Atrial fibrillation in The Tromsø Study 1994-2007. Risk factors, occurrence and gender differences.
Permanent link
https://hdl.handle.net/10037/9095View/ Open
Thesis introduction and appendices (PDF)
Inflammatory biomarkers as risk factors for future atrial fibrillation. An eleven-year follow-up of 6315 men and women: the Tromsø study. Nyrnes A. et al. Also available in Gender Medicine 2012 Dec;9(6):536-547.e2 (PDF)
Date
2016-01-14Type
Doctoral thesisDoktorgradsavhandling
Author
Nyrnes, AudhildAbstract
Summary
Atrial fibrillation (AF) is a common cardiac arrhythmia, which increases morbidity and mortality and thereby imposes high health costs on society. The prevalence of AF has increased for several decades, and is expected to increase further, with the rising numbers of elderly people and survivors of heart diseases. Several risk factors for AF related to genetics and diseases have been established. Focus is now also set on novel risk factors related to symptoms, life style and inflammation. The identification of risk factors is important, as some of them could be modifiable.
The population-based Tromsø Study made it possible to follow survey participants from the fourth survey in 1994, who were free of AF at baseline, to study different risk factors for AF and the impact of these. We also wanted to investigate the frequency of AF in our population. All research questions were analysed with a gender perspective.
We were able to follow nearly 23 000 persons for a mean of 11 years, and found that 2.2% of women and 3.3% of men in this population were diagnosed with AF.
A main new finding was the importance of self-reported palpitations as a risk factor for AF. The association was stronger in men than in women. We also found different strength of associations in women and men for several other variables. Coronary heart disease and overweight were stronger risk factors in men. Hypertension was a stronger risk factor in women, and diabetes predicted AF in women only.
A limited number of inflammatory biomarkers were available for this study. We found that hs-CRP was associated with future AF in men, but not in women. Moreover, we found a significant increase in AF with increasing levels of white blood cells.
We also found that serum uric acid was a strong risk factor for AF, and the predictive ability was stronger for women than for men.
Low physical activity, vigorous exercise, smoking and use of alcohol were not associated with AF in this population.
The findings imply that adequate antihypertensive treatment is probably important to prevent AF, as is the prevention of coronary disease and diabetes. Patients with palpitations are prone to AF and should be investigated further. The possible clinical importance of the positive associations with inflammatory biomarkers and uric acid needs further investigation in other populations. Sammendrag
Atrieflimmer (AF) er en relativt vanlig arytmi, som øker sykelighet og dødelighet, og dermed også samfunnets behandlingsbehov og helsekostnader.
Prevalensen av AF har økt gjennom flere tiår, og er forventet å øke ytterligere, på grunn av økende antall eldre i befolkningen, og fordi flere lever lenger med hjertesykdom.
Flere risikofaktorer for AF er kjent. Dette gjelder både genetiske disposisjoner, og ulike sykdomstilstander. Det fokuseres nå også på nyere risikofaktorer relatert til symptomer, livsstil og inflammasjon. Kartlegging av risikofaktorer er viktig, fordi noen av disse kan tenkes å være modifiserbare.
Den befolkningsbaserte Tromsøundersøkelsen har gjort det mulig å følge deltakerne fra den fjerde studien i 1994, for å se på ulike risikofaktorer for AF, og hvor stor betydning disse har. Vi ville også undersøke hyppigheten av AF i denne befolkningsgruppen, og om det er forskjeller mellom kjønnene.
Vi fulgte nærmere 23000 personer i gjennomsnittlig 11 år, og fant at 2,2 % av kvinnene og 3,3 % av mennene i vår studiepopulasjon fikk påvist AF. Et nytt hovedfunn i vår studie var betydningen av palpitasjoner. Dette vanlige symptomet som ble rapportert av 27 % av kvinnene og 18 % av mennene, doblet risikoen for AF hos menn og økte risikoen med 60 % hos kvinner. Vi fant også kjønnsforskjeller for flere andre risikofaktorer, der assosiasjonsstyrken var ulik hos menn og kvinner. Koronarsykdom og overvekt var sterkere risikofaktorer hos menn. Hypertensjon var en sterkere risikofaktor hos kvinner, og diabetes predikerte AF bare hos kvinner.
Et begrenset antall inflammatoriske biomarkører var tilgjengelige fra denne undersøkelsen. Vi fant at hs-CRP var assosiert med AF hos menn, men ikke hos kvinner. Det var også økende hyppighet av AF med økende nivå av hvite blodlegemer.
Vi fant videre at serum-urinsyre var en sterk risikofaktor for AF, spesielt for kvinner.
Vi fant ingen assosiasjon mellom lav fysisk aktivitet, hard/intensiv fysisk aktivitet, røyking eller alkohol i denne populasjonen.
Funnene tyder på at adekvat antihypertensiv behandling trolig er viktig for å forebygge AF, likeens vil forebygging av koronarsykdom og diabetes være viktig. Pasienter med palpitasjoner har risiko for å utvikle AF, og bør derfor følges opp. Betydningen av urinsyre og de inflammatoriske biomarkørene bør undersøkes videre i andre populasjoner.
Description
Paper I and III are not available in Munin:
Paper I. Palpitations are predictive of future atrial fibrillation. An 11-year follow-up of 22,815 men and women: the Tromsø Study. Nyrnes A. et al. Available in European Journal of Preventive Cardiology, 2013 Oct;20(5):729-36
Paper III. Uric acid is associated with future atrial fibrillation: an 11-year follow-up of 6308 men and women--the Tromso Study. Nyrnes A. et al. Available in Europace. 2014 Mar;16(3):320-6
Paper I. Palpitations are predictive of future atrial fibrillation. An 11-year follow-up of 22,815 men and women: the Tromsø Study. Nyrnes A. et al. Available in European Journal of Preventive Cardiology, 2013 Oct;20(5):729-36
Paper III. Uric acid is associated with future atrial fibrillation: an 11-year follow-up of 6308 men and women--the Tromso Study. Nyrnes A. et al. Available in Europace. 2014 Mar;16(3):320-6
Publisher
UiT The Arctic University of NorwayUiT Norges arktiske universitet
Series
ISM skriftserie; 163Metadata
Show full item recordCollections
- Doktorgradsavhandlinger (Helsefak) [734]
- ISM skriftserie [161]
Copyright 2016 The Author(s)
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