Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2023-12-04 Cooperative journals: 《中国全科医学》
ZHANG, Yuan
HOU, Qiqi
QI, Qi
JIANG, Yue
WANG, Nan
YUE, Bocheng
CHEN, Shuohua
HAN, Quanle
WU, Shouling
LI, Kangbo
Abstract： Background The prevalence of atrial fibrillation（AF）has continued to rise globally in recent years，and AF increases the risk of stroke，heart failure，myocardial infarction，chronic kidney disease，and other diseases. Studies have identified hypertension，diabetes，smoking，obstructive sleep apnea，obesity and sedentary lifestyle as risk factors for AF. And most of these factors are within the scope of the "Life's Essential 8"（LE8）proposed by the American Heart Association. Objective To investigate the relationship between cardiovascular health（CVH）score based on the LE8 and AF. Methods A prospective cohort study was conducted in which 91 131 employees of Kailuan Group in Tangshan，Hebei Province were selected for physical examination from June 2006 to October 2007，and the LE8 score was evaluated according to the algorithm developed by the American Heart Association，and combined with the actual situation of the Kailuan study to form the Kailuan study version of LE8，including 4 health behaviors（diet，physical activity，tobacco exposure，and sleep）and 4 health factors（BMI，blood lipids，blood glucose，and blood pressure）. The study subjects were divided into the three groups of the low CVH group（n=8 407）with a LE8 score less than 50，the medium CVH group（n=73 493）with a LE8 score of 50 or more but less than 80，and the high CVH group（n=9 231）with a LE8 score of 80 or more. The follow-up visit was performed per year with the time of the study subject's first Kailuan physical examination as the starting point，the occurrence of AF as the endpoint event，the end of AF and follow-up（2020-12-31）as the endpoint time. Kaplan Meier survival curve was used to analyze the cumulative incidence of new-onset AF in different groups，and log rank test was used to compare the differences between groups；Cox proportional hazards regression analysis was used to investigate the impact of different LE8 score groups and single factor scores on the risk of new-onset AF. Results There were significant differences in age，gender，education level，family income，history of alcohol consumption，and LE8 scores among the three groups of subjects（P<0.001）. During follow-up，1088 cases of new-onset AF were identified，including 133 cases（1.58%）in the low CVH group，882 cases（1.20%）in the medium CVH group，and 72 cases（0.78%）in the high CVH group. The median follow-up time was 15.0（14.7，15.2）years；there was statistically significant difference in the comparison of cumulative incidence rate of new-onset AF in the three groups （P<0.001）. Cox proportional hazards regression analysis after adjusting for age，gender，education level，household income，and history of alcohol consumption showed that，compared with the low CVH group，both the medium CVH group（HR=0.697，95%CI=0.579-0.841，P<0.001）and the high CVH group（HR=0.609，95%CI=0.454-0.816，P=0.001）reduced the risk of new-onset AF. An increase in LE8 score could reduce the risk of new-onset AF（HR=0.859，95%CI=0.804-0.918，P<0.001）. The individual factors of LE8，including BMI score（HR=0.762，95%CI=0.717-0.809，P<0.001）and blood pressure score（HR=0.824，95%CI=0.776-0.876，P<0.001），were negatively correlated with the risk of new-onset AF. Conclusion The LE8 score of CVH is negatively correlated with the risk of new-onset AF，and the individual factors of LE8，including BMI score and blood pressure score，are negatively correlated with the risk of new-onset AF.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2023-01-28 Cooperative journals: 《中国全科医学》
Aili ZHANG
Qiqi HOU
Quanle HAN
Boheng ZHANG
Jiawei ZHANG
Hongxia CAO
Chao ZHANG
Shuohua CHEN
Shouling WU
Kangbo LI
Abstract：
Background The global population disease burden report shows that atrial fibrillation and chronic kidney disease (CKD) have become one of the fastest growing causes of death in the past 20 years. The concept of cardiorenal syndrome points out that atrial fibrillation may increase the risk of new-onset chronic kidney disease， but at present， there are few relevant studies on atrial fibrillation increasing the risk of new-onset chronic kidney disease at home and abroad， and the interaction between atrial fibrillation and age is not clear．Objective To investigate whether atrial fibrillation (AF) increases the risk of new-onset chronic kidney disease (CKD) in northern China. Methods Prospective cohort study was used to select the population (Kailuan population) (n=135168， age 18-98 years old) who participated in the health examination for employees of Kailuan Group in Hebei Province from June 2006 to October 2010， excluding 19883 people with missing data and CKD history， 4430 people with previous cerebrovascular and cardiovascular diseases， malignant tumors， AF during follow-up， and 110855 people finally， The patients were divided into AF group and non AF group according to whether they had AF or not， including 368 patients with AF and 110487 patients with non AF. The follow-up was conducted once a year. The final follow-up date was December 31， 2020， with a median follow-up of 13.46 (9.70，14.05) years. The end point was new-onset CKD. Statistically analyze whether AF affects the risk of new-onset CKD. Results (1) 368 patients (63.43±10.61) years old， 338 males (91.85%) in AF group; 110487 persons in non AF group， age (49.04±12.92)， male 88288 (79.91%); Comparison of age (years)， sex (male)， diastolic blood pressure (DBP)， systolic blood pressure (SBP)， body mass index (BMI)， total cholesterol (TC)， low-density lipoprotein cholesterol (LDL-C)， triglyceride (TG)，high-sensitivity C-reactive protein (Hs CRP)， education level (high school or above)， drinking， participating in physical exercise， hypertension， diabetes， taking antihypertensive drugs， taking hypoglycemic drugs between the atrial fibrillation group and the non atrial fibrillation group， The differences were statistically significant (P<0.01 or P<0.05); There was no significant difference in fasting blood glucose (FPG)， high-density lipoprotein cholesterol (HDL-C)， smoking， and taking lipid-lowering drugs between the AF group and the non AF group (P>0.05); (2) 95 new-onset cases of CKD in AF group， with a cumulative incidence rate of 30.40%; 110487 people in the non atrial fibrillation group， 22725 people with new-onset CKD， the cumulative incidence rate was 21.77%， and the cumulative incidence rate of the two groups was statistically significant (x2=14.30， P<0.001); The incidence density of AF group and non AF group was 28.63‰ person year and 18.48‰ person year respectively; (3) Compared with non AF group， AF group increased the risk of new CKD [HR=1.477，95% CI (1.208，1.806， P<0.001)]; Age stratification was performed. For people≤65 years old， AF increased the risk of new-onset CKD [HR=1.566，95% CI (1.024，2.035)， P=0.001]; For people over 65 years old， AF no longer increases the risk of CKD [HR=0.970，95% CI (0.707，1.330)， P=0.855]; After further adjustment of age， sex (male) by multivariate Cox proportional hazard regression analysis， AF no longer increased the risk of CKD in the whole population and the population over 65 years old [HR=1.167，95% CI (0.954，1.428)， P=0.133]， [HR=1.007，95% CI (0.734，1.381)， P=0.968]; For people≤65 years old， AF still increased the risk of CKD [HR=1.363，95% CI (1.048，1.769)， P=0.021]; After further adjusting for smoking， drinking， participating in physical exercise， high school and above education background， hypertension history， diabetes history， taking antihypertensive drugs， taking hypoglycemic drugs， taking lipid-lowering drugs， BMI， TG， HDL-C， LDL-C， FPG， Hs-CRP by multivariate Cox proportional hazard regression analysis， only people aged≤65 years old had AF increased the risk of CKD [HR=1.351，95% CI (1.038，1.755)， P=0.025].Conclusion AF is an independent risk factor for new-onset CKD in northern China， especially for young and middle-aged people≤65 years old.
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