The Tromsø Study: associations between self-reported arrhythmia, psychological conditions, and lifestyle

Characterising heart rhythm abnormalities associated with Xp22.31 deletion

BACKGROUND

Genetic deletions at Xp22.31 are associated with the skin condition X linked ichthyosis (XLI), and with a substantially increased risk of atrial fibrillation/flutter (AF), in males. AF is associated with elevated thrombosis, heart failure, stroke and dementia risk.

METHODS

Through: (a) examining deletion carriers with a diagnosis of AF in UK Biobank, (b) undertaking an online survey regarding abnormal heart rhythms (AHRs) in men/boys with XLI and female carriers of XLI-associated deletions and (c) screening for association between common genetic variants within Xp22.31 and idiopathic AF-related conditions in UK Biobank, we have investigated how AHRs manifest in deletion carriers, and have identified associated risk factors/comorbidities and candidate gene(s). Finally, we examined attitudes towards heart screening in deletion carriers.

RESULTS

We show that AHRs may affect up to 35% of deletion carriers (compared with <20% of age-matched non-carriers), show no consistent pattern of onset but may be precipitated by stress, and typically resolve quickly and respond well to intervention. Gastrointestinal (GI) conditions and asthma/anaemia were the most strongly associated comorbidities in male and female deletion carriers with AHR, respectively. Genetic analysis indicated significant enrichment of common AF risk variants around STS (7 065 298-7 272 682 bp in GRCh37/hg19 genome build) in males, and of common GI disorder and asthma/anaemia risk variants around PNPLA4 (7 866 804-7 895 780 bp) in males and females, respectively. Deletion carriers were overwhelmingly in favour of cardiac screening implementation.

CONCLUSION

Our data suggest AHRs are frequently associated with Xp22.31 deletion, and highlight subgroups of deletion carriers that may be prioritised for screening. Examining cardiac function further in deletion carriers, and in model systems lacking steroid sulfatase, may clarify AF pathophysiology.

Sleep and cardiac symptoms amongst women aged 40-64 years

OBJECTIVES

To determine whether the occurrence of cardiac symptoms is related to sleep disturbances.

DESIGN

An epidemiological survey by means of a questionnaire.

SETTING

The county of Jämtland in northern Sweden.

SUBJECTS

Randomly selected women (6000) aged 40-64 years, with a similar number of women in each 5-year age group. A total of 3669 responded.

MAIN OUTCOME MEASURES

Sleep disturbances and cardiac symptoms.

RESULTS

In total, 81.9% of the women reported a good night's sleep. Amongst them, 0.4% stated that they were troubled by both spasmodic chest pain and a sensation of irregular heart beat, 0.8% spasmodic chest pain alone, 5.8% irregular heart beat and 93.0% neither of these conditions. The corresponding frequencies amongst the women who slept poorly were 1.5, 1.8, 15.0 and 81.7%, respectively (P < 0.0001). Amongst the subjects with reported sleep complaints, there was an increase in heart symptoms, both in those with trouble falling asleep, frequent awakenings and difficulty in getting to sleep again, and in those who awoke too early in the morning. Spasmodic chest pain was 8.8 (1.9-40.3) times and irregular heart beat 7.7 (3.3-18.1) times more common in women with nightmares almost every night than in those who never experienced nightmares. Daytime sleepiness was also associated with increased heart symptoms.

CONCLUSION

Poor sleep was associated with an increase in spasmodic chest pain and irregular heart beat.

Palpitations and lifestyle: impact of depression and self-rated health. The Nordland Health Study

On the basis of a questionnaire in a population study in the county of Nordland, Norway, the prevalence of palpitations and its associations to some lifestyle factors, depression and self-rated health were analysed. All the 10,497 residents aged 40 to 42 years were invited to participate, 82% attended, 87% of the attenders returned a questionnaire by mail, and 6436 subjects were included in this report. The prevalence of palpitations was 15% in men and 25% in women. Palpitations were significantly associated with coffee consumption, smoking, alcohol intoxication, physical inactivity, depression and poor self-rated health in the univariate analyses. In a logistic regression analysis, the relations between palpitations and lifestyle were weakened. Significant predictors for palpitations were depression and poor self-rated health in both sexes, in addition to heavy coffee drinking and physical inactivity in men and alcohol intoxication in women. In conclusion, palpitations were more firmly linked to depression and self-evaluated health than to lifestyle.