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Park CS, Choi J, Choi J, Lee KY, Ahn HJ, Kwon S, Lee SR, Choi EK, Kwak SH, Oh S. Alcohol is neither a risk factor nor a protective factor for sudden cardiac death and/or fatal ventricular arrhythmia: A population-based study with genetic traits and alcohol consumption in the UK Biobank. Heart Rhythm 2024; 21:1820-1826. [PMID: 38697272 DOI: 10.1016/j.hrthm.2024.04.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND The association between alcohol consumption and the risk of sudden cardiac death and/or fatal ventricular arrhythmia remains controversial. OBJECTIVE We analyzed the association between alcohol consumption, genetic traits for alcohol metabolism, and the risk of sudden cardiac death and/or fatal ventricular arrhythmia. METHODS We identified 397,164 individuals enrolled between 2006 and 2010 from the UK Biobank database and followed them until 2021. Alcohol consumption was categorized as current nondrinkers (nondrinkers and ex-drinkers), mild drinkers, moderate drinkers, or heavy drinkers. Genetic traits of alcohol metabolism were stratified according to the polygenic risk score tertiles. The primary and secondary outcomes were a composite of sudden cardiac death and fatal ventricular arrhythmia as well as their individual components. RESULTS During follow-up (median 12.5 years), 3543 cases (0.89%) of clinical outcomes occurred. Although mild, moderate, and heavy drinkers showed deceased risks of outcomes compared with current nondrinkers, there was no prognostic difference among nondrinkers, mild drinkers, moderate drinkers, and heavy drinkers. Ex-drinkers showed an increased risk in univariate analysis, but the significance was attenuated after adjusting covariates (hazard ratio 1.19; 95% confidence interval 0.94-1.50). As a continuous variable, alcohol consumption was not associated with clinical outcomes (hazard ratio 1.01; 95% confidence interval 0.99-1.02). Consistent with these findings, there was no association between genetic traits for alcohol metabolism and the risk of clinical outcomes. CONCLUSION Alcohol consumption was neither a protective factor nor a risk factor for sudden cardiac death or fatal ventricular arrhythmia. Genetic traits of alcohol metabolism were not associated with the clinical prognosis.
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Affiliation(s)
- Chan Soon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jaewon Choi
- Division of Data Science Research, Innovative Biomedical Technology Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - JungMin Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Yeon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
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Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, De Potter TJR, Dwight J, Guasti L, Hanke T, Jaarsma T, Lettino M, Løchen ML, Lumbers RT, Maesen B, Mølgaard I, Rosano GMC, Sanders P, Schnabel RB, Suwalski P, Svennberg E, Tamargo J, Tica O, Traykov V, Tzeis S, Kotecha D. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2024; 45:3314-3414. [PMID: 39210723 DOI: 10.1093/eurheartj/ehae176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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3
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Georgescu OS, Martin L, Târtea GC, Rotaru-Zavaleanu AD, Dinescu SN, Vasile RC, Gresita A, Gheorman V, Aldea M, Dinescu VC. Alcohol Consumption and Cardiovascular Disease: A Narrative Review of Evolving Perspectives and Long-Term Implications. Life (Basel) 2024; 14:1134. [PMID: 39337917 PMCID: PMC11433171 DOI: 10.3390/life14091134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 09/06/2024] [Accepted: 09/07/2024] [Indexed: 09/30/2024] Open
Abstract
Cardiovascular illnesses remain the primary cause of death, accounting for at least 17.9 million fatalities per year and posing a significant public health problem because of its extensive predominance and effect on healthcare systems. The etiology of cardiovascular disease is complex and involves several environmental and lifestyle factors. Alcohol use is a highly important determinant because of its dual-edged effect on cardiovascular health. Multiple studies indicate that moderate alcohol consumption may have certain advantages, such as slight enhancements in lipid profiles. Conversely, excessive alcohol intake is associated with serious negative consequences, including cardiomyopathy, hypertension, arrhythmias, and even mortality. The aim of this study is to provide a comprehensive analysis of the several effects of alcohol on cardiovascular health and their understanding within the medical field over time. It uses an interpretative narrative review methodology and analyzes studies that focus on genetic risk factors, gender differences, and shifts in paradigms in recent years. This article highlights the need for obtaining a thorough understanding of the effects of alcohol on cardiovascular health to support public health guidelines and clinical practice, and it underscores the significance of including alcohol consumption into the broader context of cardiovascular risk management and identifies important subjects for further study.
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Affiliation(s)
- Ovidiu Stefan Georgescu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania
| | - Liviu Martin
- Faculty of Medical Care, Titu Maiorescu University, Văcărești Road, no 187, 040051 Bucharest, Romania
| | - Georgică Costinel Târtea
- Department of Physiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania
| | | | - Sorin Nicolae Dinescu
- Department of Epidemiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania
| | - Ramona Constantina Vasile
- Department of Epidemiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania
| | - Andrei Gresita
- Department of Physiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania
| | - Veronica Gheorman
- Department 3 Medical Semiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania
| | - Madalina Aldea
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania
| | - Venera Cristina Dinescu
- Department of Health Promotion and Occupational Medicine, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Str., 200349 Craiova, Romania
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4
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Lu X, Liu C, Lu H, Qian X, Wang C, Jia C, Jia F. Eight-year total, cognitive-affective, and somatic depressive symptoms trajectories and risks of cardiac events. Transl Psychiatry 2024; 14:356. [PMID: 39231933 PMCID: PMC11374896 DOI: 10.1038/s41398-024-03063-y] [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] [Received: 06/09/2024] [Revised: 08/20/2024] [Accepted: 08/22/2024] [Indexed: 09/06/2024] Open
Abstract
In this study, we analyzed pooled data from two prospective population-based cohorts-the Health Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA)-to explore the association between trajectories of depressive symptoms and the risk of cardiac events. Depressive symptoms were assessed using the 8-item CES-D scale and categorized into somatic and cognitive-affective subtypes. Trajectories were tracked for four surveys from baseline. Heart disease was identified based on self-reported physician-diagnosed conditions. Hazard ratios and 95% confidence intervals were calculated with Cox proportional risk models that adjusted for potential confounders. In total, 17,787 subjects (59.7% female, median age 63 years) were enrolled at baseline. During a 10-year follow-up, 2409 cases of heart disease were identified. Participants with fluctuating (HR = 1.13, 95% CI: 1.06-1.20), increasing (HR = 1.43, 95% CI: 1.25-1.64), and consistently high (HR = 1.64, 95% CI: 1.45-1.84) depressive symptom trajectories exhibited an increased risk of heart disease compared to those with consistently low depressive symptoms, while a decreasing (HR = 1.07, 95% CI: 0.96-1.19) depressive symptom trajectory did not significantly affect the risk of heart disease. Moreover, the association between heart disease and somatic depressive symptoms was found to be stronger than with cognitive-affective symptoms. These findings suggest a significant link between depressive symptom trajectories and heart disease, with particular emphasis on stronger associations with somatic symptoms. It is recommended that the identification and management of depressive symptoms be incorporated into heart disease prevention strategies.
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Affiliation(s)
- Xinyi Lu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Chunxiao Liu
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Hong Lu
- Department of Pharmacy, Yucheng City People's Hospital, Dezhou, Shandong, China
| | - Xiaoyu Qian
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Congdi Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Cunxian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Feifei Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
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5
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Kneihsl M, Berger N, Sumerauer S, Asenbaum-Nan S, Höger FS, Gattringer T, Enzinger C, Aigner M, Ferrari J, Lang W. Management of delirium in acute stroke patients: a position paper by the Austrian Stroke Society on prevention, diagnosis, and treatment. Ther Adv Neurol Disord 2024; 17:17562864241258788. [PMID: 39161955 PMCID: PMC11331472 DOI: 10.1177/17562864241258788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/14/2024] [Indexed: 08/21/2024] Open
Abstract
Delirium is a common complication in acute stroke patients, occurring in 15-35% of all stroke unit admissions and is associated with prolonged hospital stay and a poor post-stroke prognosis. Managing delirium in acute stroke patients necessitates an intensive and multiprofessional therapeutic approach, placing a significant burden on healthcare staff. However, dedicated practical recommendations for delirium management developed for the population of acute stroke patients are lacking. For this purpose, the Austrian Stroke Society, in cooperation with the Austrian Society of Neurology, the Austrian Society of Neurorehabilitation, and the Austrian Society of Psychiatry, Psychotherapy, and Psychosomatics has formulated an evidence-based position paper addressing the management of delirium in acute stroke patients. The paper outlines practical recommendations on the three pillars of care in stroke patients with delirium: (a) Key aspects of delirium prevention including stroke-specific delirium risk factors and delirium prediction scores are described. Moreover, a non-pharmacological delirium prevention bundle is presented. (b) The paper provides recommendations on timing and frequency of delirium screening to ensure early diagnosis of delirium in acute stroke patients. Moreover, it reports on the use of different delirium screening tools in stroke populations. (c) An overview of non-pharmacological and pharmacological treatment strategies in patients with delirium and acute stroke is presented and summarized as key recommendation statements.
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Affiliation(s)
- Markus Kneihsl
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz A-8036, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Natalie Berger
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Stefan Sumerauer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | | | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | | | - Martin Aigner
- Department of Psychiatry and Psychotherapy, Karl Landsteiner University for Health and Science, Tulln, Austria
| | - Julia Ferrari
- Department of Neurology, Hospital Barmherzige Brüder Vienna, Vienna, Austria
| | - Wilfried Lang
- Medical Faculty, Sigmund Freud University, Vienna, Austria
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6
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van den Broek JLPM, Gottlieb LA, Vermeer JR, Overeem S, Dekker LRC. When the Clock Strikes A-fib. JACC Clin Electrophysiol 2024; 10:1916-1928. [PMID: 39093277 DOI: 10.1016/j.jacep.2024.05.035] [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: 01/31/2024] [Revised: 05/09/2024] [Accepted: 05/25/2024] [Indexed: 08/04/2024]
Abstract
Within the broad spectrum of atrial fibrillation (AF) symptomatology, there is a striking subset of patients with predominant or even solitary nocturnal onset of the arrhythmia. This review covers AF with nocturnal onset, with the aim of defining this distinctive subgroup among patients with AF. A periodicity analysis is provided showing a clear increased onset between 10:00 pm and 7:00 am. Multiple interacting mechanisms are discussed, such as circadian modulation of electrophysiological properties, vagal tone, and sleep disorders, as well as the potential interaction and synergism between these factors, to provide a better understanding of this clinical entity. Lastly, potential therapeutic targets for AF with nocturnal onset are addressed such as upstream therapy for underlying comorbidities, type of drug and timing of drug administration and pulmonary vein isolation, ablation of the ganglionated plexus, and autonomic nervous system modulation. Understanding the underlying AF mechanisms in the individual patient with nocturnal onset will contribute to patient-specific therapy.
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Affiliation(s)
- Johannes L P M van den Broek
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | | | - Jasper R Vermeer
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Sebastiaan Overeem
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Kempenhaeghe Centre for Sleep Medicine, Heeze, the Netherlands
| | - Lukas R C Dekker
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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7
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Lim MW, Kalman JM. The impact of lifestyle factors on atrial fibrillation. J Mol Cell Cardiol 2024; 193:91-99. [PMID: 38838814 DOI: 10.1016/j.yjmcc.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/04/2024] [Accepted: 05/31/2024] [Indexed: 06/07/2024]
Abstract
Atrial fibrillation (AF), with its significant associated morbidity and mortality contributes to significant healthcare utilisation and expenditure. Given its progressively rising incidence, strategies to limit AF development and progression are urgently needed. Lifestyle modification is a potentially potent but underutilised weapon against the AF epidemic. The purpose of this article is to review the role of lifestyle factors as risk factors for AF, outline potential mechanisms of pathogenesis and examine the available evidence for lifestyle intervention in primary and secondary AF prevention. It will also highlight the need for investment by physicians, researchers, health services and governments in order to facilitate delivery of the comprehensive, multidisciplinary AF care that is required to manage this complex and multifactorial disease.
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Affiliation(s)
- Michael W Lim
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Jonathan M Kalman
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, The University of Melbourne, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia.
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8
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Fu B, Yu Y, Cheng S, Huang H, Long T, Yang J, Cai C, Gu M, Niu H, Hua W. The combined association of physical activity and alcohol use with long-term mortality: an age-stratified analysis. BMC Public Health 2024; 24:1817. [PMID: 38978061 PMCID: PMC11229205 DOI: 10.1186/s12889-024-19326-8] [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: 01/12/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND The combined association of physical activity (PA) and alcohol use (AU) with long-term mortality is yet to be investigated. METHODS For the current study, 12,621 participants aged ≥ 20 years were enrolled from the National Health and Nutrition Examination Survey (1999-2004). The study endpoint was all-cause mortality. Cox proportional hazards regression models were used to examine the combined effect of PA and AU on long-term mortality. RESULTS The study population was divided into young (< 60 years, N = 8,258) and old (≥ 60 years, N = 4,363) groups. The median follow-up time was 203 months. In both young and old group, sedentary lifestyle combined with even minimal AU were associated with elevated risk of death (all P < 0.05). In young group, the integration of high volume AU with any degree of PA, including sedentary PA (HR = 2.35, 95% CI 1.24-4.44, P = 0.009), low PA (HR = 1.64, 95% CI 1.01-2.68, P = 0.047), and moderate-to-vigorous PA (HR = 1.99, 95% CI 1.03-3.84, P = 0.041), was associated with an increased risk of mortality. This relationship persisted as significant after adjusting for potential confounders (all P < 0.05). In old group, combining moderate-to-vigorous PA and low volume AU (HR = 0.59, 95% CI 0.37-0.94, P = 0.027) was associated with a reduction in mortality. After adjustment, the combination of moderate-to-vigorous PA and low volume AU was independently associated with favorable prognostic outcomes (all P < 0.05). CONCLUSIONS In both age groups, combining sedentary lifestyle with even minimal AU was a risk factor for death. In young group, combining any level of PA with high volume AU was associated with increased mortality. In old group, combining moderate-to-vigorous PA with low volume AU was related to reduced mortality.
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Affiliation(s)
- Bingqi Fu
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Yu Yu
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Sijing Cheng
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Hao Huang
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Tianxin Long
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Juwei Yang
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Chi Cai
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Min Gu
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Hongxia Niu
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China
| | - Wei Hua
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Rd, Xicheng District, Beijing, 100037, China.
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9
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González-Ferrero T, Bergonti M, Marcon L, Minguito-Carazo C, Tilves Bellas C, Pesquera Lorenzo JC, Martínez-Sande JL, González-Melchor L, García-Seara FJ, Fernández-López JA, González-Juanatey JR, Heidbuchel H, Sarkozy A, Rodríguez-Mañero M. Characterization of patients with extensive left atrial myopathy referred for atrial fibrillation ablation: incidence, predictors, and outcomes. Clin Res Cardiol 2024:10.1007/s00392-024-02467-6. [PMID: 38922425 DOI: 10.1007/s00392-024-02467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 05/16/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Although atrial fibrosis has a relevant impact on ablation success rate, experimental studies have reported that extensive fibrosis may be accompanied by a reduced burden secondary to a prominent depression of atrial excitability. OBJECTIVES We aimed to identify clinical and echocardiographic factors associated with extensive left atrial myopathy (ELAM), to analyze the predictive ability of established scores (AF score, APPLE, and DR-FLASH) and assess outcomes in terms of AF recurrence, left atrial flutter, and post-procedural heart failure admissions. METHODS A total of 950 consecutive patients undergoing the first AF ablation were included. A 3D electroanatomical mapping system (CARTO3, Biosense Webster) was created using a multipolar mapping catheter (PentaRay, Biosense Webster). ELAM was defined as ≥ 50% low voltage area. A subanalysis with four groups was also created (< 10%; 10-20%; 10-20%; and > 30%). Logistic regressions, Cox proportional hazards models, and log-rank test were used to test the predictors independently associated with the presence of ELAM and AF recurrence. The model was prospectively validated in a cohort of 150 patients obtaining an excellent ability for prediction AUC 0.90 (CI 95% 0.84-0.96). RESULTS Overall, 78 (8.42%) presented ELAM. Age, female sex, persistent AF, first-degree AV block, and E/e' were significant predictors. The model incorporating these factors outperformed the existing scores (AUC = 0.87). During a mean follow-up of 20 months (IQR 9 to 36), patients with ELAM presented a higher rate of AF recurrence (42.02% vs 26.01%, p = 0.030), left atrial flutter (26.03% vs 8.02%, p < 0.001), and post-procedural heart failure admissions (12.01% vs 0.61%, p < 0.001) than non-ELAM patients. CONCLUSIONS This study reveals the incidence and clinical factors associated with ELAM in AF, highlighting age, female, persistent AF, first-degree AV block, and E/e'. Importantly, the presence of ELAM is associated with poorer outcomes in terms of recurrence and HF admission.
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Affiliation(s)
- Teba González-Ferrero
- Division of Cardiac Electrophysiology, Department of Cardiology, University Hospital Lucus Augusti, Lugo, Spain
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Marco Bergonti
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900, Lugano, Switzerland
| | - Lorenzo Marcon
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Research, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Carlos Minguito-Carazo
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Carlos Tilves Bellas
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
| | - Juan Carlos Pesquera Lorenzo
- Division of Cardiac Electrophysiology, Department of Cardiology, University Hospital Lucus Augusti, Lugo, Spain
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900, Lugano, Switzerland
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Heart Rhythm Management Center, University Hospital of Brussels, Brussels, Belgium
- Cardiovascular Research, GENCOR, University of Antwerp, Antwerp, Belgium
| | - José Luis Martínez-Sande
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Laila González-Melchor
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco Javier García-Seara
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jesús Alberto Fernández-López
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Ramón González-Juanatey
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Research, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Andrea Sarkozy
- Heart Rhythm Management Center, University Hospital of Brussels, Brussels, Belgium
| | - Moisés Rodríguez-Mañero
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain.
- CIBERCV, Institute of Health Carlos III, Madrid, Spain.
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
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10
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Ma C, Wu S, Liu S, Han Y. Chinese guidelines for the diagnosis and management of atrial fibrillation. Pacing Clin Electrophysiol 2024; 47:714-770. [PMID: 38687179 DOI: 10.1111/pace.14920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 05/02/2024]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, significantly impacting patients' quality of life and increasing the risk of death, stroke, heart failure, and dementia. Over the past two decades, there have been significant breakthroughs in AF risk prediction and screening, stroke prevention, rhythm control, catheter ablation, and integrated management. During this period, the scale, quality, and experience of AF management in China have greatly improved, providing a solid foundation for the development of the guidelines for the diagnosis and management of AF. To further promote standardized AF management, and apply new technologies and concepts to clinical practice timely and fully, the Chinese Society of Cardiology of Chinese Medical Association and the Heart Rhythm Committee of Chinese Society of Biomedical Engineering jointly developed the Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation. The guidelines comprehensively elaborated on various aspects of AF management and proposed the CHA2DS2‑VASc‑60 stroke risk score based on the characteristics of the Asian AF population. The guidelines also reevaluated the clinical application of AF screening, emphasized the significance of early rhythm control, and highlighted the central role of catheter ablation in rhythm control.
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Affiliation(s)
- Changsheng Ma
- Chinese Society of Cardiology, Chinese Medical Association, Heart Rhythm Committee of Chinese Society of Biomedical Engineering, Beijing, China
| | - Shulin Wu
- Chinese Society of Cardiology, Chinese Medical Association, Heart Rhythm Committee of Chinese Society of Biomedical Engineering, Beijing, China
| | - Shaowen Liu
- Chinese Society of Cardiology, Chinese Medical Association, Heart Rhythm Committee of Chinese Society of Biomedical Engineering, Beijing, China
| | - Yaling Han
- Chinese Society of Cardiology, Chinese Medical Association, Heart Rhythm Committee of Chinese Society of Biomedical Engineering, Beijing, China
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11
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Guan L, Wang CH, Sun H, Sun ZJ. Development and validation of a nomogram model for all-cause mortality risk in patients with chronic heart failure and atrial fibrillation. BMC Geriatr 2024; 24:470. [PMID: 38811919 PMCID: PMC11138095 DOI: 10.1186/s12877-024-05059-1] [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: 08/05/2023] [Accepted: 05/08/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND As the global aging process continues to accelerate, heart failure (HF) has become an important cause of increased morbidity and mortality in elderly patients. Chronic atrial fibrillation (AF) is a major risk factor for HF. Patients with HF combined with AF are more difficult to treat and have a worse prognosis. The aim of this study was to explore the risk factors for 1-year mortality in patients with HF combined with AF and to develop a risk prediction assessment model. METHODS We recruited hospitalized patients with HF and AF who received standardized care in the Department of Cardiology at Shengjing Hospital of China Medical University from January 2013 to December 2018. The patients were randomly divided into modeling and internal validation groups using a random number generator at a 1:1 ratio. Multivariate Cox regression analysis was used to identify risk factors for all-cause mortality during a one-year follow-up period. Then, a nomogram was constructed based on the weights of each index and validated. Receiver operating characteristic curve, the area under the curve (AUC), decision curve, and calibration curve analyses for survival were used to evaluate the model's predictive and clinical validities and calibration. RESULTS We included 3,406 patients who met the eligibility criteria; 1,703 cases each were included in the modeling and internal validation groups. Eight statistically significant predictors were identified: age, sex, New York Heart Association cardiac function class III or IV, a history of myocardial infarction, and the albumin, triglycerides, N-terminal pro-b-type natriuretic peptide, and blood urea nitrogen levels. The AUCs were 0.793 (95% confidence interval: 0.763-0.823) and 0.794 (95% confidence interval: 0.763-0.823) in the modeling and validation cohorts, respectively. CONCLUSIONS We present a predictive model for all-cause mortality in patients with coexisting HF and AF comprising eight key factors. This model gives clinicians a simple assessment tool that may improve the clinical management of these patients.
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Affiliation(s)
- Lin Guan
- Department of Cardiology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi Zone, Shenyang, 110022, China
| | - Chuan-He Wang
- Department of Cardiology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi Zone, Shenyang, 110022, China
| | - Hao Sun
- Department of Clinical Epidemiology and Evidence-Based Medicine, the First Hospital of China Medical University, Shenyang, 110001, China.
| | - Zhi-Jun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi Zone, Shenyang, 110022, China.
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12
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Huang W, Xu S, Zhou H, Ji W, Chen Y. Global association of incidence between atrial fibrillation and the major gastrointestinal cancers: An analysis based on the 2019 Global burden of disease study. Heliyon 2024; 10:e29929. [PMID: 38699016 PMCID: PMC11064153 DOI: 10.1016/j.heliyon.2024.e29929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024] Open
Abstract
Atrial Fibrillation (AF) and gastrointestinal (GI) cancers are age-related diseases with shared environmental risk factors and underlying biological mechanisms. This study aimed to assess the association between AF and GI cancers on a global scale, analyzing incidence data from 204 countries. This ecological study utilized data from the Global Burden of Disease. Spearman's correlation and logistic regression analyses were employed to assess the association between AF and specific GI cancers, including esophagus cancer (EC), colon and rectum cancer (CRC), liver cancer (LC), pancreatic cancer (PC), and stomach cancer (SC). AF, CRC and PC exhibited increasing crude incidence rates from 2000 to 2019, whereas EC and SC demonstrated decreasing trends specifically in females. From 2000 to 2010, there was a noticeable fall in the incidence rate of LC, which was followed by a minor growth through 2019. The age-standardized incidence rate (ASIR) of AF was positively correlated with CRC and PC, but a negative relationship with AF was revealed for EC. Unexpectedly, no significant relationship was discovered for SC and LC associated with AF. Logistic regression analysis revealed a positive correlation between a country's ASIR of AF and its ASIR of CRC, LC and PC. Conversely, these countries demonstrated a decreased ASIR for EC. Our findings showed a significant correlation between national incidence rates of AF with CRC and PC, worldwide. Countries with higher ASIR of AF had higher ASIR of CRC and PC. Additional research is necessary to confirm the association between GI cancers and AF at the individual level.
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Affiliation(s)
- Weipeng Huang
- Department of Cardiology, Jieyang People's Hospital, 522000, Jieyang, Guangdong, China
| | - Shangbo Xu
- Department of Cardiology, Jieyang People's Hospital, 522000, Jieyang, Guangdong, China
| | - Haoyue Zhou
- Department of Cardiology, Jieyang People's Hospital, 522000, Jieyang, Guangdong, China
| | - Weibiao Ji
- Department of Cardiology, Jieyang People's Hospital, 522000, Jieyang, Guangdong, China
| | - Yangbo Chen
- Department of Cardiology, Jieyang People's Hospital, 522000, Jieyang, Guangdong, China
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13
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Vlachakis PK, Tsiachris D, Doundoulakis I, Tsioufis P, Kordalis A, Botis M, Leontsinis I, Antoniou CK, Papachrysostomou C, Dimitroula V, Maneta E, Chalkitis V, Kotsakis T, Skantzikas P, Kafkas N, Sidiropoulos G, Roussos D, Trikas A, Koudounis G, Kolettis TM, Smyrnioudis N, Christakos D, Chasikidis C, Gatzoulis KA, Tsioufis K. Therapeutic inertia in rhythm control strategies in hospitalized patients with fibrillation: Insights from Hellenic Cardiorenal Morbidity Snapshot (HECMOS) study. J Cardiol 2024; 83:313-317. [PMID: 37979719 DOI: 10.1016/j.jjcc.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Current guidelines recommend a rhythm control strategy in patients with symptomatic atrial fibrillation (AF) while catheter ablation has been shown to be a safer and more efficacious approach than antiarrhythmic medications. METHODS HECMOS was a nationwide snapshot survey of cardiorenal morbidity in hospitalized cardiology patients. In this sub-study, we included 276 cases who had a history of AF, particularly on the rhythm strategy, and catheter ablation procedures had been performed before the index admission. RESULTS Among 276 AF patients (mean age: 76.4 ± 11.5 years, 58 % male), 60.9 % (N = 168) had persistent AF and 39.1 % (N = 108) had paroxysmal AF. Heart failure was the main cause of admission in 54.3 % (N = 145) of the patients, while 14.1 % (N = 39) were admitted due to paroxysmal AF, 7.3 % (N = 20) due to bradyarrhythmic reasons, and 6.5 % (N = 18) suffered from acute coronary syndrome. Most importantly, heart failure with reduced ejection fraction was present in 76 (27 %) patients. Only 10 patients out of the total (3 %, mean age 59.7 years) had undergone AF ablation while electrical cardioversion had been attempted in 37 (13.4 %) patients. Interestingly, in this AF population with heart failure, 3.6 % (N = 10) had a defibrillator implanted (4 single-chamber), and only 1.5 % (N = 4) had a cardiac resynchronization therapy defibrillator (CRT-D). CONCLUSION High prevalence of persistent AF was detected in hospitalized patients, with heart failure being the leading cause of admission and main co-morbidity. Rhythm control strategies are notably underused, along with CRT-D implantation in patients with AF and heart failure.
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Affiliation(s)
- Panayotis K Vlachakis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Dimitris Tsiachris
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece; Athens Heart Center, Athens Medical Center, Athens, Greece.
| | - Ioannis Doundoulakis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Panagiotis Tsioufis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Athanasios Kordalis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Michail Botis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Ioannis Leontsinis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Christos-Konstantinos Antoniou
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece; Athens Heart Center, Athens Medical Center, Athens, Greece
| | | | - Vasiliki Dimitroula
- Department of Cardiology, G. Hatzikosta General Hospital of Ioannina, Ioannina, Greece
| | - Eleni Maneta
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - Theodoros Kotsakis
- Department of Cardiology, Democritus University of Thrace, Medical School, Alexandroupoli, Greece
| | | | - Nikolaos Kafkas
- Department of Cardiology, General Hospital of Attica "KAT", Athens, Greece
| | - Georgios Sidiropoulos
- Department of Cardiology, Georgios Papanikolaou General Hospital, Thessaloniki, Greece
| | - Dimitris Roussos
- Department of Cardiology, Argos General Hospital, Nafplio, Argolis, Greece
| | | | - Georgios Koudounis
- Cardiology Department & Department of Cardiac Catheterization, General Hospital of Messinia, Kalamata, Greece
| | | | | | | | - Christos Chasikidis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Konstantinos A Gatzoulis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
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14
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MA CS, WU SL, LIU SW, HAN YL. Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation. J Geriatr Cardiol 2024; 21:251-314. [PMID: 38665287 PMCID: PMC11040055 DOI: 10.26599/1671-5411.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, significantly impacting patients' quality of life and increasing the risk of death, stroke, heart failure, and dementia. Over the past two decades, there have been significant breakthroughs in AF risk prediction and screening, stroke prevention, rhythm control, catheter ablation, and integrated management. During this period, the scale, quality, and experience of AF management in China have greatly improved, providing a solid foundation for the development of guidelines for the diagnosis and management of AF. To further promote standardized AF management, and apply new technologies and concepts to clinical practice in a timely and comprehensive manner, the Chinese Society of Cardiology of the Chinese Medical Association and the Heart Rhythm Committee of the Chinese Society of Biomedical Engineering have jointly developed the Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation. The guidelines have comprehensively elaborated on various aspects of AF management and proposed the CHA2DS2-VASc-60 stroke risk score based on the characteristics of AF in the Asian population. The guidelines have also reevaluated the clinical application of AF screening, emphasized the significance of early rhythm control, and highlighted the central role of catheter ablation in rhythm control.
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15
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Reddy KR, Freeman AM. Lifestyle Medicine: An Antidote to Cardiovascular Diseases. Am J Lifestyle Med 2024; 18:216-232. [PMID: 38559785 PMCID: PMC10979734 DOI: 10.1177/15598276221130684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Despite numerous advances in basic understanding of cardiovascular disease pathophysiology, pharmacology, therapeutic procedures, and systems improvement, there hasn't been much decline in heart disease related mortality in the US since 2010. Hypertension and diet induced risk continue to be the leading causes of cardiovascular morbidity. Even with the excessive mortality associated with the COVID-19 pandemic, in 2020, heart disease remained the leading cause of death. Given the degree of disease burden, morbidity, and mortality, there is an urgent need to redirect medical professionals' focus towards prevention through simple and cost effective lifestyle strategies. However, current practice paradigm and financial compensation systems are mainly centered disease management and not health promotion. For example, the financial value placed on 3-10 min smoking cessation counseling (.24RVUs) is 47-fold lower than an elective PCI (11.21 RVUs). The medical community seems to be enamored with the latest and greatest technology, new devices, and surgical procedures. What if the greatest technology of all was simply the way we live every day? Perhaps when this notion is known by enough, we will switch to this lifestyle medicine technology to prevent disease in the first place.
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Affiliation(s)
- Koushik R. Reddy
- Division of Cardiology, Department of Medicine, James A. Haley VA Medical Center and University of South Florida, Tampa, FL, USA (KRR); and Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO, USA (AMF)
| | - Andrew M. Freeman
- Division of Cardiology, Department of Medicine, James A. Haley VA Medical Center and University of South Florida, Tampa, FL, USA (KRR); and Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO, USA (AMF)
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16
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Gautier A, Picard F, Ducrocq G, Elbez Y, Fox KM, Ferrari R, Ford I, Tardif JC, Tendera M, Steg PG. New-onset atrial fibrillation and chronic coronary syndrome in the CLARIFY registry. Eur Heart J 2024; 45:366-375. [PMID: 37634147 PMCID: PMC10834159 DOI: 10.1093/eurheartj/ehad556] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 07/13/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND AND AIMS Data on new-onset atrial fibrillation (NOAF) in patients with chronic coronary syndromes (CCS) are scarce. This study aims to describe the incidence, predictors, and impact on cardiovascular (CV) outcomes of NOAF in CCS patients. METHODS Data from the international (45 countries) CLARIFY registry (prospeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) were used. Among 29 001 CCS outpatients without previously reported AF at baseline, patients with at least one episode of AF/flutter diagnosed during 5-year follow-up were compared with patients in sinus rhythm throughout the study. RESULTS The incidence rate of NOAF was 1.12 [95% confidence interval (CI) 1.06-1.18] per 100 patient-years (cumulative incidence at 5 years: 5.0%). Independent predictors of NOAF were increasing age, increasing body mass index, low estimated glomerular filtration rate, Caucasian ethnicity, alcohol intake, and low left ventricular ejection fraction, while high triglycerides were associated with lower incidence. New-onset atrial fibrillation was associated with a substantial increase in the risk of adverse outcomes, with adjusted hazard ratios of 2.01 (95% CI 1.61-2.52) for the composite of CV death, non-fatal myocardial infarction, or non-fatal stroke, 2.61 (95% CI 2.04-3.34) for CV death, 1.64 (95% CI 1.07-2.50) for non-fatal myocardial infarction, 2.27 (95% CI 1.85-2.78) for all-cause death, 8.44 (95% CI 7.05-10.10) for hospitalization for heart failure, and 4.46 (95% CI 2.85-6.99) for major bleeding. CONCLUSIONS Among CCS patients, NOAF is common and is strongly associated with worse outcomes. Whether more intensive preventive measures and more systematic screening for AF would improve prognosis in this population deserves further investigation.
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Affiliation(s)
- Alexandre Gautier
- Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, French Alliance for Cardiovascular Trials, INSERM U1148, Laboratory for Vascular Translational Science, 46 rue Henri Huchard, 75018 Paris, France
- Université Paris Cité, 85 boulevard Saint-Germain, 75006 Paris, France
| | - Fabien Picard
- Université Paris Cité, 85 boulevard Saint-Germain, 75006 Paris, France
- Department of Cardiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, French Alliance for Cardiovascular Trials, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Gregory Ducrocq
- Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, French Alliance for Cardiovascular Trials, INSERM U1148, Laboratory for Vascular Translational Science, 46 rue Henri Huchard, 75018 Paris, France
- Université Paris Cité, 85 boulevard Saint-Germain, 75006 Paris, France
| | - Yedid Elbez
- Signifience, 35 rue de l'Oasis, 92800 Puteaux, France
| | - Kim M Fox
- NHLI Imperial College, Dovehouse Street, London SW3 6LP, UK
| | - Roberto Ferrari
- Centro Cardiologico Universitario di Ferrara, University of Ferrara, Via Aldo Moro 8, 44124 Cona (FE) Italy, Scientific Department of Medical Trial Analysis (MTA), Via Antonio Riva 6, 6900, Lugano, Switzerland
| | - Ian Ford
- Robertson Centre for Biostatistics, Boyd Orr Building, University Avenue, University of Glasgow, Glasgow G12 8QQ, UK
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montreal, 5000 Belanger Street, Montreal, QC H1T 1C8, Canada
| | - Michal Tendera
- Department of Cardiology and Structural Heart Disease, School of Medicine in Katowice, Medical University of Silesia, Ziolowa Street 45/47, 40-635 Katowice, Poland
| | - Philippe Gabriel Steg
- Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, French Alliance for Cardiovascular Trials, INSERM U1148, Laboratory for Vascular Translational Science, 46 rue Henri Huchard, 75018 Paris, France
- Université Paris Cité, 85 boulevard Saint-Germain, 75006 Paris, France
- Institut Universitaire de France, 1 Rue Descartes, 75005 Paris, France
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17
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1-e156. [PMID: 38033089 PMCID: PMC11095842 DOI: 10.1161/cir.0000000000001193] [Citation(s) in RCA: 286] [Impact Index Per Article: 286.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines liaison
| | | | | | | | | | - Paul L Hess
- ACC/AHA Joint Committee on Performance Measures liaison
| | | | | | | | | | - Kazuhiko Kido
- American College of Clinical Pharmacy representative
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18
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:109-279. [PMID: 38043043 PMCID: PMC11104284 DOI: 10.1016/j.jacc.2023.08.017] [Citation(s) in RCA: 95] [Impact Index Per Article: 95.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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19
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Park CS, Choi J, Choi J, Lee KY, Ahn HJ, Kwon S, Lee SR, Choi EK, Kwak SH, Oh S. Risk of newly developed atrial fibrillation by alcohol consumption differs according to genetic predisposition to alcohol metabolism: a large-scale cohort study with UK Biobank. BMC Med 2023; 21:509. [PMID: 38129845 PMCID: PMC10740225 DOI: 10.1186/s12916-023-03229-3] [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: 08/04/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The predictive relationship between mild-to-moderate alcohol consumption and the risk of incident atrial fibrillation (AF) remains controversial. OBJECTIVE We investigated whether the relationship between alcohol consumption and the risk of incident AF could be associated with the genetic predisposition to alcohol metabolism. METHODS A total of 399,329 subjects with genetic data from the UK Biobank database, enrolled between 2006 and 2010, were identified and followed for incident AF until 2021. Genetic predisposition to alcohol metabolism was stratified according to the polygenic risk score (PRS) tertiles. Alcohol consumption was categorized as non-drinkers, mild-to-moderate drinkers (< 30 g/day), and heavy drinkers (≥ 30 g/day). RESULTS During the follow-up (median 12.2 years), 19,237 cases of AF occurred. When stratified by PRS tertiles, there was a significant relationship between genetic predisposition to alcohol metabolism and actual alcohol consumption habits (P < 0.001). Mild-to-moderate drinkers showed a decreased risk of AF (HR 0.96, 95% CI 0.92-0.99), and heavy drinkers showed an increased risk of AF (HR 1.06, 95% CI 1.02-1.10) compared to non-drinkers. When stratified according to PRS tertiles for genetic predisposition to alcohol metabolism, mild-to-moderate drinkers had equivalent AF risks, and heavy drinkers showed increased AF risk in the low PRS tertile group. However, mild-to-moderate drinkers had decreased AF risks and heavy drinkers showed similar risks of AF in the middle/high PRS tertile groups. CONCLUSIONS Differential associations between alcohol consumption habits and incident AF across genetic predisposition to alcohol metabolism were observed; individuals with genetic predisposition to low alcohol metabolism were more susceptible to AF.
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Affiliation(s)
- Chan Soon Park
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jaewon Choi
- Division of Data Science Research, Innovative Biomedical Technology Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - JungMin Choi
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Yeon Lee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Jeong Ahn
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soonil Kwon
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soo Heon Kwak
- Division of Data Science Research, Innovative Biomedical Technology Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seil Oh
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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20
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Edavettal JM, Harris NR, Cohen SE, Paloczi J, Chandrasekar B, Gardner JD. Abstinence Restores Cardiac Function in Mice with Established Alcohol-Induced Cardiomyopathy. Cells 2023; 12:2783. [PMID: 38132102 PMCID: PMC10742080 DOI: 10.3390/cells12242783] [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: 10/11/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Alcohol-induced cardiomyopathy (ACM) has a poor prognosis with up to a 50% chance of death within four years of diagnosis. There are limited studies investigating the potential of abstinence for promoting repair after alcohol-induced cardiac damage, particularly in a controlled preclinical study design. Here, we developed an exposure protocol that led to significant decreases in cardiac function in C57BL6/J mice within 30 days; dP/dt max decreased in the mice fed alcohol for 30 days (8054 ± 664.5 mmHg/s compared to control mice: 11,188 ± 724.2 mmHg/s, p < 0.01), and the dP/dt min decreased, as well (-7711 ± 561 mmHg/s compared to control mice: -10,147 ± 448.2 mmHg/s, p < 0.01). Quantitative PCR was used to investigate inflammatory and fibrotic biomarkers, while histology was used to depict overt changes in cardiac fibrosis. We observed a complete recovery of function after abstinence (dP/dt max increased from 8054 ± 664 mmHg/s at 30 days to 11,967 ± 449 mmHg/s after abstinence, p < 0.01); further, both inflammatory and fibrotic biomarkers decreased after abstinence. These results lay the groundwork for future investigation of the molecular mechanisms underlying recovery from alcohol-induced damage in the heart.
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Affiliation(s)
- Joshua M. Edavettal
- Department of Physiology, LSU Health Sciences Center—New Orleans, New Orleans, LA 70112, USA; (J.M.E.); (N.R.H.); (S.E.C.); (J.P.)
| | - Nicholas R. Harris
- Department of Physiology, LSU Health Sciences Center—New Orleans, New Orleans, LA 70112, USA; (J.M.E.); (N.R.H.); (S.E.C.); (J.P.)
| | - Sarah E. Cohen
- Department of Physiology, LSU Health Sciences Center—New Orleans, New Orleans, LA 70112, USA; (J.M.E.); (N.R.H.); (S.E.C.); (J.P.)
| | - Janos Paloczi
- Department of Physiology, LSU Health Sciences Center—New Orleans, New Orleans, LA 70112, USA; (J.M.E.); (N.R.H.); (S.E.C.); (J.P.)
| | - Bysani Chandrasekar
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA;
- Department of Medical Pharmacology and Physiology, Dalton Cardiovascular Research Center, and Harry S. Truman Memorial Veterans Hospital, Columbia, MO 65212, USA
| | - Jason D. Gardner
- Department of Physiology, LSU Health Sciences Center—New Orleans, New Orleans, LA 70112, USA; (J.M.E.); (N.R.H.); (S.E.C.); (J.P.)
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21
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Turner A, LaMonica HM, Moroney C, O'Leary F, Naismith SL, Flood VM. Knowledge, Attitudes, and Behaviours Concerning the Mediterranean Diet Among Older Adults in Australia. J Community Health 2023; 48:951-962. [PMID: 37289354 PMCID: PMC10248335 DOI: 10.1007/s10900-023-01237-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/09/2023]
Abstract
Despite the growing body of evidence demonstrating the positive health effects of the Mediterranean diet, it is not routinely recommended in practice and adherence is low in the general population in Australia. The knowledge-attitude-behaviour model explains how health behaviours are supported through a process of acquiring knowledge, developing attitudes, and forming behaviours. Evidence has suggested that having a high level of nutrition-related knowledge is associated with more positive attitudes, which is directly linked to positive dietary behaviours. However, reports of knowledge and attitudes towards the Mediterranean diet, and how these directly relate to behaviours in older adults, are lacking. This study explored Mediterranean diet-related knowledge, attitudes, and behaviours among community-dwelling older adults in Australia. Participants were adults aged 55 years and older who completed an online survey that contained three parts: (a) knowledge - Mediterranean Diet Nutrition Knowledge Questionnaire (Med-NKQ); (b) nutrition-related attitudes and behaviours, and barriers and enablers to dietary change; (c) demographics. The sample included 61 adults who ranged in age from 55 to 89 years. The overall knowledge score was 30.5 out of a possible 40 points, with 60.7% classified as having a high level of knowledge. Knowledge was lowest for nutrient content and label reading. Attitudes and behaviours were generally positive and were not associated with level of knowledge. The most common barriers to dietary change were perceived cost and lack of knowledge, and motivational factors. There are a number of key gaps in knowledge that should be addressed through targeted educational programs. Strategies and tools to overcome perceived barriers and improve self-efficacy are needed to facilitate positive dietary behaviours.
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Affiliation(s)
- Ashlee Turner
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Haley M LaMonica
- Faculty of Medicine and Health, Translational Research Collective, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Carissa Moroney
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Fiona O'Leary
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Discipline of Nutrition and Dietetics, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Sharon L Naismith
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
- Brain and Mind Centre, Healthy Brain Ageing Program, The University of Sydney, Sydney, NSW, 2006, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Victoria M Flood
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia.
- Faculty of Medicine and Health, The University of Sydney, University Centre for Rural Health, Northern Rivers, NSW, 2480, Australia.
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22
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Seitz HK, John U. [Alcohol as a health risk: new recommendations for dealing with alcohol]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023; 64:1224-1229. [PMID: 37707519 DOI: 10.1007/s00108-023-01574-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Chronic alcohol consumption is related to more than 200 disorders. Up until now, limits for low-risk use of alcohol were 24 g/ day for men and 12 g/ day for women. Recent epidemiologic studies have shown that any alcohol may be harmful. AIM The aim of this review is to reassess the health risk of alcohol. RESULTS There is a linear relationship between the amount of alcohol consumed and mortality risk. No risk-free dose of alcohol exists. However, health risk varies not only with the amount of alcohol consumed but also with target organs, as well as individual genetic and non-genetic factors such as smoking, medication use, exposure to environmental toxins, and pre-existing disease that deteriorates with alcohol use. High-risk groups for the damaging effect of alcohol include children and adolescents, old people, and women. Diseases that are affected by alcohol even at a low dose include arterial hypertension, cardiac arrhythmia (extrasystole, arterial fibrillation), some liver diseases (non-alcoholic fatty liver disease, hepatitis C, porphyria) as well as breast cancer. For these disorders, a threshold of low risk does not exist. Finally, in addition to breast cancer, alcohol is a risk factor for cancer of the oral cavity, the larynx, pharynx, oesophagus, liver, and colorectum. During pregnancy alcohol is completely forbidden. CONCLUSION There is no such thing as a risk-free dose of alcohol.
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Affiliation(s)
- Helmut K Seitz
- Zentrum für Leber- und Alkoholerkrankungen, Ethianum Klinik, Voßstraße 6, Heidelberg, Deutschland.
- Medizinische Fakultät, Universität Heidelberg, Heidelberg, Deutschland.
| | - Ulrich John
- Präventionsforschung und Sozialmedizin, Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
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23
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Hazarapetyan L, Zelveian PH, Grigoryan S. Inflammation and Coagulation are Two Interconnected Pathophysiological Pathways in Atrial Fibrillation Pathogenesis. J Inflamm Res 2023; 16:4967-4975. [PMID: 37927962 PMCID: PMC10625332 DOI: 10.2147/jir.s429892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Atrial fibrillation (AF) is associated with elevated levels of clotting factors such as tissue factor (TF) and factor XII (FXII). Various inflammation markers, such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF- α), and high-sensitive C-reactive protein (hs-CRP), have also been associated with AF. This study explores the relationship between inflammation markers and coagulation activity, including their impact on heart structural changes in these patients. Methods We observed 283 patients with nonvalvular AF who underwent a complete examination at admission, but only 183 patients have successful cardioversion. As a control group, similar patients without AF were examined. The markers of the coagulation and inflammation were studied by ELISA on the analyzer "Stat Fax 303 Plus". Studies were conducted using l statistical package SPSS 13.0. Results It was revealed that patients with AF had significantly higher levels of hs-CRP, IL-6, and TNF-α and had elevated levels of TF and FXII compared with control group. The moderate correlations were observed between IL-6 and left atrial diameter (LAD), IL-6 and LA stiffness, hs-CRP and left atrial volume (LAV), TF and LAV. Conclusion We have demonstrated that patients with AF have the relationship between elevated levels of inflammatory markers and coagulation activity, which contributes to structural atrial remodeling.
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Affiliation(s)
- Lusine Hazarapetyan
- Department of Cardiology, Yerevan State Medical University Named After M. Heratsi, Yerevan, Armenia
- Scientific Research Institute of Cardiology Named After L Hovhannisyan, Yerevan, Armenia
| | - Parounak H Zelveian
- Scientific Research Institute of Cardiology Named After L Hovhannisyan, Yerevan, Armenia
| | - Svetlana Grigoryan
- Department of Cardiology, Yerevan State Medical University Named After M. Heratsi, Yerevan, Armenia
- Scientific Research Institute of Cardiology Named After L Hovhannisyan, Yerevan, Armenia
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24
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Yang L, Chung MK. Lifestyle changes in atrial fibrillation management and intervention. J Cardiovasc Electrophysiol 2023; 34:2163-2178. [PMID: 36598428 PMCID: PMC10318120 DOI: 10.1111/jce.15803] [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: 07/18/2022] [Revised: 12/13/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023]
Abstract
Atrial fibrillation (AF) is one of the most common arrhythmias in adults, and its continued rise in the United States is complicated by the increased incidence and prevalence of several AF risk factors, such as obesity, physical inactivity, hypertension, obstructive sleep apnea, diabetes mellitus, coronary artery disease, and alcohol, tobacco, or caffeine use. Lifestyle and risk factor modification has been proposed as an additional pillar of AF therapy, added to rhythm control, rate control, and anticoagulation, to reduce AF burden and risk. Although emerging evidence largely supports the integration of lifestyle and risk factor management in clinical practice, randomized clinical trials investigating the long-term sustainability and reproducibility of these benefits remain sparse. The purpose of this review is to discuss potentially reversible risk factors on AF, share evidence for the impact on AF by modification of these risk factors, and then provide an overview of the effects of reversing or managing these risk factors on the success of various AF management strategies, such as antithrombotic, rate control, and rhythm control therapies.
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Affiliation(s)
- Lucy Yang
- The Departments of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, and Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mina K Chung
- The Departments of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, and Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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25
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Frederiksen TC, Christiansen MK, Benjamin EJ, Overvad K, Olsen A, Dahm CC, Jensen HK. Five-year changes in alcohol intake and risk of atrial fibrillation: a Danish cohort study. Eur J Prev Cardiol 2023; 30:1046-1053. [PMID: 36508613 PMCID: PMC10442053 DOI: 10.1093/eurjpc/zwac293] [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: 10/25/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
AIMS Alcohol intake is a well-established risk factor for atrial fibrillation (AF). However, evidence on the effects of changes in alcohol intake to primary AF prevention is sparse. The aim of this study was to examine the association between 5-year changes in alcohol intake and the risk of incident AF. METHODS AND RESULTS This study was based on the Danish cohort study Diet, Cancer and Health. Lifestyle factors were assessed using questionnaires at a recruitment research examination and a second examination 5 years later. Diagnoses of AF and comorbidities were retrieved from the Danish National Patient Registry. 43 758 participants without prior AF were included. The median age was 61 (25th-75th percentile 58-66) years and 54% were female. Over a median follow-up time of 15.7 years, 5312 participants had incident AF (incidence rate 8.6/1000 person-years). Compared with stable intake, increases in alcohol intake to ≥21 drinks/week from ≤6.9 drinks/week (HR: 1.38, 95% CI: 1.09-1.72) or 14-20.9 drinks/week (HR: 1.27, 95% CI: 1.01-1.59) at baseline were associated with a higher risk of AF. In contrast, we did not observe a statistically significant association between reductions in alcohol intake and the risk of AF. CONCLUSION A 5-year increase in alcohol intake was associated with a greater risk of AF compared with a stable low/moderate intake.
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Affiliation(s)
- Tanja Charlotte Frederiksen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark
| | - Morten Krogh Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark
| | - Emelia J Benjamin
- Sections of Cardiovascular Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, 725 Albany Street, MA 02118, USA
| | - Kim Overvad
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Anja Olsen
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Christina Catherine Dahm
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark
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26
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Georgiou A, Georgiopoulos G, Delialis D, Maneta E, Masci PG, Neophytou O, Tsiachris D, Evangelou E. Causal Relationship Between Average Alcohol Consumption and Risk of Atrial Fibrillation: A Mendelian Randomization Study. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2023; 16:406-408. [PMID: 37191011 DOI: 10.1161/circgen.122.003766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Andrea Georgiou
- Department of Hygiene and Epidemiology, University of Ioannina Medical School (A.G., E.E.)
| | - Georgios Georgiopoulos
- Clinical Therapeutics, National & Kapodistrian University of Athens School of Medicine, Athens, Greece (G.G., D.D., E.M., O.N.)
- School of Biomedical Engineering and Imaging Sciences, Kings College London, United Kingdom (G.G., P.G.M.)
| | - Dimitrios Delialis
- Clinical Therapeutics, National & Kapodistrian University of Athens School of Medicine, Athens, Greece (G.G., D.D., E.M., O.N.)
| | - Eleni Maneta
- Clinical Therapeutics, National & Kapodistrian University of Athens School of Medicine, Athens, Greece (G.G., D.D., E.M., O.N.)
| | - Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, Kings College London, United Kingdom (G.G., P.G.M.)
| | - Onisiphoros Neophytou
- Clinical Therapeutics, National & Kapodistrian University of Athens School of Medicine, Athens, Greece (G.G., D.D., E.M., O.N.)
| | | | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, University of Ioannina Medical School (A.G., E.E.)
- Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, United Kingdom (E.E.)
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27
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Kaul R, Kaul R, Paul P, Maksymiuk V, Frishman WH, Aronow WS. Alcohol and Atrial Fibrillation: A Pathophysiologic Perspective. Cardiol Rev 2023; 31:177-184. [PMID: 36398336 DOI: 10.1097/crd.0000000000000479] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia responsible for significant morbidity and mortality. Its burden on patients and the health care system is only expected to increase. Several studies have established a dose-response relationship between the amount and frequency of alcohol consumption and the incidence of new onset AF independent of sex, age, and other risk factors. This causal relationship is mediated by the impact alcohol consumption has on conduction properties of the atrium, structural and cellular effect on cardiac myocytes, and dysregulation of the autonomic nervous system. This article reviews the current literature supporting the link between alcohol consumption and AF while attempting to provide an insight into pathophysiological mechanisms.
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Affiliation(s)
- Risheek Kaul
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Ridhima Kaul
- Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Pradipta Paul
- Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha, Qatar
| | | | | | - Wilbert S Aronow
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
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28
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Lombardo M, Feraco A, Camajani E, Caprio M, Armani A. Health Effects of Red Wine Consumption: A Narrative Review of an Issue That Still Deserves Debate. Nutrients 2023; 15:1921. [PMID: 37111141 PMCID: PMC10146095 DOI: 10.3390/nu15081921] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
A strong controversy persists regarding the effect of red wine (RW) consumption and health. Guidelines for the prevention of cardiovascular diseases (CVD) and cancers discourage alcohol consumption in any form, but several studies have demonstrated that low RW intake may have positive effects on CVD risk. This review evaluated randomised controlled trials (RCTs), examining the recent literature on the correlations between acute and chronic RW consumption and health. All RCTs published in English on PubMed from 1 January 2000 to 28 February 2023 were evaluated. Ninety-one RCTs were included in this review, seven of which had a duration of more than six months. We assessed the effect of RW on: (1) antioxidant status, (2) cardiovascular function, (3) coagulation pathway and platelet function, (4) endothelial function and arterial stiffness, (5) hypertension, (6) immune function and inflammation status, (7) lipid profile and homocysteine levels, (8) body composition, type 2 diabetes and glucose metabolism, and (9) gut microbiota and the gastrointestinal tract. RW consumption mostly results in improvements in antioxidant status, thrombosis and inflammation markers, lipid profile, and gut microbiota, with conflicting results on hypertension and cardiac function. Notably, beneficial effects were observed on oxidative stress, inflammation, and nephropathy markers, with a modest decrease in CVD risk in five out of seven studies that evaluated the effect of RW consumption. These studies were conducted mainly in patients with type 2 diabetes mellitus, and had a duration between six months and two years. Additional long-term RCTs are needed to confirm these benefits, and assess the potential risks associated with RW consumption.
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Affiliation(s)
- Mauro Lombardo
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00166 Rome, Italy
| | - Alessandra Feraco
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00166 Rome, Italy
- Laboratory of Cardiovascular Endocrinology, San Raffaele Research Institute, IRCCS San Raffaele Roma, Via di Val Cannuta, 247, 00166 Rome, Italy
| | - Elisabetta Camajani
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00166 Rome, Italy
- Laboratory of Cardiovascular Endocrinology, San Raffaele Research Institute, IRCCS San Raffaele Roma, Via di Val Cannuta, 247, 00166 Rome, Italy
| | - Massimiliano Caprio
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00166 Rome, Italy
- Laboratory of Cardiovascular Endocrinology, San Raffaele Research Institute, IRCCS San Raffaele Roma, Via di Val Cannuta, 247, 00166 Rome, Italy
| | - Andrea Armani
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00166 Rome, Italy
- Laboratory of Cardiovascular Endocrinology, San Raffaele Research Institute, IRCCS San Raffaele Roma, Via di Val Cannuta, 247, 00166 Rome, Italy
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29
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Kilcoyne J, Assaassa A. Alcohol and Cardiac Arrythmias: A Review of the Current Data. Rev Cardiovasc Med 2023; 24:105. [PMID: 39076274 PMCID: PMC11273001 DOI: 10.31083/j.rcm2404105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 07/31/2024] Open
Abstract
Background Alcohol is a pervasive substance in the US and the world in general. Cardiac arrythmias, specifically atrial fibrillation, are also a critical health issue. The interplay between alcohol and arrythmia is explored here. Methods Original research, editorials and other literature reviews were searched and assessed for candidacy for inclusion and ability to contribute to this article. Conclusions Alcohol consumption has a significant interplay with cardiac arrhythmia.
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Affiliation(s)
- James Kilcoyne
- Saint Mary Physician Group, Comprehensive Cardiology Section, Langhorne,
PA 19067, USA
| | - Abdalrahman Assaassa
- Saint Mary Medical Center, Internal Medicine Residency, Langhorne,
PA 19067, USA
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30
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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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31
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Grindal AW, Sparrow RT, McIntyre WF, Conen D, Healey JS, Wong JA. Alcohol Consumption and Atrial Arrhythmia Recurrence After Atrial Fibrillation Ablation: A Systematic Review and Meta-analysis. Can J Cardiol 2023; 39:266-273. [PMID: 36549481 DOI: 10.1016/j.cjca.2022.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/19/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Although alcohol consumption is associated with an increased risk of atrial fibrillation (AF), it is unclear whether alcohol is associated with AF recurrences after catheter ablation for AF. We aimed to systematically review the medical literature to assess the impact of alcohol consumption on the recurrence of AF after AF ablation. METHODS A structured electronic database search of the scientific literature (Medline, Embase, and Central from inceptions to December 2021) was performed for studies reporting rates of AF recurrence after catheter ablation stratified by patients' level of alcohol consumption according to study-specific definitions. Unadjusted study-specific odds ratios (ORs) were meta-analysed with the use of random-effects models. Risk of bias was evaluated by means of the ROBINS-I tool. RESULTS We identified 9 observational studies which included 5436 patients who underwent catheter ablation for AF. Compared with patients consuming little or no alcohol, patients consuming moderate to high amounts of alcohol had a greater risk of AF recurrence (summary OR 1.45, 95% confidence interval [CI] 1.06-1.99; P = 0.02; I2 = 79%). Results remained robust when we excluded studies with < 100 participants (OR 1.40, 95% CI 1.03-1.9) or abstract-only publications (OR 1.84, 95% CI 1.21-2.8). All included studies were found to be at serious risk of bias, primarily due to confounding. CONCLUSIONS Increased alcohol consumption is associated with an increased risk of AF recurrence after catheter ablation for AF. Reduction of alcohol consumption may be beneficial in this context.
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Affiliation(s)
| | - Robert T Sparrow
- Department of Medicine, Western University, London, Ontario, Canada
| | - William F McIntyre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | - David Conen
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jeff S Healey
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jorge A Wong
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada.
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32
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Surma S, Lip GY. Alcohol and Atrial Fibrillation. Rev Cardiovasc Med 2023; 24:73. [PMID: 39077490 PMCID: PMC11264018 DOI: 10.31083/j.rcm2403073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 07/31/2024] Open
Abstract
Dietary habits, including alcohol consumption, are among the significant risk factors for the occurrence of atrial fibrillation (AF). The pathophysiological relationship between alcohol consumption and AF is complex and multifactorial. However, there is conflicting information about the impact of alcohol consumption (in various doses and types) on the risk of AF and AF-related outcomes. Alcohol consumption is significantly associated with AF in a gender-independent manner. The widespread belief that moderate amounts of alcohol, especially red wine, have cardioprotective effects may mean that more people will use alcohol. Even small amounts of alcohol regularly consumed increase the risk of AF. In this narrative review, we will review the epidemiological associations between alcohol and AF, and the implications for incident AF and AF-related outcomes.
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Affiliation(s)
- Stanisław Surma
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, L14 3PE Liverpool, UK
- Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
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33
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Alcohol and aging - An area of increasing concern. Alcohol 2023; 107:19-27. [PMID: 35940508 DOI: 10.1016/j.alcohol.2022.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 12/18/2022]
Abstract
Alcohol use is increasing among adults 65 and older and the size of this population is expanding rapidly. Aging is associated with systemic inflammation, sleep disturbances, cancers, cognitive decline, and increased risk of injury and death from falls and other accidents. Alcohol misuse exacerbates and accelerates these age-related changes. Older drinkers are more sensitive to acute alcohol-induced impairments in memory, coordination, reaction time, and driving performance. Oxidative stress and DNA damage resulting from chronic heavy alcohol consumption contribute to an increased risk of cancer, liver disease, and cardiovascular disease. Medication use increases with age and many medications prescribed to older adults can interact negatively with alcohol. The rapid expansion of the population aged 65 and older, combined with higher levels of alcohol use and AUD in the Baby Boomer cohort than the preceding generation, could significantly increase the burden of alcohol on the healthcare system resulting from AUD and alcohol-related injuries and diseases. Screening and brief intervention for hazardous alcohol use among older patients along with education regarding potential interactions between alcohol and medications could substantially reduce the risk of harms from alcohol but currently is underutilized.
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34
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[Rehabilitation for atrial fibrillation : Impact on arrhythmia and cumulative risk factors]. Herzschrittmacherther Elektrophysiol 2023; 34:33-38. [PMID: 36512094 DOI: 10.1007/s00399-022-00912-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/11/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) occurs in cardiovascular diseases but also in hyperthyroidism. The independent risk factors (RF) that are cumulatively the cause of AF include arterial hypertension, obesity, malnutrition, alcohol and tobacco consumption, lack of exercise, diabetes mellitus, and sleep-related breathing disorders. These cause and reinforce each other and are amplified by psychosocial RF. This also leads to morphological consequences such as atrial cardiomyopathy or diastolic heart failure (HFpEF). Therapy focuses on stroke prophylaxis through anticoagulation and rhythm or frequency control of the AF. AIM The risk factors of AF are presented here in detail. RF control must be included in the management of AF. Effective risk management should definitely include the patient's lifestyle. RESULTS AND CONCLUSION Although RF management can be integrated into the acute medical and outpatient treatment of AF, there is little scope to deal with the individual risk profile of individual patients. With the bio-psycho-social treatment approach, cardiological rehabilitation offers the opportunity to establish individual, lifestyle-oriented risk management and to achieve symptomatic improvement, decreased AF burden, better performance, and a better quality of life through correctly dosed training. Further studies to clarify the question of whether clinical endpoints such as hospitalization or morbidity and mortality are reduced by cardiac rehabilitation in AF are desirable.
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35
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Crea F. New facets of prevention: diet assessment, childhood adversity, influenza vaccination, and guideline implementation. Eur Heart J 2023; 44:537-540. [PMID: 36780922 DOI: 10.1093/eurheartj/ehad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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36
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Butler T, Cowie A, McHale S, Horne S, O'Reilly M, Meelu OA, Ahmed F, Kirresh A, Thomson RJ, Brown J, Ahmad M, Lambiase PD, Manmathan GPR, Morselli F, Dawkes S. Interventions for alcohol cessation in people with atrial fibrillation. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2023. [PMCID: PMC9924033 DOI: 10.1002/14651858.cd015004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of interventions for alcohol cessation compared to usual treatment for people with atrial fibrillation.
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Affiliation(s)
| | - Tom Butler
- Faculty of Health, Social Care and MedicineEdge Hill UniversityOrmskirkUK
| | - Aynsley Cowie
- Cardiac Rehabilitation, Lister CenterUniversity Hospital CrosshouseKilmarnockUK
| | - Sheona McHale
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
| | - Sebastian Horne
- Department of CardiologyRussells Hall Hospital (The Dudley Group NHS Trust)DudleyUK
| | - Michelle O'Reilly
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
| | | | - Fareed Ahmed
- ITU DepartmentQueen Elizabeth the Queen Mother Hospital, East Kent Hospitals University Foundation TrustMargateUK
| | - Ali Kirresh
- Department of CardiologyRoyal Free Hospital, Royal Free London NHS Foundation TrustLondonUK
| | - Ross J Thomson
- William Harvey Research InstituteBarts and The London School of Medicine and Dentistry, Queen Mary University of LondonLondonUK
| | - James Brown
- Department of CardiologyRoyal Free Hospital, Royal Free London NHS Foundation TrustLondonUK
| | - Mahmood Ahmad
- Department of CardiologyRoyal Free Hospital, Royal Free London NHS Foundation TrustLondonUK
| | - Pier D Lambiase
- Centre for Cardiology in the YoungThe Heart Hospital, University College London HospitalsLondonUK
| | - Gavin Paul Raphael Manmathan
- Department of CardiologyRoyal Free Hospital, Royal Free London NHS Foundation TrustLondonUK,Institute of Cardiovascular SciencesUniversity College LondonLondonUK
| | - Franca Morselli
- School of Cardiovascular Medicine and SciencesKing's College LondonLondonUK
| | - Susan Dawkes
- School of Nursing, Midwifery and Paramedic PracticeRobert Gordon UniversityAberdeenUK
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37
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Vandenberk B, Altieri MH, Liu H, Raj SR, Lee SS. Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension. Aliment Pharmacol Ther 2023; 57:290-303. [PMID: 36571829 DOI: 10.1111/apt.17368] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/16/2022] [Accepted: 12/08/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia and its management in cirrhosis can be challenging due to the altered hepatic metabolism of medications and increased risk of bleeding. AIMS To provide a comprehensive overview of the diagnosis, pathophysiology and management of AF in patients with cirrhosis from both a cardiology and a hepatology perspective. METHODS An extensive literature search was performed using the terms 'atrial fibrillation' and 'cirrhosis'. Guideline documents and consensus statements were explored. RESULTS The prevalence of AF in patients with cirrhosis ranges between 6.6% and 14.2%, while the incidence of new-onset AF in the post-operative period after liver transplant ranged between 6.8% and 10.2%. AF in patients with cirrhosis is associated with adverse outcomes in both pre-transplant and post-transplant settings, including an increased risk of stroke when compared to the general population. We review the pathogenesis of AF in general and in cirrhosis. This review also provides guidance on the management of AF, including the use of anticoagulation and rate versus rhythm control. In the absence of strict contraindications, all patients with cirrhosis and AF should be anticoagulated. The use of DOACs is preferred over vitamin K antagonists. In patients with a high bleeding risk, a DOAC with an approved antidote may be preferred. CONCLUSIONS Atrial fibrillation is increased in patients with cirrhosis. AF management requires careful consideration of treatment options. Since patients with cirrhosis were excluded from all major randomised clinical trials, dedicated research on the pathophysiology and management of AF in cirrhosis is needed.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Mario H Altieri
- Division of Gastroenterology, Hepatology and Nutrition, CHU Caen, Caen, France
| | - Hongqun Liu
- Liver Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Satish R Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Samuel S Lee
- Liver Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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38
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Wong CX, Tu SJ, Marcus GM. Alcohol and Arrhythmias. JACC Clin Electrophysiol 2023; 9:266-279. [PMID: 36858701 DOI: 10.1016/j.jacep.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/12/2022] [Indexed: 03/03/2023]
Abstract
The association between alcohol consumption and abnormalities of heart rate and rhythm has long been recognized. Significant attention has focused on the risk of atrial fibrillation (AF) and sudden cardiac death (SCD) with excessive alcohol intake. Recent studies have advanced our understanding of these relationships and provided additional insights into potentially arrhythmogenic mechanisms. However, considerable uncertainty remains, such as the level of consumption at which harm begins and whether alcohol plays a role in other arrhythmias. This review characterizes the spectrum of conduction abnormalities and heart rhythm disorders in relation to alcohol consumption. In addition, it discusses the latest epidemiologic and experimental evidence, the potential importance of beverage type and constituent ingredients, and conflicting information on drink definitions, thresholds, and recommendations.
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Affiliation(s)
- Christopher X Wong
- Department of Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA; Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Samuel J Tu
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Gregory M Marcus
- Department of Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA.
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39
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Yu LM, Dong X, Huang T, Zhao JK, Zhou ZJ, Huang YT, Xu YL, Zhao QS, Wang ZS, Jiang H, Yin ZT, Wang HS. Inhibition of ferroptosis by icariin treatment attenuates excessive ethanol consumption-induced atrial remodeling and susceptibility to atrial fibrillation, role of SIRT1. Apoptosis 2023; 28:607-626. [PMID: 36708428 DOI: 10.1007/s10495-023-01814-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/29/2023]
Abstract
Ferroptosis contributes to the pathogenesis of atrial fibrillation (AF), although the mechanisms are still largely uncovered. The current study was designed to explore the pharmacological effects of icariin against ethanol-induced atrial remodeling, if any, and the mechanisms involved with a focus on SIRT1 signaling. Excessive ethanol-treated animals were administered with Ferrostatin-1, Erastin or icariin to evaluate the potential effects of icariin or ferroptosis. Then, the underling mechanisms was further explored in the in vitro experiments using HL-1 atrial myocytes. Excessive ethanol administration caused significant atrial damage as evidenced by increased susceptibility to AF, altered atrial conduction pattern, atrial enlargement, and enhanced fibrotic markers. These detrimental effects were reversed by Ferrostatin-1 or icariin treatment, while Erastin co-administration markedly abolished the beneficial actions conferred by icariin. Mechanistically, ethanol-treated atria exhibited markedly up-regulated pro-ferroptotic protein (PTGS2, ACSL4, P53) and suppressed anti-ferroptotic molecules (GPX4, FTH1). Icariin treatment inhibited ethanol-induced atrial ferroptosis by reducing atrial mitochondrial damage, ROS accumulation and iron overload. Interestingly, the in vivo and in vitro data showed that icariin activated atrial SIRT1-Nrf-2-HO-1 signaling pathway, while EX527 not only reversed these effects, but also abolished the therapeutic effects of icariin. Moreover, the stimulatory effects on GPX4, SLC7A11 and the suppressive effects on ACSL4, P53 conferred by icariin were blunted by EX527 treatment. These data demonstrate that ferroptosis plays a causative role in the pathogenesis of ethanol-induced atrial remodeling and susceptibility to AF. Icariin protects against atrial damage by inhibiting ferroptosis via SIRT1 signaling. Its role as a prophylactic/therapeutic drug deserves further clinical study.
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Affiliation(s)
- Li-Ming Yu
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, Liaoning, 110016, People's Republic of China.
| | - Xue Dong
- The Third Outpatient Department, General Hospital of Northern Theater Command, 49 Beiling Road, Shenyang, Liaoning, 110032, People's Republic of China
| | - Tao Huang
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, Liaoning, 110016, People's Republic of China
| | - Ji-Kai Zhao
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, Liaoning, 110016, People's Republic of China
| | - Zi-Jun Zhou
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, Liaoning, 110016, People's Republic of China
| | - Yu-Ting Huang
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, Liaoning, 110016, People's Republic of China
| | - Yin-Li Xu
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, Liaoning, 110016, People's Republic of China
| | - Qiu-Sheng Zhao
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, Liaoning, 110016, People's Republic of China
| | - Zhi-Shang Wang
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, Liaoning, 110016, People's Republic of China
| | - Hui Jiang
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, Liaoning, 110016, People's Republic of China
| | - Zong-Tao Yin
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, Liaoning, 110016, People's Republic of China
| | - Hui-Shan Wang
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, Liaoning, 110016, People's Republic of China.
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40
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Crea F. Management of atrial fibrillation: role of population screening, biomarkers, and polygenic risk scores. Eur Heart J 2023; 44:167-170. [PMID: 36638838 DOI: 10.1093/eurheartj/ehac802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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41
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Sharashova E, Gerdts E, Ball J, Espnes H, Jacobsen BK, Kildal S, Mathiesen EB, Njølstad I, Rosengren A, Schirmer H, Wilsgaard T, Løchen ML. Sex-specific time trends in incident atrial fibrillation and the contribution of risk factors: the Tromsø Study 1994-2016. Eur J Prev Cardiol 2023; 30:72-81. [PMID: 36239184 DOI: 10.1093/eurjpc/zwac234] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/02/2022] [Accepted: 10/08/2022] [Indexed: 01/14/2023]
Abstract
AIMS To explore sex-specific time trends in atrial fibrillation (AF) incidence and to estimate the impact of changes in risk factor levels using individual participant-level data from the population-based Tromsø Study 1994-2016. METHODS AND RESULTS A total of 14 818 women and 13 225 men aged 25 years or older without AF were enrolled in the Tromsø Study between 1994 and 2008 and followed up for incident AF throughout 2016. Poisson regression was used for statistical analyses. During follow-up, age-adjusted AF incidence rates in women decreased from 1.19 to 0.71 per 1000 person-years. In men, AF incidence increased from 1.18 to 2.82 per 1000 person-years in 2004, and then declined to 1.94 per 1000 person-years in 2016. Changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP), body mass index (BMI), physical activity, smoking and alcohol consumption together accounted for 10.9% [95% confidence interval (CI): -2.4 to 28.6] of the AF incidence decline in women and for 44.7% (95% CI: 19.2; 100.0) of the AF incidence increase in men. Reduction in SBP and DBP had the largest contribution to the decrease in AF incidence in women. Increase in BMI had the largest contribution to the increase in AF incidence in men. CONCLUSION In the population-based Tromsø Study 1994-2016, AF incidence decreased in women and increased following a reverse U-shape in men. Individual changes in SBP and DBP in women and individual changes in BMI in men were the most important risk factors contributing to the AF incidence trends.
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Affiliation(s)
- Ekaterina Sharashova
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway.,University Hospital of North Norway, Postboks 100, 9038 Tromsø, Norway
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jocasta Ball
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Hilde Espnes
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway
| | - Bjarne K Jacobsen
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway.,Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Simon Kildal
- University Hospital of North Norway, Postboks 100, 9038 Tromsø, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Schirmer
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Akershus University Hospital, Lørenskog, Oslo, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway
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Abstract
The global prevalence of atrial fibrillation (AF) has increased substantially over the past three decades and is currently approximately 60 million cases. Incident AF and its clinical consequences are largely the result of risk factors that can be modified by lifestyle changes. In this Review, we provide evidence that the lifetime risk of AF is modified not only by sex and race but also through the clinical risk factor and comorbidity burden of individual patients. We begin by summarizing the epidemiology of AF, focusing on non-modifiable and modifiable risk factors, as well as targets and strategies for the primary prevention of AF. Furthermore, we evaluate the role of modifiable risk factors in the secondary prevention of AF as well as the potential effects of risk factor interventions on the frequency and severity of subsequent AF episodes. We end the Review by proposing strategies that require evaluation as well as global policy changes that are needed for the prevention of incident AF and the management of recurrent episodes in patients already affected by AF.
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43
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Wine, beer and Chinese Baijiu in relation to cardiovascular health: the impact of moderate drinking. FOOD SCIENCE AND HUMAN WELLNESS 2023. [DOI: 10.1016/j.fshw.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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44
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Gawałko M, Sanders P. Drug abuse and risk of atrial fibrillation: a neglected association. Eur Heart J 2022; 43:4943-4945. [PMID: 36285878 DOI: 10.1093/eurheartj/ehac614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Monika Gawałko
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands.,1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.,Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Essen, Germany
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia.,Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
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45
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Ganjikunta VS, Maddula RR, Bhasha S, Sahukari R, Kondeti Ramudu S, Chenji V, Kesireddy SR, Zheng Z, Korivi M. Cardioprotective Effects of 6-Gingerol against Alcohol-Induced ROS-Mediated Tissue Injury and Apoptosis in Rats. Molecules 2022; 27:8606. [PMID: 36500700 PMCID: PMC9738005 DOI: 10.3390/molecules27238606] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
The present study investigated the cardioprotective properties of 6-gingerol against alcohol-induced ROS-mediated cardiac tissue damage in rats. Experiments were conducted on 4 groups of rats, orally treated with control, 6-gingerol (10 mg/kg body weight), alcohol (6 g/kg body weight) and combination of 6-gingerol plus alcohol for two-month. In the results, we found 6-ginger treatment to alcohol-fed rats substantially suppressed ROS production in cardiac tissue. Alcohol-induced elevated 8-OHDG and protein carbonyls which represent oxidative modification of DNA and proteins were completely reversed by 6-gingerol. This was further endorsed by restored superoxide dismutase and catalase activities with 6-gingerol against alcohol-induced loss. The elevated cardiac biomarkers (CK-MB, cTn-T, cTn-I) and dyslipidemia in alcohol-intoxicated rats was significantly reversed by 6-gingerol. Furthermore, alcohol-induced apoptosis characterized by overexpression of cytochrome C, caspase-8 and caspase-9 was diminished with 6-gingerol treatment. Transmission electron microscope images conferred the cardioprotective properties of 6-gingerol as we have seen less structural derangements in mitochondria and reappearance of myofilaments. Our findings conclude that 6-ginger effectively protect alcohol-induced ROS-mediated cardiac tissue damage, which may be due to its potent antioxidant efficacy. Therefore, 6-gingerol could be a potential therapeutic molecule that can be used in the treatment of alcohol-induced myocardial injury.
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Affiliation(s)
| | - Ramana Reddy Maddula
- Division of Molecular Biology and Ethanopharmacology, Sri Venkateswara University, Tirupati 517 502, India
| | - Shanmugam Bhasha
- Division of Molecular Biology and Ethanopharmacology, Sri Venkateswara University, Tirupati 517 502, India
| | - Ravi Sahukari
- Division of Molecular Biology and Ethanopharmacology, Sri Venkateswara University, Tirupati 517 502, India
| | | | - Venkatrayulu Chenji
- Department of Marine Biology, Vikarama Simhapuri University, Nellore 524320, India
| | - Sathyavelu Reddy Kesireddy
- Division of Molecular Biology and Ethanopharmacology, Sri Venkateswara University, Tirupati 517 502, India
| | - Zhe Zheng
- Exercise and Metabolism Research Center, College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua 321004, China
| | - Mallikarjuna Korivi
- Exercise and Metabolism Research Center, College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua 321004, China
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Ge J, Han W, Ma C, Chen T, Liu H, Maduray K, Qu Y, Li Y, Hu T, Wang Q, Zhong J. Association of acetaldehyde dehydrogenase 2 rs671 polymorphism with the occurrence and progression of atrial fibrillation. Front Cardiovasc Med 2022; 9:1027000. [PMID: 36426220 PMCID: PMC9679000 DOI: 10.3389/fcvm.2022.1027000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/24/2022] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Acetaldehyde dehydrogenase 2 (ALDH2) is an essential enzyme in alcohol metabolism, playing a vital function in resisting oxidative stress. Lots of gene variants have been associated with atrial fibrillation (AF), among which the association between ALDH2 rs671 polymorphism and AF is variable. This study aimed to investigate the relationship between ALDH2 rs671 polymorphism and AF occurrence or progression and AF recurrence after catheter ablation. METHODS A total of 924 subjects were enrolled in the study. The ALDH2 genotypes are composed of wild-type homozygotes (ALDH2*1/*1), heterozygotes (ALDH2*1/*2), and mutant homozygotes (ALDH2*2/*2), in which the genotypes ALDH2*1/*2 and ALDH2*2/*2 are combined into the ALDH2*2. Univariate and multivariate logistic regression analyses were performed to investigate the association between ALDH2*2 and AF occurrence and progression. COX regression analysis was used to explore the association of ALDH2*2 with AF recurrence after catheter ablation. RESULTS The prevalence of AF differed significantly between the ALDH2*2 group (102/251) and ALDH2*1/*1 group (330/673) (P = 0.023). For AF occurrence, in the univariate analysis, alcohol consumption was a risk factors (OR: 1.503, P = 0.003), whereas ALDH2*2 was a protective factor (OR: 0.712, P = 0.023). In the multivariate analysis, alcohol consumption (P = 0.156) and ALDH2*2 (P = 0.096) were no longer independent factors. ALDH2*2 with non-drinking was associated with a decreased AF occurrence (OR: 0.65, P = 0.021), whereas ALDH2*2 with drinking was not (P = 0.365). For AF progression, multivariate analysis revealed ALDH2*2 could promote persistent AF in female AF patients (OR: 2.643, P = 0.008). Cox regression analysis suggested that ALDH2*2 (P = 0.752) was not a risk factor for AF recurrence after catheter ablation during a median 6 months follow-up. CONCLUSION While ALDH2*2 was not directly related to AF, ALDH2*2 with non-drinking was associated with a decreased incidence of AF. ALDH2*2 may accelerate AF progression in female patients, increasing the likelihood of developing persistent AF. Therefore, individuals with ALDH2*2 should refrain from consuming alcohol to decrease the onset and progression of AF.
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Affiliation(s)
- Junye Ge
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenqiang Han
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chuanzhen Ma
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tongshuai Chen
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Huiyu Liu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Kellina Maduray
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yinan Qu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yihan Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tong Hu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qinhong Wang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jingquan Zhong
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
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Liu Z, Song C, Suo C, Fan H, Zhang T, Jin L, Chen X. Alcohol consumption and hepatocellular carcinoma: novel insights from a prospective cohort study and nonlinear Mendelian randomization analysis. BMC Med 2022; 20:413. [PMID: 36303185 PMCID: PMC9615332 DOI: 10.1186/s12916-022-02622-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heavy drinking was well associated with an increased risk of hepatocellular carcinoma (HCC), whereas the effect of low-to-moderate drinking on HCC remains under debate. METHODS Participants from the UK Biobank with detailed information on alcohol use and free of common diseases were included. Daily pure alcohol intake (g/day) was calculated, and the predominant alcoholic beverage type was assigned for each participant. Additive Cox regression model and nonlinear Mendelian randomization (NLMR) analyses were performed to evaluate the association of alcohol intake with HCC. RESULTS Of 329,164 participants (52.3% females, mean [SD] age = 56.7 [8.0] years), 201 incident HCC cases were recorded during the median follow-up of 12.6 years. The best-fitted Cox regression model suggested a J-shaped relationship between daily alcohol intake level and HCC risk. However, NLMR analysis did not detect a nonlinear correlation between alcohol use and HCC (nonlinearity P-value: 0.386). The J-shaped correlation pattern was detected only in subjects who mainly drank wine but not in those who mainly drank beer, spirits, or fortified wine. Moderate wine drinking showed a significant alanine transaminase (ALT)- and aspartate aminotransferase-lowering effect compared to that of the nondrinkers. In low-risk populations of HCC including women, people aged < 60 years, subjects with normal ALT levels, and those carrying non-risk genotypes of PNPLA3 rs738409 and TM6SF2 rs58542926, we observed a J-shaped correlation between alcohol use and HCC; however, a positive dose-response correlation was found in their respective counterparts, even in those predominantly drinking wine. CONCLUSIONS Low-to-moderate drinking may be inversely associated with the risk of HCC in low-risk populations, which may be largely driven by wine drinking. However, those in high-risk populations of HCC, such as men and older people, and those with abnormal ALT levels and carry genetic risk variants, should abstain from drinking alcohol. Given the small HCC case number, further validations with larger case numbers are warranted in future works.
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Affiliation(s)
- Zhenqiu Liu
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, 200438, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, 225316, China
| | - Ci Song
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Chen Suo
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, 200032, China.,Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Hong Fan
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, 200032, China.,Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Tiejun Zhang
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, 200032, China. .,Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, China.
| | - Li Jin
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, 200438, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, 225316, China
| | - Xingdong Chen
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, 200438, China. .,Fudan University Taizhou Institute of Health Sciences, Taizhou, 225316, China. .,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China.
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Han M, Lee SR, Choi EK, Choi J, Chung J, Park SH, Lee H, Ahn HJ, Kwon S, Lee SW, Han KD, Oh S, Lip GYH. Habitual Alcohol Intake and Risk of Atrial Fibrillation in Young Adults in Korea. JAMA Netw Open 2022; 5:e2229799. [PMID: 36053532 PMCID: PMC9440398 DOI: 10.1001/jamanetworkopen.2022.29799] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/10/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Guidelines recommend that all risk factors for early-onset atrial fibrillation, including lifestyle factors, be proactively managed, considering the poor prognosis of the disease. Not much is known about the association of cumulative alcohol intake with the risk of atrial fibrillation in young adults aged 20 to 39 years, especially among heavy drinkers. Objective To explore the association of alcohol consumption with the risk of incident atrial fibrillation in young adults. Design, Setting, and Participants Using the National Health Insurance Service database, a nationwide population-based cohort study of adults aged 20 to 39 years without prior atrial fibrillation who underwent 4 serial annual health examinations between 2009 and 2012 was conducted. The cumulative alcohol consumption burden over 4 years was calculated by assigning 1 point to more than moderate drinking (≥105 g of alcohol per week) each year. Additionally, a semiquantitative cumulative burden was calculated by assigning 0, 1, 2, and 3 points to non, mild (<105 g per week), moderate (105-210 g per week), and heavy (≥210 g per week) drinking, respectively. Data were analyzed from May to June 2021. Exposure Amount of alcohol intake in 4 years. Main Outcomes and Measures The primary outcome was incident atrial fibrillation during the follow-up period. Results A total of 1 537 836 participants (mean [SD] age 29.5 [4.1] years, 1 100 099 [71.5%] male) were included in the final analysis. According to the 4-year cumulative burden of alcohol consumption stratified by moderate to heavy drinking, 889 382 participants (57.8%) were in the burden 0 group, 203 374 participants (13.2%) in the burden 1 group, 148 087 participants (9.6%) in the burden 2 group, 144 023 participants (9.4%) in the burden 3 group, and 152 970 participants (9.9%) in the burden 4 group. During a median (IQR) follow-up of 6.13 (4.59-6.48) years, atrial fibrillation was newly diagnosed in 3066 participants (0.36 per 1000 person-years). Participants with a cumulative burden of 4 points who continued more than moderate drinking for 4 years showed a 25% higher risk of atrial fibrillation compared with 0-point participants who kept non-to-mild drinking over 4 years (adjusted HR, 1.25; 95% CI, 1.12-1.40). In a semiquantitative analysis, participants who sustained heavy drinking for 4 consecutive years were associated with a 47% higher atrial fibrillation risk than those who remained nondrinkers over 4 years (aHR, 1.47, CI 1.18-1.83). Conclusions and Relevance Persistent moderate to heavy drinking and higher cumulative alcohol consumption burden might increase the risk of atrial fibrillation even in young adults aged 20 to 39 years.
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Affiliation(s)
- Minju Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - JungMin Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jaewook Chung
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Hyeon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - HuiJin Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-Woo Lee
- Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Do Han
- Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gregory Y. H. Lip
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Frost L, Schnabel RB. Self-reported Alcohol Consumption and Risk of Atrial Fibrillation. JAMA Netw Open 2022; 5:e2229808. [PMID: 36053540 DOI: 10.1001/jamanetworkopen.2022.29808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lars Frost
- Section of Cardiology, Department of Medicine, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Renate B Schnabel
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
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Ohlrogge AH, Frost L, Schnabel RB. Harmful Impact of Tobacco Smoking and Alcohol Consumption on the Atrial Myocardium. Cells 2022; 11:2576. [PMID: 36010652 PMCID: PMC9406618 DOI: 10.3390/cells11162576] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [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
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