of disease onset and identified predictors of MI, AF, and all-cause mortality in 108 363 individuals (median age, 46.0 years; 48.2% men) free of MI and AF at baseline from 6 European population-based cohorts. During a maximum follow-up of 10.0 years, 3558 (3.3%) individuals were diagnosed exclusively with MI, 1922 (1.8%) with AF but no MI, and 491 (0.5%) individuals developed both MI and AF. Association of sex, systolic blood pressure, antihypertensive treatment, and diabetes appeared to be stronger with incident MI than with AF, whereas increasing age and body mass index showed a higher risk for incident AF. Total cholesterol and daily smoking were significantly related to incident MI but not AF. Combined population attributable fraction of cardiovascular risk factors was >70% for incident MI, whereas it was only 27% for AF. Subsequent MI after AF (hazard ratio [HR], 1.68; 95% CI, 1.03-2.74) and subsequent AF after MI (HR, 1.75; 95% CI, 1.31-2.34) both significantly increased overall mortality risk. Conclusions We observed different associations of cardiovascular risk factors with both diseases indicating distinct pathophysiological pathways. Subsequent diagnoses of MI and AF significantly increased mortality risk.
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Affiliation(s)
- Stephan Camen
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg‐EppendorfHamburgGermany,German Center for Cardiovascular Research (DZHK)Partner Site Hamburg/Kiel/LuebeckHamburgGermany
| | - Dora Csengeri
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg‐EppendorfHamburgGermany
| | - Bastiaan Geelhoed
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg‐EppendorfHamburgGermany
| | - Teemu Niiranen
- Finnish Institute for Health and WelfareHelsinkiFinland,Department of MedicineTurku University Hospital and University of TurkuTurkuFinland
| | - Francesco Gianfagna
- Research Center in Epidemiology and Preventive MedicineDepartment of Medicine and SurgeryUniversity of InsubriaVareseItaly,Mediterranea CardiocentroNapoliItaly
| | - Julie K. Vishram‐Nielsen
- Center for Clinical Research and PreventionBispebjerg and Frederiksberg HospitalThe Capital Region of DenmarkCopenhagenDenmark,Department of Cardiology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Simona Costanzo
- Department of Epidemiology and PreventionIstituto Neurologico Mediterraneo è un Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) NeuromedPozzilliItaly
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, and Heart CentreUmeå UniversityUmeåSweden
| | | | - Christin S. Börschel
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg‐EppendorfHamburgGermany,German Center for Cardiovascular Research (DZHK)Partner Site Hamburg/Kiel/LuebeckHamburgGermany
| | - Maria Benedetta Donati
- Department of Epidemiology and PreventionIstituto Neurologico Mediterraneo è un Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) NeuromedPozzilliItaly
| | - Maja‐Lisa Løchen
- Department of Community MedicineUiT The Arctic University of NorwayTromsøNorway
| | - Francisco M. Ojeda
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg‐EppendorfHamburgGermany
| | - Jukka Kontto
- Finnish Institute for Health and WelfareHelsinkiFinland
| | - Ellisiv B. Mathiesen
- Brain and Circulation Research GroupDepartment of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway,Department of NeurologyUniversity Hospital of North NorwayTromsøNorway
| | - Steen Jensen
- Department of Public Health and Clinical Medicine, and Heart CentreUmeå UniversityUmeåSweden
| | - Wolfgang Koenig
- German Heart Center MunichTechnical University of MunichMunichGermany,German Centre for Cardiovascular Research (DZHK)Partner Site Munich Heart AllianceMunichGermany,Institute of Epidemiology and Medical BiometryUniversity of UlmGermany
| | - Frank Kee
- Centre for Public Health, Queens University of BelfastBelfastUK
| | - Giovanni de Gaetano
- Department of Epidemiology and PreventionIstituto Neurologico Mediterraneo è un Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) NeuromedPozzilliItaly
| | - Tanja Zeller
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg‐EppendorfHamburgGermany,German Center for Cardiovascular Research (DZHK)Partner Site Hamburg/Kiel/LuebeckHamburgGermany
| | - Torben Jørgensen
- Center for Clinical Research and PreventionBispebjerg and Frederiksberg HospitalThe Capital Region of DenmarkCopenhagenDenmark,Department of Public HealthFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Hugh Tunstall‐Pedoe
- Cardiovascular Epidemiology UnitInstitute of Cardiovascular ResearchUniversity of DundeeDundeeUK
| | - Stefan Blankenberg
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg‐EppendorfHamburgGermany,German Center for Cardiovascular Research (DZHK)Partner Site Hamburg/Kiel/LuebeckHamburgGermany
| | | | - Allan Linneberg
- Center for Clinical Research and PreventionBispebjerg and Frederiksberg HospitalThe Capital Region of DenmarkCopenhagenDenmark,Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | | | - Licia Iacoviello
- Research Center in Epidemiology and Preventive MedicineDepartment of Medicine and SurgeryUniversity of InsubriaVareseItaly,Department of Epidemiology and PreventionIstituto Neurologico Mediterraneo è un Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) NeuromedPozzilliItaly
| | - Renate B. Schnabel
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg‐EppendorfHamburgGermany,German Center for Cardiovascular Research (DZHK)Partner Site Hamburg/Kiel/LuebeckHamburgGermany
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Affiliation(s)
- Chuyan Long
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University
| | - Xiao Liu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University
| | - Qinmei Xiong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University
| | - YuHao Su
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University
| | - Kui Hong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University
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Fredgart MH, Lindholt JS, Brandes A, Steffensen FH, Frost L, Lambrechtsen J, Karon M, Busk M, Urbonaviciene G, Egstrup K, Khurrami L, Gerke O, Diederichsen ACP. Association of Left Atrial Size Measured by Non-Contrast Computed Tomography with Cardiovascular Risk Factors—The Danish Cardiovascular Screening Trial (DANCAVAS). Diagnostics (Basel) 2022; 12:diagnostics12020244. [PMID: 35204336 PMCID: PMC8871467 DOI: 10.3390/diagnostics12020244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/18/2022] [Indexed: 02/06/2023] Open
Abstract
Left atrium (LA) size is associated with adverse cardiovascular events. The purpose of this study was to investigate the association of LA enlargement measured by non-contrast CT (NCCT) with traditional cardiovascular risk factors. Individuals aged 60–75 years from the population-based multicentre Danish Cardiovascular Screening (DANCAVAS) trial were included in this cross-sectional study. The LA was manually traced on the NCCT scans, and the largest cross-section area was indexed to body surface area. All traditional risk factors were recorded, and a subgroup received an echocardiographic examination. We enrolled 14,987 individuals. Participants with known cardiovascular disease or lacking measurements of LA size or body surface area were excluded, resulting in 10,902 men for the main analysis and 616 women for a sensitivity analysis. Adjusted multivariable analysis showed a significantly increased indexed LA size by increasing age and pulse pressure, while smoking, HbA1c, and total cholesterol were associated with decreased indexed LA size. The findings were confirmed in a supplementary analysis including left ventricle ejection fraction and mass. In this population-based cohort of elderly men, an association was found between age and pulse pressure and increasing LA size. Surprisingly, smoking, HbA1c, and total cholesterol were associated with a decrease in LA size. This indicates that the pathophysiology behind atrial cardiomyopathy is not only reflected by enlargement, but also shrinking.
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Affiliation(s)
- Maise Høigaard Fredgart
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark; (M.H.F.); (A.B.); (L.K.)
- Odense Patient Data Explorative Network (OPEN), Odense University Hospital, 5000 Odense, Denmark
| | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, 5000 Odense, Denmark;
- Cardiovascular Centre of Excellence (CAVAC), Odense University Hospital, 5000 Odense, Denmark
- Elitary Research Centre of Individualised Medicine in Arterial Disease, Odense University Hospital, 5000 Odense, Denmark
| | - Axel Brandes
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark; (M.H.F.); (A.B.); (L.K.)
| | | | - Lars Frost
- Department of Cardiology, Regional Hospital Central Jutland, 8600 Silkeborg, Denmark; (L.F.); (G.U.)
| | - Jess Lambrechtsen
- Department of Cardiology, Svendborg Hospital, 5700 Svendborg, Denmark; (J.L.); (K.E.)
| | - Marek Karon
- Department of Medicine, Nykøbing Falster Hospital, 4800 Nykøbing Falster, Denmark;
| | - Martin Busk
- Department of Cardiology, Hospital Lillebælt, 7100 Vejle, Denmark; (F.H.S.); (M.B.)
| | - Grazina Urbonaviciene
- Department of Cardiology, Regional Hospital Central Jutland, 8600 Silkeborg, Denmark; (L.F.); (G.U.)
| | - Kenneth Egstrup
- Department of Cardiology, Svendborg Hospital, 5700 Svendborg, Denmark; (J.L.); (K.E.)
| | - Lida Khurrami
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark; (M.H.F.); (A.B.); (L.K.)
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark;
| | - Axel Cosmus Pyndt Diederichsen
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark; (M.H.F.); (A.B.); (L.K.)
- Elitary Research Centre of Individualised Medicine in Arterial Disease, Odense University Hospital, 5000 Odense, Denmark
- Correspondence:
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Gao Z, Shi H, Xu W, Guan Z, Su X, Guo N, Ma H. Hyperuricemia Increases the Risk of Atrial Fibrillation: A Systematic Review and Meta-Analysis. Int J Endocrinol 2022; 2022:8172639. [PMID: 36046801 PMCID: PMC9420608 DOI: 10.1155/2022/8172639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Association between hyperuricemia (HUA) and atrial fibrillation (AF) remains unclear. We reviewed clinical evidence and aimed to determine whether hyperuricemia leads to a high risk of atrial fibrillation. Most studies were identified through databases online. Keywords used in literature search were hyperuricemia, atrial fibrillation, metabolic disorder, endocrine disorder, or uric acid. Three studies were provided by the authors. Literature search was performed without any data or language restriction. Observational studies, including cohort studies and cross-sectional studies, were used. Study type should be clearly defined. Cross-sectional studies should clearly introduce the sources of epidemiological data. Studies were excluded if with too many complications unrelated to AF enrolled. Data were independently extracted by three individuals. Data synthesis was conducted by R version 4.1.2. Prevalence of atrial fibrillation was the main outcome. Results of meta-analysis were presented as risk ratio (RR) for different prevalence of AF between individuals with and without HUA. All data included were obtained after follow-up work is completed. Data from 608,810 participants showed that patients with hyperuricemia were easier to suffer from atrial fibrillation (RR, 2.42; 95% CI, 1.24-3.03). And the meta-regressions suggested growth of linear proportion between the ratio of current drinkers and hyperuricemia (QM = 41.0069, P < 0.001). Subgroup analyses demonstrated consistent results in different countries. And design of the observational studies brought heterogeneity, but no uncertainties. Patients with hyperuricemia were easier to suffer from atrial fibrillation. Treatment of hyperuricemia or gout may bring potential benefits for AF patients.
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Affiliation(s)
- Zheng Gao
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
- Department of First Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hekai Shi
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
- Department of Second Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Xu
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
- Department of Second Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | | | - Xiuxiu Su
- College of Physical Education, Hebei Normal University, Shijiazhuang, China
| | - Nuojin Guo
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
- Department of Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huijie Ma
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
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Chao T, Joung B, Takahashi Y, Lim TW, Choi E, Chan Y, Guo Y, Sriratanasathavorn C, Oh S, Okumura K, Lip GYH. 2021 Focused update of the 2017 consensus guidelines of the Asia Pacific Heart Rhythm Society (APHRS) on stroke prevention in atrial fibrillation. J Arrhythm 2021; 37:1389-1426. [PMID: 34887945 PMCID: PMC8637102 DOI: 10.1002/joa3.12652] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/22/2021] [Indexed: 12/19/2022] Open
Abstract
The consensus of the Asia Pacific Heart Rhythm Society (APHRS) on stroke prevention in atrial fibrillation (AF) has been published in 2017 which provided useful clinical guidance for cardiologists, neurologists, geriatricians, and general practitioners in Asia-Pacific region. In these years, many important new data regarding stroke prevention in AF were reported. The Practice Guidelines subcommittee members comprehensively reviewed updated information on stroke prevention in AF, and summarized them in this 2021 focused update of the 2017 consensus guidelines of the APHRS on stroke prevention in AF. We highlighted and focused on several issues, including the importance of AF Better Care (ABC) pathway, the advantages of non-vitamin K antagonist oral anticoagulants (NOACs) for Asians, the considerations of use of NOACs for Asian patients with AF with single 1 stroke risk factor beyond gender, the role of lifestyle factors on stroke risk, the use of oral anticoagulants during the "coronavirus disease 2019" (COVID-19) pandemic, etc. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician's decision remains the most important factor in the management of AF.
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Affiliation(s)
- Tze‐Fan Chao
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiTaiwan
- Institute of Clinical Medicine, and Cardiovascular Research CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Boyoung Joung
- Division of CardiologyDepartment of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Yoshihide Takahashi
- The Department of Advanced Arrhythmia ResearchTokyo Medical and Dental UniversityTokyoJapan
| | - Toon Wei Lim
- National University Heart CentreNational University HospitalSingaporeSingapore
| | - Eue‐Keun Choi
- Department of Internal MedicineSeoul National University HospitalSeoulRepublic of Korea
| | - Yi‐Hsin Chan
- Microscopy Core LaboratoryChang Gung Memorial HospitalLinkouTaoyuanTaiwan
- College of MedicineChang Gung UniversityTaoyuanTaiwan
- Microscopy Core LaboratoryChang Gung Memorial HospitalLinkouTaoyuanTaiwan
| | - Yutao Guo
- Pulmonary Vessel and Thrombotic DiseaseChinese PLA General HospitalBeijingChina
| | | | - Seil Oh
- Department of Internal MedicineSeoul National University HospitalSeoulRepublic of Korea
| | - Ken Okumura
- Division of CardiologySaiseikai Kumamoto HospitalKumamotoJapan
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular ScienceUniversity of Liverpool & Liverpool Heart and Chest HospitalLiverpoolUK
- Aalborg Thrombosis Research UnitDepartment of Clinical MedicineAalborg UniversityAalborgDenmark
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2021 Focused Update Consensus Guidelines of the Asia Pacific Heart Rhythm Society on Stroke Prevention in Atrial Fibrillation: Executive Summary. Thromb Haemost 2021; 122:20-47. [PMID: 34773920 PMCID: PMC8763451 DOI: 10.1055/s-0041-1739411] [Citation(s) in RCA: 199] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The consensus of the Asia Pacific Heart Rhythm Society (APHRS) on stroke prevention in atrial fibrillation (AF) has been published in 2017 which provided useful clinical guidance for cardiologists, neurologists, geriatricians, and general practitioners in the Asia-Pacific region. In these years, many important new data regarding stroke prevention in AF were reported. The practice guidelines subcommittee members comprehensively reviewed updated information on stroke prevention in AF, and summarized them in this 2021 focused update of the 2017 consensus guidelines of the APHRS on stroke prevention in AF. We highlighted and focused on several issues, including the importance of the AF Better Care pathway, the advantages of non-vitamin K antagonist oral anticoagulants (NOACs) for Asians, the considerations of use of NOACs for Asian AF patients with single one stroke risk factor beyond gender, the role of lifestyle factors on stroke risk, the use of oral anticoagulants during the “coronavirus disease 2019” pandemic, etc. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician's decision remains the most important factor in the management of AF.
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Wan Q, Li S, Hu J. Association of smoking with postoperative atrial fibrillation in patients with cardiac surgery: A PRISMA-compliant article. Medicine (Baltimore) 2021; 100:e26179. [PMID: 34115000 PMCID: PMC8202588 DOI: 10.1097/md.0000000000026179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/13/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cigarette smoking is an important modifiable risk factor for incident atrial fibrillation. However, the impact of smoking on postoperative atrial fibrillation in patients undergoing cardiac surgery remains controversial. We performed this meta-analysis to explore the association of smoking with postoperative atrial fibrillation in patients with cardiac surgery. METHODS We systematically searched 2 computer-based databases (PubMed and EMBASE) up to July 2019 for all relevant studies. A random-effects model was selected to pool the odds ratios (ORs) and 95% confidence intervals (CIs). In this meta-analysis, the protocol and reporting of the results were based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. RESULTS A total of 36 studies were included in this meta-analysis. Overall, smoking was not associated with an increased risk of postoperative atrial fibrillation in patients undergoing cardiac surgery (odds ratio [OR] = 0.89; 95% confidence interval [CI] 0.79-1.02). The corresponding results were stable in the subgroup analyses. Specifically, smoking was not associated with an increased risk of postoperative atrial fibrillation regardless of the type of cardiac surgery: coronary artery bypass grafting (OR = 0.91; 95% CI 0.77-1.07), valve surgery (OR = 0.15; 95% CI 0.01-1.56), and coronary artery bypass grafting+valve surgery (OR = 0.91; 95% CI 0.70-1.18). CONCLUSIONS Based on currently published studies, smoking was not associated with an increased risk of postoperative atrial fibrillation in patients undergoing cardiac surgery.
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Affiliation(s)
- Qin Wan
- Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang of Jiangxi
| | - Siyuan Li
- Grade 2017, The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Jian Hu
- Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang of Jiangxi
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Gallagher C, Middeldorp ME, Hendriks JM, Lau DH, Sanders P. Lifestyle as a Risk Factor for Atrial Fibrillation. Card Electrophysiol Clin 2021; 13:263-272. [PMID: 33516405 DOI: 10.1016/j.ccep.2020.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The growing burden of atrial fibrillation health care resource utlization has created an urgent need to develop preventative strategies and opportunities to improve outcomes in the prevalent population. Modifiable risk factors contribute to both disease development and progression. In the prevalent atrial fibrillation population, modifying cardiovascular risk factors has decreased disease burden and progression. However, further research is required to determine the role of comprehensive cardiovascular risk factor modification programs in primary prevention. An understanding of strategies required to facilitate health behavior change is crucial to the effective implementation of cardiovascular risk factor management programs.
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Affiliation(s)
- Celine Gallagher
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Port Road, Adelaide, South Australia 5000, Australia
| | - Melissa E Middeldorp
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Port Road, Adelaide, South Australia 5000, Australia
| | - Jeroen M Hendriks
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Port Road, Adelaide, South Australia 5000, Australia; College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia 5042 Australia
| | - Dennis H Lau
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Port Road, Adelaide, South Australia 5000, Australia
| | - Prashanthan Sanders
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Port Road, Adelaide, South Australia 5000, Australia.
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Abstract
Modifiable risk factor management is becoming one of the 3 treatment pillars in atrial fibrillation management along with anticoagulation as well as conventional rate and rhythm control strategies. Preventive therapies, such as reducing blood pressure and treating obstructive sleep apnea, are paramount in the strategy of preventing atrial fibrillation. Identification of new modifiable risk factors and triggers also could help in the global strategy to reduce atrial fibrillation. This article covers alcohol intake, tobacco smoking, caffeine, chocolate, cannabis use, and air pollution as social risk factors related to lifestyle habits that potentially could contribute to atrial fibrillation development.
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Affiliation(s)
- Andres Klein
- Arrhythmia Service, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
| | - Mohammad Shenasa
- Department of Cardiovascular Services, Heart and Rhythm Medical Group, 18324 Twin Creeks Road, Monte Sereno, CA 95030, USA
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada.
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31
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Cintra FD, Figueiredo MJDO. Atrial Fibrillation (Part 1): Pathophysiology, Risk Factors, and Therapeutic Basis. Arq Bras Cardiol 2021; 116:129-139. [PMID: 33566977 PMCID: PMC8159512 DOI: 10.36660/abc.20200485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 09/09/2020] [Indexed: 01/14/2023] Open
Abstract
A fibrilação atrial é a arritmia sustentada mais comum na prática clínica com predileção pelas faixas etárias mais avançadas. Com o envelhecimento populacional, as projeções para as próximas décadas são alarmantes. Além de sua importância epidemiológica, a fibrilação atrial é destacada por suas repercussões clínicas, incluindo fenômenos tromboembólicos, hospitalizações e maior taxa de mortalidade. Seu mecanismo fisiopatológico é complexo, envolvendo uma associação de fatores hemodinâmicos, estruturais, eletrofisiológicos e autonômicos. Desde os anos 1990, o estudo Framingham em análises multivariadas já demonstrou que, além da idade, a presença de hipertensão, diabetes, insuficiência cardíaca e doença valvar é preditor independente dessa normalidade do ritmo. Entretanto, recentemente, vários outros fatores de risco estão sendo implicados no aumento do número de casos de fibrilação atrial, tais como sedentarismo, obesidade, anormalidades do sono, tabagismo e uso excessivo de álcool. Além disso, as mudanças na qualidade de vida apontam para uma redução na recorrência de fibrilação atrial, tornando-se uma nova estratégia para o tratamento de excelência dessa arritmia cardíaca. A abordagem terapêutica envolve um amplo conhecimento do estado de saúde e hábitos do paciente, e compreende quatro pilares principais: mudança de hábitos de vida e tratamento rigoroso de fatores de risco; prevenção de eventos tromboembólicos; controle da frequência; e controle do ritmo. Pela dimensão de fatores envolvidos no cuidado ao paciente portador de fibrilação atrial, ações integradas com equipes multiprofissionais estão associadas aos melhores resultados clínicos.
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Bahloul A, Bouattour N, Triki F, Hammami R, Charfeddine S, Ellouze T, Mhiri C, Abid L, Kammoun S. [Observational study of the prevalence of non-valvular atrial fibrillation and ischemic stroke and the factors associated with non-valvular atrial fibrillation in hypertensive patients: about 2887 cases]. Pan Afr Med J 2021; 38:31. [PMID: 33777299 PMCID: PMC7955596 DOI: 10.11604/pamj.2021.38.31.25569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/20/2020] [Indexed: 01/18/2023] Open
Abstract
Introduction high blood pressure (HBP), atrial fibrillation (AF) and ischemic stroke are three public health problems. The purpose of this study was to determine the prevalence of AF and ischemic stroke in hypertensive patients and the factors associated with the occurrence of non-valvular AF in these patients. Methods we used data collected in the Department of Cardiology at the University Hospital of Sfax as a part of National Tunisian Registry of Hypertension. We examined the associations between different socio-demographic, clinical, paraclinical, and therapeutic variables and AF in hypertensive patients using logistic regression models. Results our sample consisted of 2887 patients with a sex ratio of 0.95. The average age of patients was 65 years (±11). AF was found in 230 patients (8%), while ischemic stroke was found in 152 patients (5.3%). Multivariate analysis highlighted that independent factors associated with an increase in the prevalence of AF were: advanced age (p = 0,001, Odds Ratio (OR) = 1,647, 95% confidence interval ( CI): 1,1227-2,213), the detection of left ventricular hypertrophy (LVH) on cardiac ultrasound (p= 0,004, OR= 2,140, 5%CI 9: 1,281-3,576), and left ventricular ejection fraction (LVEF) < 50% (p<0,001, OR=4,677, 95% CI: 2,715 and 8.057). Conclusion this study confirms that there is a direct and independent relationship between high blood pressure, advanced age, LVH and AF. AF in patients with high blood pressure is a disease progression leading to an increased risk of ischemic stroke. Optimal high blood pressure control is a priority in hypertensive patients, especially in the elderly, aiming at preventing the risk of AF and ischemic stroke.
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Affiliation(s)
- Amine Bahloul
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Nadia Bouattour
- Service de Neurologie, Centre Hospitalo-Universitaire Habib Bourguiba, Sfax, Tunisie
| | - Faten Triki
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Rania Hammami
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Selma Charfeddine
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Tarek Ellouze
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Chokri Mhiri
- Service de Neurologie, Centre Hospitalo-Universitaire Habib Bourguiba, Sfax, Tunisie
| | - Leila Abid
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Samir Kammoun
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
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Xu S, Ye Z, Ma J, Yuan T. The impact of chronic obstructive pulmonary disease on hospitalization and mortality in patients with heart failure. Eur J Clin Invest 2021; 51:e13402. [PMID: 32916000 DOI: 10.1111/eci.13402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/13/2020] [Accepted: 08/27/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Several studies have suggested that chronic obstructive pulmonary disease (COPD) could be predictive of the prognosis in patients with heart failure (HF), but yield conflicting findings. Therefore, we conducted a meta-analysis to examine the impact of COPD on adverse outcomes in patients with HF. METHODS We systematically searched the databases of PubMed, EMBASE, Google Scholar, Cochrane library from inception to August 2020 for the relevant studies. Adjusted risk ratios (RRs) and confidence intervals (CIs) were collected and then pooled by the Review Manager version 5.30 software with a random-effects model. RESULTS A total of 18 studies (6 post hoc analyses of trials and 12 observational studies) were included in this meta-analysis. COPD was associated with an increased risk of all-cause mortality (hospitalized HF: RR 1.43, 95% CI: 1.20-1.70; chronic HF: RR 1.24, 95% CI: 1.16-1.33), but not cardiovascular mortality, in patients with hospitalized HF or chronic HF. In addition, COPD was associated with increased risks of all-cause hospitalization (RR 1.31, 95% CI: 1.21-1.42) and HF hospitalization (RR 1.31, 95% CI: 1.21-1.42) in the chronic HF patients. CONCLUSIONS COPD comorbidity could increase the risk of all-cause mortality of HF patients. Future research should confirm the findings on hospitalization because of the limited studies included for this outcome.
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Affiliation(s)
- Shuo Xu
- Department of Respiratory and Critical Care Medicine, the Ganzhou people's Hospital, Ganzhou of Jiangxi, Ganzhou, China
| | - Zi Ye
- St Vincent Clinical School, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Jianyong Ma
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Taiwen Yuan
- Department of Respiratory and Critical Care Medicine, the Ganzhou people's Hospital, Ganzhou of Jiangxi, Ganzhou, China
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Dai Q, Deng X, Zhou L, Zhang L, Xiao X, Liao Y. Real-world use of nonvitamin K antagonist oral anticoagulant in atrial fibrillation patients with liver disease: A meta-analysis. Clin Cardiol 2020; 43:676-683. [PMID: 32557677 PMCID: PMC7368301 DOI: 10.1002/clc.23408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/23/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022] Open
Abstract
Several studies have investigated the effectiveness and safety of nonvitamin K antagonist oral anticoagulants (NOACs) vs vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) and liver disease. Herein, we conducted a meta‐analysis to compare the effect of NOACs with VKAs in patients with AF and liver disease. We also conducted a subsidiary analysis to compare the risk of liver injury between NOACs and VKA in AF patients. We systematically searched the PubMed and Embase databases from January 2009 to May 2020 for the relevant studies. Hazard ratios (HRs) with 95% confidence intervals (CIs) were selected and pooled using a random‐effects model. A total of six cohorts were included. Compared with VKA use, the use of NOACs was associated with reduced risks of stroke or systemic embolism (HR 0.68, 95% CI 0.49‐0.93), all‐cause death (HR 0.69, 95% CI 0.63‐0.75), and intracranial bleeding (HR 0.49, 95% CI 0.40‐0.59), whereas the outcomes of major bleeding (HR 0.72, 95% CI 0.51‐1.01) and gastrointestinal bleeding (HR 0.84, 95% CI 0.51‐1.36) were not significantly different between groups in AF patients with liver disease. Moreover, compared with VKA use, the use of NOACs was associated with a reduced risk of liver injury (HR 0.72, 95% CI 0.61‐0.84) in AF patients. Compared with VKAs, the use of NOACs was associated with reduced risks of stroke or systemic embolism, all‐cause death, and intracranial bleeding in AF patients with liver disease, and associated with a reduced risk of liver injury in AF patients.
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Affiliation(s)
- Qixin Dai
- Department of Hepatopancreatobiliary Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Xiaohong Deng
- Department of Hepatopancreatobiliary Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Lin Zhou
- Department of Hepatopancreatobiliary Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Long Zhang
- Department of Hepatopancreatobiliary Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Xiulin Xiao
- Department of Hepatopancreatobiliary Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Yonghui Liao
- Department of Hepatopancreatobiliary Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
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35
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Chung MK, Eckhardt LL, Chen LY, Ahmed HM, Gopinathannair R, Joglar JA, Noseworthy PA, Pack QR, Sanders P, Trulock KM. Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e750-e772. [DOI: 10.1161/cir.0000000000000748] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is associated with substantial morbidity, mortality, and healthcare use. Great strides have been made in stroke prevention and rhythm control strategies, yet reducing the incidence of AF has been slowed by the increasing incidence and prevalence of AF risk factors, including obesity, physical inactivity, sleep apnea, diabetes mellitus, hypertension, and other modifiable lifestyle-related factors. Fortunately, many of these AF drivers are potentially reversible, and emerging evidence supports that addressing these modifiable risks may be effective for primary and secondary AF prevention. A structured, protocol-driven multidisciplinary approach to integrate lifestyle and risk factor management as an integral part of AF management may help in the prevention and treatment of AF. However, this aspect of AF management is currently underrecognized, underused, and understudied. The purpose of this American Heart Association scientific statement is to review the association of modifiable risk factors with AF and the effects of risk factor intervention. Implementation strategies, care pathways, and educational links for achieving impactful weight reduction, increased physical activity, and risk factor modification are included. Implications for clinical practice, gaps in knowledge, and future directions for the research community are highlighted.
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36
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Fu Y, He W, Ma J, Wei B. Relationship between psychological factors and atrial fibrillation: A meta-analysis and systematic review. Medicine (Baltimore) 2020; 99:e19615. [PMID: 32311930 PMCID: PMC7220243 DOI: 10.1097/md.0000000000019615] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although several studies have investigated the role of psychological factors in atrial fibrillation (AF), the results are still under debate. Therefore, we performed a meta-analysis to examine the relationship between psychological factors and the risk of incident AF. METHODS We systematically searched the PubMed and EMBASE databases from inception to December 2019 to identify eligible studies. The hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled by using a random-effects model. RESULTS A total of 11 cohort studies were included in this meta-analysis. There were 5, 2, 4, and 5 studies examining the association of anxiety, anger, depression, and psychological stress with AF, respectively. In the pooled analysis by a random-effects model, anxiety (HR = 1.10, 95%CI 0.97-1.24; P = .14), anger (HR = 1.08, 95%CI 0.95-1.23; P = .21), depression (HR = 1.15, 95%CI 0.98-1.35; P = .08), and work stress (HR = 1.14, 95%CI 0.98-1.34; P = .09) were not associated with the risk of AF. These results were not changed when we re-performed the analysis using a fixed-effects model. CONCLUSIONS Based on current evidence, no associations were observed for anger, anxiety, and work stress with the risk of AF.
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Affiliation(s)
- Yonghui Fu
- Department of Psychiatry, Jiangxi Mental Hospital, Nanchang, Jiangxi
| | - Wenfeng He
- Jiangxi Key Laboratory of Molecular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi China
| | - Jianyong Ma
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Bo Wei
- Department of Psychiatry, Jiangxi Mental Hospital, Nanchang, Jiangxi
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37
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Kobalava ZD, Lazarev PV. [Risk of Coronary Events in Atrial Fibrillation]. KARDIOLOGIIA 2020; 60:43-52. [PMID: 32245354 DOI: 10.18087/cardio.2020.1.n828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 10/30/2019] [Indexed: 06/11/2023]
Abstract
It has been established that cardiovascular events due to coronary heart disease are highly prevalent in the population of patients with atrial fibrillation. In this review, pathophysiologic mechanisms explaining this association are detailed along with supporting epidemiological evidence. Various methods for the prediction and prevention of coronary events in atrial fibrillation are iscussed, including modification of shared risk factors, antithrombotic therapy and selection of the optimal direct oral anticoagulant in terms of favourable influence on ischemic cardiac outcomes.
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Affiliation(s)
- Zh D Kobalava
- Peoples Friendship University of Russia (RUDN University)
| | - P V Lazarev
- Peoples Friendship University of Russia (RUDN University)
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Coppini R, Santini L, Palandri C, Sartiani L, Cerbai E, Raimondi L. Pharmacological Inhibition of Serine Proteases to Reduce Cardiac Inflammation and Fibrosis in Atrial Fibrillation. Front Pharmacol 2019; 10:1420. [PMID: 31956307 PMCID: PMC6951407 DOI: 10.3389/fphar.2019.01420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/07/2019] [Indexed: 12/18/2022] Open
Abstract
Systemic inflammation correlates with an increased risk of atrial fibrillation (AF) and thrombogenesis. Systemic inflammation alters vessel permeability, allowing inflammatory and immune cell migration toward target organs, including the heart. Among inflammatory cells infiltrating the atria, macrophages and mast cell have recently attracted the interest of basic researchers due to the pathogenic mechanisms triggered by their activation. This chemotactic invasion is likely implicated in short- and long-term changes in cardiac cell-to-cell communication and in triggering fibrous tissue accumulation in the atrial myocardium and electrophysiological re-arrangements of atrial cardiomyocytes, thus favoring the onset and progression of AF. Serine proteases are a large and heterogeneous class of proteases involved in several processes that are important for cardiac function and are involved in cardiac diseases, such as (i) coagulation, (ii) fibrinolysis, (iii) extracellular matrix degradation, (iv) activation of receptors (i.e., protease-activated receptors [PPARs]), and (v) modulation of the activity of endogenous signals. The recognition of serine proteases substrates and their involvement in inflammatory/profibrotic mechanisms allowed the identification of novel cardio-protective mechanisms for commonly used drugs that inhibit serine proteases. The aim of this review is to summarize knowledge on the role of inflammation and fibrosis as determinants of AF. Moreover, we will recapitulate current findings on the role of serine proteases in the pathogenesis of AF and the possible beneficial effects of drugs inhibiting serine proteases in reducing the risk of AF through decrease of cardiac inflammation and fibrosis. These drugs include thrombin and factor Xa inhibitors (used as oral anticoagulants), dipeptidyl-peptidase 4 (DPP4) inhibitors, used for type-2 diabetes, as well as novel experimental inhibitors of mast cell chymases.
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Affiliation(s)
- Raffaele Coppini
- Section of Pharmacology, Department of Neurology, Psychology, Drug Sciences and Child Health, University of Florence, Florence, Italy
| | - Lorenzo Santini
- Section of Pharmacology, Department of Neurology, Psychology, Drug Sciences and Child Health, University of Florence, Florence, Italy
| | - Chiara Palandri
- Section of Pharmacology, Department of Neurology, Psychology, Drug Sciences and Child Health, University of Florence, Florence, Italy
| | - Laura Sartiani
- Section of Pharmacology, Department of Neurology, Psychology, Drug Sciences and Child Health, University of Florence, Florence, Italy
| | - Elisabetta Cerbai
- Section of Pharmacology, Department of Neurology, Psychology, Drug Sciences and Child Health, University of Florence, Florence, Italy
| | - Laura Raimondi
- Section of Pharmacology, Department of Neurology, Psychology, Drug Sciences and Child Health, University of Florence, Florence, Italy
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5247] [Impact Index Per Article: 1049.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Risk and predictors of subsequent cancers of patients with newly-diagnosed atrial fibrillation — A nationwide population-based study. Int J Cardiol 2019; 296:81-86. [DOI: 10.1016/j.ijcard.2019.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 07/14/2019] [Accepted: 08/07/2019] [Indexed: 11/19/2022]
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Chamberlain AM. Secondhand Smoke and Atrial Fibrillation. J Am Coll Cardiol 2019; 74:1665-1666. [DOI: 10.1016/j.jacc.2019.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 11/28/2022]
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Groh CA, Vittinghoff E, Benjamin EJ, Dupuis J, Marcus GM. Childhood Tobacco Smoke Exposure and Risk of Atrial Fibrillation in Adulthood. J Am Coll Cardiol 2019; 74:1658-1664. [PMID: 31558248 PMCID: PMC6768078 DOI: 10.1016/j.jacc.2019.07.060] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/23/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cigarette smoking is known to increase the risk of atrial fibrillation (AF), and a recent cross-sectional analysis suggested that parental smoking may be an AF risk factor. OBJECTIVES The purpose of this study was to assess if parental smoking predicts offspring AF in the Framingham Heart Study. METHODS This study analyzed Framingham Offspring cohort participants with parents in the Original cohort with known smoking status during the offspring's childhood. Framingham participants were evaluated every 2 to 8 years and were under routine surveillance for incident AF. The authors assessed AF incidence among Offspring participants exposed to parental smoking through age 18 years and performed a mediation analysis to determine the extent to which offspring smoking might explain observed associations. RESULTS Of 2,816 Offspring cohort participants with at least 1 parent in the Original cohort, 82% were exposed to parental smoking. For every pack/day increase in parental smoking, there was an 18% increase in offspring AF incidence (adjusted hazard ratio [HR]: 1.18; 95% confidence interval [CI]: 1.00 to 1.39; p = 0.04). Additionally, parental smoking was a risk factor for offspring smoking (adjusted odds ratio [OR]: 1.34; 95% CI: 1.17 to 1.54; p < 0.001). Offspring smoking mediated 17% (95% CI: 1.5% to 103.3%) of the relationship between parental smoking and offspring AF. CONCLUSIONS Childhood secondhand smoke exposure predicted increased risk for adulthood AF after adjustment for AF risk factors. Some of this relationship may be mediated by a greater propensity among offspring of smoking parents to smoke themselves. These findings highlight potential new pathways for AF risk that begin during childhood, offering new evidence to motivate smoking avoidance and cessation.
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Affiliation(s)
- Christopher A Groh
- Electrophysiology Section, Division of Cardiology, University of California, San Francisco, California
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Emelia J Benjamin
- Department of Medicine, Boston University School of Medicine and Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Gregory M Marcus
- Electrophysiology Section, Division of Cardiology, University of California, San Francisco, California.
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Innocent bystander or criminal? Influence of respiratory dysfunction on risk of atrial fibrillation. J Cardiol 2019; 74:483-487. [PMID: 31353169 DOI: 10.1016/j.jjcc.2019.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 11/23/2022]
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Influence of Smoking Status on Risk of Incident Heart Failure: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152697. [PMID: 31362333 PMCID: PMC6696428 DOI: 10.3390/ijerph16152697] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/13/2019] [Accepted: 07/22/2019] [Indexed: 12/25/2022]
Abstract
Smoking is a well-known risk factor for atherosclerotic cardiovascular disease. However, there are insufficient data regarding the predictive influence of smoking status on the risk of incident heart failure (HF). This study involved a systematic review and meta-analysis of prospective cohort studies to identify the association of smoking status with incident risk of HF. Peer-reviewed articles published in PubMed, Embase, Web of Science, Cochrane, and CINAHL up to May 2019 were identified. Seven studies, based on 42,759 participants and 4826 HF cases, were included. Pooled hazard ratios (HRs) and their 95% confidence intervals (CI) were estimated using the fixed effects model. Subgroup analyses were conducted to define possible sources of heterogeneity. Current smokers aged 18 years and over had a greater risk of HF incidence compared with non-smokers (never or former smokers) (HR = 1.609, 95% CI, 1.470–1.761). Additionally, former smokers had a greater risk of HF incidence compared with never smokers (HR = 1.209, 95% CI, 1.084–1.348). The present study highlighted that never smokers have more obvious cardiovascular benefits than current or former smokers. Therefore, health professionals should support cessation at the earliest among current smokers and encourage young people and non-smokers not to start smoking.
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Liu X, Guo N, Zhu W, Zhou Q, Liu M, Chen C, Yuan P, Wan R, Hong K. Resting Heart Rate and the Risk of Atrial Fibrillation. Int Heart J 2019; 60:805-811. [PMID: 31204373 DOI: 10.1536/ihj.18-470] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
In a previous meta-analysis, it was demonstrated that the resting heart rate (RHR) is a potential risk factor for atrial fibrillation (AF). However, the results of that meta-analysis were conflicting, and the relationship between the RHR and AF is still not well established. In the current meta-analysis, our aim is to update evidence with a better statistical model. We searched the Cochrane Library, PubMed, and Embase databases for relevant studies and used a "one-stage approach" with a restricted cubic spline model to summarize the dose-specific relationships between the RHR and AF. Relative risk (RR) was used to measure the effects. In total, 10 studies were included, with a total of 18,630 cases of AF among 431,432 participants. In the dose-response analysis, there was evidence of a nonlinear association between the RHR and the risk of AF (nonlinearity, P < 0.0001), which exhibited a significant J-shaped association between the two factors. An RHR between 68 and 80 bpm had the lowest risk of AF. Among people who had RHR < 70 bpm, the summary RR was 1.09 per 10-RHR decrease (95% confidence interval [CI] = 1.06-1.12; P < 0.001). The results were similar for participants with RHR > 70 bpm (per 10 bpm increase) (RR = 1.06, 95% CI = 1.03-1.08; P < 0.001). Our dose-response meta-analysis revealed a significant J-shaped association between the RHR and AF. Both low RHR and high RHR were associated with an increased risk of AF compared with a modest RHR of 68-80 bpm.
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Affiliation(s)
- Xiao Liu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Ninghong Guo
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Wengen Zhu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Quan Zhou
- Department of Science and Education, First People's Hospital of Changde City
| | - Menglu Liu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Chen Chen
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Ping Yuan
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Rong Wan
- Jiangxi Key Laboratory of Molecular Medicine
| | - Kui Hong
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
- Jiangxi Key Laboratory of Molecular Medicine
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Kim BS, Park JK, Lee Y, Shin JH, Lim YH, Park HC, Kim CK, Shin J. The relationship between decreased pulmonary function and atrial fibrillation in general population: Findings from Ansung-Ansan cohort of the Korean Genome and Epidemiology Study. J Cardiol 2019; 74:488-493. [PMID: 31253525 DOI: 10.1016/j.jjcc.2019.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/30/2019] [Accepted: 05/13/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Decreased pulmonary function is a possible risk factor for atrial fibrillation (AF). However, data on this relationship in Asian populations are scant. The aim of this study was to evaluate the relationship between decreased pulmonary function and the incidence of AF in a prospective cohort of Koreans aged 40-69 years. METHODS We assessed AF in 9631 Korean people enrolled in the community-based cohort who were followed for up to 12 years. AF at baseline was identified by electrocardiography (ECG) performed during the baseline visit and/or the self-reported history of physician-determined diagnosis made before the baseline visit. Similarly, AF newly developed after the baseline visit was also identified by biennially performed ECGs and/or the self-reported history of physician-determined diagnosis that occurred between each biennial visit. If AF was identified by both ECGs and the history in the same subject, the earlier identification date was considered the time of AF development. RESULTS The median age was 50 (interquartile range, 44-60) years, and 4633 (48.1%) were male. The prevalence of AF at baseline was significantly higher in subjects with lower quartiles of forced expiratory volume in second (FEV1)% predicted (1.2% in the lowest quartile versus 0.3% in the highest quartile; p<0.001). After adjustment for cardiovascular risk factors, FEV1% predicted and forced vital capacity (FVC)% predicted were independent risk factors for AF at baseline. Over a median follow-up period of 138 (interquartile range, 70-141) months, AF was newly documented in 162 subjects (1.7%). The lowest quartiles of FEV1% predicted (adjusted hazard ratio, 1.59; 95% confidence interval, 1.02-2.50) was associated with a higher risk of incident AF than the highest quartiles. CONCLUSIONS In this large community-based cohort study with a long-term follow-up, decreased pulmonary function was found to be an independent risk factor for AF in the general Korean population.
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Affiliation(s)
- Byung Sik Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Jin-Kyu Park
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Yonggu Lee
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri City, Gyounggi-do, Republic of Korea
| | - Jeong Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri City, Gyounggi-do, Republic of Korea
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Hwan-Cheol Park
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri City, Gyounggi-do, Republic of Korea
| | - Chun Ki Kim
- Department of Nuclear Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea.
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Jiang T, Wang YN, Qu Q, Qi TT, Chen YD, Qu J. Association between gene variants and the recurrence of atrial fibrillation: An updated meta-analysis. Medicine (Baltimore) 2019; 98:e15953. [PMID: 31169720 PMCID: PMC6571381 DOI: 10.1097/md.0000000000015953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 02/10/2019] [Accepted: 05/15/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Studies showed the controversial results about the effect of common genetic polymorphisms on the atrial fibrillation (AF) recurrence. We performed the systematic review and meta-analysis to qualify the association between common genetic polymorphisms and AF recurrence. METHODS Articles were systematically retrieved PubMed, Web of Science, EMBASE, Wanfang, and CNKI database and 9 studies including 3204 patients were enrolled in our meta-analysis. RESULTS Results showed that the associations were significant under rs2200733 3 genetic models (TT vs CC: odds ratio [OR] [confidence interval [CI]] = 1.336 [1.061-1.683], P = .014; CT vs CC: OR [CI] = 0.759 [0.614-0.937], P = .01; TT vs CT + CC: OR [CI] = 2.308 [1.440-3.700], P = .001). The association was significant under rs10033464 genetic model (TT vs GG: OR [CI] = 1.517 [1.165-1.976], P = .002). CONCLUSIONS Rs13376333 on chromosome 1q21 (in KCNN3), rs7193343 and rs2106261 on chromosome 16q22 (in ZFHX3) were not associated with AF recurrence in our meta-analysis. In total, our meta-analysis found that rs2200733 and rs10033464 on chromosome 4q25 (near PITX2) were associated with the risk of AF recurrence.
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Affiliation(s)
- Tao Jiang
- Department of Cardiovascular Medicine
| | - Ya-Nan Wang
- Department of Respiratory, Hospital of Laiwu Iron and Steel Co. Ltd, Laiwu
| | - Qiang Qu
- Department of Pharmacy, Xiangya Hospital
| | - Ting-Ting Qi
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha
| | - Yun-Dai Chen
- Department of Cardiovascular Medicine, The General Hospital of the People's Liberation Army, Beijing, People's Republic of China
| | - Jian Qu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha
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[Smoking cessation: A challenge for cardiologists and pulmonologists]. Rev Mal Respir 2019; 36:527-537. [PMID: 31006577 DOI: 10.1016/j.rmr.2018.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 03/18/2018] [Indexed: 12/23/2022]
Abstract
In addition to public health measures that need to be strongly supported politically, smoking is also a major medical issue. Tobacco dependence is a chronic disease, and, given its extremely addictive nature, treatment for tobacco dependence must be addressed actively by all health professionals. Because smoking is a major contributor to many of the pathologies their specialties address, cardiologists and pulmonologists must be at the forefront of this care. In this review we analyse the current state of smoking cessation treatment and its inadequacies, the limiting impact that doctors' own smoking has, as well as the misconceptions held by smokers and sometimes by doctors as well, which act as brakes on smoking cessation. Smoking cessation must become a treatment delivered in real clinical practice and any doctor must know how to manage it fluently. Do not be satisfied with simply advising smokers to quit. Learn how to approach the subject with smokers effectively, know how the various pharmacotherapies are used and know how to organize smoking cessation follow-up, an essential guarantee of success. If optimal management of this major pathological factor is a role for all doctors, it is of course especially so for our two specialties. It's up to us, cardiologists and pulmonologists, to take up this challenge.
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Nagahapitiye MC, Rozec P, Rosec-Page AH, Tanguy-Laine K, Dewitte JD, Pougnet R. [Smoking among hospital staff and the impact of the November, No Smoking Month campaign on this population]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:369-374. [PMID: 30266552 DOI: 10.1016/j.pneumo.2018.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/13/2018] [Accepted: 06/28/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Smoking cessation is a public health priority. Several prevention campaigns exist, including this one of the "month without tobacco", made in November in France. Healthcare workers have an important role to play in stopping smoking, while many of the healthcare workers are themselves smokers. The purpose of this article is to study the prevalence of tobacco consumption among hospital staff and to evaluate its effects. MATERIAL AND METHOD It is a transversal study, carried out among the 734 agents of a French hospital, between December 2016 and January 2017, by anonymous self-questionnaires. The study included all hospital employees, whether they were caregivers or not. RESULTS The participation rate was 35%, of whom 193 (75.7%) were health care workers, 46 (17.6%) were administrative and 17 (6.7%) were working in technical services. There were 31% smokers and 26% forming smokers. There were no significant differences in smoking by age, or socio-occupational category. During this campaign, 66.7% of smokers had plans to quit, and 29% tried to quit. CONCLUSION The prevalence of smoking in this hospital was comparable to that of the general population, and among the highest in hospital in the literature. The campaign of the month without tobacco has influenced the consumption of smokers. Other studies need to analyze how to handle this population.
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Affiliation(s)
- M C Nagahapitiye
- Cadre supérieur de santé, CHRU de Morvan, institut qualité, sécurité et gestion de risques, 29200 Brest, France
| | - P Rozec
- Service d'addictologie, hôpital Ferdinand-Grall, 29800 Landerneau, France
| | - A H Rosec-Page
- Direction qualité, hôpital Ferdinand-Grall, 29800 Landerneau, France
| | | | - J D Dewitte
- Consultation hospitalière de tabacologie, CHRU de Morvan Brest, 29200 Brest, France; Laboratoire d'étude et de recherche en sociologie (LABERS), EA3149, université de Bretagne Occidentale, 29200 Brest, France
| | - R Pougnet
- Consultation hospitalière de tabacologie, CHRU de Morvan Brest, 29200 Brest, France; Centre de ressource en pathologies professionnelles et environnementales, CHRU de Morvan Brest, 29200 Brest, France; EA3149, laboratoires d'études et de recherche en sociologie (LABERS), faculté des lettres et des sciences humaines, Victor Segalen, université de Bretagne Occidentale, 29200 Brest, France.
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Börschel CS, Schnabel RB. The imminent epidemic of atrial fibrillation and its concomitant diseases - Myocardial infarction and heart failure - A cause for concern. Int J Cardiol 2018; 287:162-173. [PMID: 30528622 PMCID: PMC6524760 DOI: 10.1016/j.ijcard.2018.11.123] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 11/19/2018] [Accepted: 11/27/2018] [Indexed: 12/12/2022]
Abstract
Atrial fibrillation (AF) is increasingly common in the general population. It often coincides with myocardial infarction (MI) and heart failure (HF) which are also diseases in older adults. All three conditions share common cardiovascular risk factors. While hypertension and obesity are central risk factors for all three diseases, smoking and diabetes appear to have less impact on AF. To date, age is the single most important risk factor for AF in the general population. Further, epidemiological studies suggest a strong association of AF to MI and HF. The underlying pathophysiological mechanisms are complex and not fully understood. Both MI and HF can trigger development of AF, mainly by promoting structural and electrical atrial remodeling. On the other hand, AF facilitates HF and MI development via multiple mechanisms, resulting in a vicious circle of cardiac impairment and adverse cardiovascular prognosis. Consequently, to prevent and treat the coincidence of AF and HF or MI a strict optimization of cardiovascular risk factors is required.
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Affiliation(s)
- Christin S Börschel
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.
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