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1.
Medicine (Baltimore) ; 99(18): e19542, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358343

RESUMO

BACKGROUND: Data of non-vitamin K antagonist oral anticoagulants (NOACs) in current management of atrial fibrillation (AF) are predominantly derived from North American and European regions. However, the effects of NOACs for stroke prevention in Latin America remain unclear. Therefore, we aimed to compare the efficacy and safety of NOACs with warfarin in Latin American patients with AF. METHODS: The PubMed and Embase databases were systematically searched until July 12, 2019 for applicable randomized clinical trials. The risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using a random-effects model. RESULTS: Four trials involving 8943 Latin American patients were included in this meta-analysis. In anticoagulated patients with AF, Latin American patients had higher rates of stroke or systemic embolism and all-cause death compared with non-Latin American subjects. Compared with warfarin use, the use of NOACs was significantly associated with reduced risks of stroke or systemic embolism, major bleeding, intracranial bleeding, and any bleeding in Latin American patients. There were no significant differences in the risks of ischemic stroke, all-cause death, and gastrointestinal bleeding between Latin and non-Latin American groups. All the interactions between Latin and non-Latin American groups about efficacy and safety outcomes of NOACs compared with warfarin were non-significant (all Pinteraction > .05). CONCLUSIONS: Our meta-analysis suggested that the use of NOACs was at least non-inferior to warfarin use for stroke prevention in Latin American patients with AF.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Hispano-Americanos/estatística & dados numéricos , Acidente Vascular Cerebral/prevenção & controle , Varfarina/uso terapêutico , Administração Oral , Adulto , Fibrilação Atrial/complicações , Fibrilação Atrial/etnologia , Embolia/etnologia , Embolia/prevenção & controle , Feminino , Hemorragia/induzido quimicamente , Hemorragia/etnologia , Humanos , América Latina , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/etnologia , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(5): e18937, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000410

RESUMO

This study is to investigate the relationship of P-selectin (Ps) gene rs1800807 and rs1800808 polymorphisms with plasma soluble P-selectin (sPs) in Han, Uygur, and Kazakh people with atrial fibrillation (AF) and thromboembolism (TE) in Xinjiang, China.A total of 778 Han patients (including 131 patients with AF and TE, 229 patients with AF and 418 healthy individuals), 660 Uygur patients (including 118 patients with AF and TE, 232 patients with AF and 310 healthy individuals), and 505 Kazakh patients (including 42 patients with AF and TE, 156 patients with AF and 307 healthy individuals) were enrolled in this study. Polymerase chain reaction-restriction fragment length polymorphism and direct DNA sequence analysis were used to analyze the polymorphisms of rs1800807 and rs1800808 of Ps gene. ELISA was used to determine the plasma sPs level. The association between plasma sPs levels and Ps gene polymorphisms was further analyzed.The sPs concentrations of GG genotype at rs1800807 locus in the Han, Uygur and Kazakh ethnic groups in Xinjiang, China were significantly higher than those of the CC genotype and CG genotype (P < .05). In the rs1800808 locus, plasma sPs concentrations of the heterozygous mutant CT genotypes in Han and Uygur populations were significantly higher than those in the CC and TT genotypes, whereas the plasma sPs concentrations in Kazakh TT genotypes were significantly higher than those in the CC and CT genotypes (P < .05). Among different ethnic groups, there were significant differences in sPs levels of rs1800807 and rs1800808 genotypes (P < .05).Plasma sPs concentrations are associated with Ps genotypes and sPs concentration of the same genotype shows racial differences.


Assuntos
Fibrilação Atrial/sangue , Fibrilação Atrial/genética , Selectina-P/sangue , Selectina-P/genética , Tromboembolia/sangue , Tromboembolia/genética , Grupo com Ancestrais do Continente Asiático/genética , Fibrilação Atrial/complicações , Fibrilação Atrial/etnologia , Biomarcadores/sangue , China , Feminino , Estudos de Associação Genética , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético , Tromboembolia/complicações , Tromboembolia/etnologia
3.
Am J Cardiol ; 125(1): 55-62, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31706453

RESUMO

Atrial fibrillation (AF) is prevalent and strongly associated with higher cardiovascular disease (CVD) risk. Machine learning is increasingly used to identify novel predictors of CVD risk, but prediction improvements beyond established risk scores are uncertain. We evaluated improvements in predicting 5-year AF risk when adding novel candidate variables identified by machine learning to the CHARGE-AF Enriched score, which includes age, race/ethnicity, height, weight, systolic and diastolic blood pressure, current smoking, use of antihypertensive medication, diabetes, and NT-proBNP. We included 3,534 participants (mean age, 61.3 years; 52.0% female) with complete data from the prospective Multi-Ethnic Study of Atherosclerosis. Incident AF was defined based on study electrocardiograms and hospital discharge diagnosis ICD-9 codes, supplemented by Medicare claims. Prediction performance was evaluated using Cox regression and a parsimonious model was selected using LASSO. Within 5 years of baseline, 124 participants had incident AF. Compared with the CHARGE-AF Enriched model (c-statistic, 0.804), variables identified by machine learning, including biomarkers, cardiac magnetic resonance imaging variables, electrocardiogram variables, and subclinical CVD variables, did not significantly improve prediction. A 23-item score derived by machine learning achieved a c-statistic of 0.806, whereas a parsimonious model including the clinical risk factors age, weight, current smoking, NT-proBNP, coronary artery calcium score, and cardiac troponin-T achieved a c-statistic of 0.802. This analysis confirms that the CHARGE-AF Enriched model and a parsimonious 6-item model performed similarly to a more extensive model derived by machine learning. In conclusion, these simple models remain the gold standard for risk prediction of AF, although addition of the coronary artery calcium score should be considered.


Assuntos
Aterosclerose/complicações , Fibrilação Atrial/etnologia , Grupos Étnicos , Previsões , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/diagnóstico , Aterosclerose/etnologia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/etiologia , Eletrocardiografia , Feminino , Seguimentos , Humanos , Incidência , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco , Estados Unidos/epidemiologia
4.
Clin Lab ; 65(7)2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31307168

RESUMO

BACKGROUND: MicroRNA molecules have been identified to play key roles in a broad range of physiological and pathological processes. Polymorphisms in the corresponding sequence space are likely to make a significant con-tribution to phenotypic variation. The aim of this study was to evaluate the pre-miR-146a C/G (rs2910164) and pre-miR-499 T/C (rs3746444) polymorphisms and their putative association with inflammatory markers in AF in Han Chinese. METHODS: A total of 123 participants were enrolled, 65 AF patients were confirmed with electrocardiogram (ECG) or dynamic electrocardiography, 58 normal individuals were assigned to the control group. RESULTS: Genotypes of the pre-miR-146a C/G (rs2910164) and pre-miR-499 T/C (rs3746444) polymorphisms were distinguished using the method of polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay. The distribution of the pre-miR-146a C/G (rs2910164) genotypes CC, CG, and GG was 33.85%, 52.31%, and 13.84% in the AF group and 37.93%, 51.72%, and 10.35% in the controls, respectively. There was no significant difference in either genotype frequency distributions (p = 0.7973) or allele frequency distributions (p = 0.5411) between these two groups. The distribution of the pre-miR-499 T/C (rs3746444) genotypes TT, TC, and CC was 72.41%, 22.41%, and 5.18% in the controls and 49.23%, 38.46%, and 12.31% in AF subjects, respec-tively (p = 0.0296). The frequency of the C allele in the AF group was significantly higher than that in the control group (31.54% vs. 16.38%, p = 0.0057). Compared with the TT genotype, the C allele carriers (TC+CC genotypes) had a 2.7070-fold increased risk of AF. After being adjusted for age, gender, leucocytes, left atrial dimension, left ventricular ejection fraction, serum levels of lipids, and inflammatory markers, the association persisted (adjusted OR = 2.3387, 95% CI =1.1094 - 4.9300, p = 0.0280). Individuals with TC+CC genotype in pre-miR-499 T/C (rs3746444) had greater serum levels of IL-6 and hs-CRP than did patients with the TT genotype. CONCLUSIONS: Our data support that the pre-miR-499 T/C (rs3746444) polymorphism is associated with AF, and the C allele has increased risk for AF in Han Chinese.


Assuntos
Fibrilação Atrial/genética , Predisposição Genética para Doença/genética , MicroRNAs/genética , Polimorfismo de Nucleotídeo Único , Idoso , Grupo com Ancestrais do Continente Asiático/genética , Fibrilação Atrial/sangue , Fibrilação Atrial/etnologia , Biomarcadores/sangue , Proteína C-Reativa/análise , China , Feminino , Frequência do Gene , Predisposição Genética para Doença/etnologia , Genótipo , Humanos , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade
5.
Stroke ; 50(6): 1452-1459, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31084325

RESUMO

Background and Purpose- Ischemic stroke (IS) secondary to atrial fibrillation (AF) is largely preventable with the use of anticoagulation. We sought to identify race-ethnicity and sex disparities with the use of direct oral anticoagulants (DOACs), aspirin, and warfarin in IS patients with AF and to identify temporal trends in the utilization of these medications. Methods- The FLiPER-AF Stroke Study (Florida Puerto Rico Atrial Fibrillation) included 24 040 IS cases enrolled in the Florida-Puerto Rico Collaboration to Reduce Stroke Registry from 2010 to 2016. Multivariable logistic regression models were performed to evaluate the effect of race-ethnicity and sex on utilization of DOACs, aspirin, and warfarin for stroke prevention in AF after adjustment for sociodemographic, hospital, and clinical factors. Results- Among 24 040 IS cases, 54% were women and 10% black, 12% FL-Hispanics, 4% PR-Hispanic, and 74% whites. From 2010 to 2016, DOAC use increased from 0% to 36%, warfarin use decreased from 51% to 17%, and aspirin use remained relatively stable (42%-40%). After adjustment, blacks had higher odds of warfarin (odds ratio, 1.22; 95% CI, 1.07-1.40) prescription at discharge compared with whites. Men had higher rates of aspirin (42.1% versus 38.8%), warfarin (33.6% versus 28.9%), and DOAC (21.3% versus 19.3%) use compared with women. After adjustment, women had lower odds of being discharged on aspirin (odds ratio, 0.92; 95% CI, 0.86-0.98) or warfarin (odds ratio, 0.91; 95% CI, 0.84-0.99). There was no sex difference in use of DOACs. Conclusions- Our study confirmed the increasing use of DOACs, downtrending use of warfarin, whereas aspirin use remained similar over the years. There are sex and race-ethnicity disparities in anticoagulation use in IS patients with AF. It is critical to understand underlying drivers of these disparities to develop better practice strategies for stroke prevention in patients with AF. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT03627806.


Assuntos
Anticoagulantes/administração & dosagem , Aspirina/administração & dosagem , Fibrilação Atrial , Isquemia Encefálica , Sistema de Registros , Acidente Vascular Cerebral , Varfarina/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etnologia , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/etnologia , Isquemia Encefálica/etiologia , Isquemia Encefálica/prevenção & controle , Feminino , Florida/epidemiologia , Humanos , Masculino , Porto Rico/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etnologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle
6.
Am J Cardiol ; 123(12): 1949-1954, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-30979410

RESUMO

The CHA2DS2-VASc and HAS-BLED scoring systems are used in patients with atrial fibrillation (AF) to estimate risk of stroke and bleeding, respectively. Both were developed in minimally diverse European populations and these scores have not yet been extensively studied in US whites and nonwhites. In a retrospective cohort study, we included patients with AF who received inpatient or outpatient care in a large integrated academic health system from 2011 to 2017. Cox proportional hazards were used to analyze associations between stroke and CHA2DS2-VASc score in AF patients not prescribed anticoagulation and between incident bleeding and HAS-BLED score in anticoagulated patients. After exclusions for previous stroke, the cohort included 21,648 patients with a mean age of 66.8 ± 15.8. Anticoagulation was prescribed in 52% of whites and 46% of nonwhites (p < 0.001) with a CHA2DS2-VASc score of ≥2. Mean CHA2DS2-VASc scores were 2.4 ± 1.6 in whites and 2.2 ± 1.6 in nonwhites and mean HAS-BLED scores was 1.5 ± 1.1 in whites and 1.3 ± 1.0 in nonwhites. After adjusting for baseline differences, the discriminative ability of CHA2DS2-VASc and HAS-BLED was similar in whites and nonwhites (p = 0.52, 0.33, respectively). The discriminative ability of HAS-BLED was similar in patients on vitamin K antagonists and direct oral anticoagulants. In conclusion, oral anticoagulation was prescribed less frequently in nonwhites. However, the discriminative ability of CHA2DS2-VASc and HAS-BLED were similar in whites and nonwhites.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/etnologia , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hemorragia/etnologia , Acidente Vascular Cerebral/etnologia , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Acidente Vascular Cerebral/prevenção & controle
8.
Am J Cardiol ; 123(9): 1453-1457, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30771859

RESUMO

We examined whether the sex differences in atrial fibrillation (AF) is related to difference in risk factors leading to AF or due to a differential impact of the same risk factors in 11,806 participants (55.2 % women) from the REGARDS study. Incident AF was ascertained by electrocardiograms and medical history at a follow-up examination. Backwards elimination logistic regression was used to identify AF risk factors in men and women, separately. Over a median follow-up of 9.0years, 588 (11.1%) men and 428 (6.6%) women (p value <0.001) developed AF. Men had a higher risk of AF than women (age and race adjusted odds ratio [OR] [95% confidence interval (CI)]: 1.61 [1.26, 1.75]). Age, white race, height, weight, use of blood pressure lowering medications and history of cardiovascular disease were identified by backward elimination as AF risk factors shared by both sexes. On the other hand, diabetes was an AF risk factor in women but not in men. Among the shared risk factors between men and women, only age showed a stronger association in women than in men [Interaction p-value = 0.003]. Adjustment for the shared risk factors eliminated the sex difference in AF risk (OR [95% CI]: 0.90 [0.74, 1.09]), which was more noticeable in those younger than the median age (62 years) compared to those who were older (interaction p value 0.003). In conclusion, women and men share several AF risk factors, and these shared risk factors explain the sex differences. However, age association with AF differs by sex, and age modifies the associations between sex and other AF risk factors.


Assuntos
Fibrilação Atrial/etnologia , Grupos de Populações Continentais , Medição de Risco/métodos , Acidente Vascular Cerebral/etnologia , Fibrilação Atrial/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Fatores Sexuais , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Estados Unidos/epidemiologia
9.
Circulation ; 139(12): 1497-1506, 2019 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-30700141

RESUMO

BACKGROUND: Efforts to improve prescription of oral anticoagulation (OAC) drugs in patients with atrial fibrillation have had limited success in improving guideline adherence. METHODS: We evaluated adherence to the American College of Cardiology/American Heart Association performance measures for OAC in eligible patients with a CHA2DS2-VASc score ≥2 and trends in prescription over time in the American Heart Association's Get With The Guidelines-AFIB (atrial fibrillation) registry. Adjusted associations with in-hospital outcomes were also determined. The cohort included 33 235 patients with a CHA2DS2-VASc score ≥2 who were admitted for atrial fibrillation and were enrolled at 115 sites between January 1, 2013, and September 31, 2017. RESULTS: The median (25th, 75th percentile) age was 73 years (65, 81 years); 51% were female; and the median (25th, 75th percentile) CHA2DS2-VASc score was 4 (3, 5). At admission, 16 206 (59.5%) of 27 221 patients with a previous diagnosis of atrial fibrillation were taking OAC agents, and OAC drug use at admission was associated with a lower adjusted odds of in-hospital ischemic stroke (odds ratio, 0.38; 95% CI, 0.24-0.59; P<0.0001). At discharge, prescription of OAC in eligible patients (no contraindications) was 93.5% (n=25 499 of 27 270). In a sensitivity analysis, when excluding only strict contraindications (4.6%, n=1497 of 32 806), OAC prescription at discharge was 80.3%. OAC prescription at discharge was higher in those aged ≤75 years, men, those with heart failure, those with previous atrial fibrillation ablation, and those with rhythm control ( P<0.0001 for all). OAC use was lowest in Hispanic patients (90.2%, P<0.0001). Prescription of OAC at discharge in eligible patients improved over time from 79.9% to 96.6% ( P<0.0001). CONCLUSIONS: Among hospitals participating in the GWTG-AFIB quality improvement program, OAC prescription at discharge in eligible guideline-indicated patients increased significantly and improved consistently over time. These data confirm that high-level adherence to guideline-recommended stroke prevention is achievable.


Assuntos
Fibrilação Atrial/patologia , Fidelidade a Diretrizes , Acidente Vascular Cerebral/prevenção & controle , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/etnologia , Feminino , Humanos , Masculino , Razão de Chances , Alta do Paciente , Melhoria de Qualidade , Sistema de Registros , Índice de Gravidade de Doença , Resultado do Tratamento
10.
Am J Cardiol ; 123(4): 598-604, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30527770

RESUMO

Little is known about how warfarin is prescribed for stroke prevention in maintenance dialysis patients with chronic atrial fibrillation (AF). We examined patterns of warfarin use, and associated factors, after AF diagnosis. This retrospective cohort analysis studied US Medicare patients receiving maintenance dialysis January 1, 2008, to June 30, 2010. Demographics, co-morbidity, and a durable medical equipment claims-based disability proxy score predicted warfarin prescription after AF diagnosis. The analysis included 8,964 patients with nonvalvular AF. Compared with nonusers, warfarin users were younger (age 65.4 ± 12.1 vs 67.0 ± 12.9 years) and more likely to be men (54.3% vs 52.8%) and of white race (64.0% vs 59.6%). After adjustment for other factors, nonwhite, versus white, race was associated with significantly less warfarin use within 30 days: odds ratios (ORs), 95% confidence intervals (CIs), were 0.80, 0.71 to 91, for black patients; 0.57, 0.43 to 0.76, for Asians; and 0.74, 0.49 to 1.12, for members of other races. Percentages of patients receiving warfarin decreased as Hypertension Abnormal renal and liver function Stroke-Bleeding Labile INR Elderly Drugs or alcohol (HAS-BLED) bleeding risk score increased (OR 0.82, 95% CI 0.73 to 0.92, HAS-BLED score 3 to 4 versus 2; 0.38, 0.26 to 0.57, score ≥ 5 vs 2). However, as CHA2DS2-Vasc stroke-risk score increased, warfarin use tended to decrease (OR 0.90, 95% CI 0.78 to 1.03, p = 0.13, CHA2DS2-Vasc score 4 versus 1 to 3; 0.69, 0.61 to 0.78, p < 0.0001, score 5 vs 1 to 3). In conclusion, providers appear to weigh bleeding risk more heavily than stroke-prevention potential when prescribing warfarin for maintenance dialysis patients. Racial minorities received warfarin substantially less often than whites, even after accounting for other factors.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/etnologia , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Diálise Renal , Acidente Vascular Cerebral/epidemiologia , Varfarina/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Fibrilação Atrial/terapia , Doença Crônica , Feminino , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/etnologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
11.
Chest ; 155(3): 510-518, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30292759

RESUMO

BACKGROUND: The incidence of atrial fibrillation (AF) is increasing, conferring a major health-care issue in Asia. No risk score for predicting incident AF has been specifically developed in Asian subjects. Our aim was to investigate risk factors for incident AF in Asian subjects and to combine them into a simple clinical risk score. METHODS: Risk factors for incident AF were analyzed in 471,446 subjects from the Chinese Yunnan Insurance Database (internal derivation cohort) and then combined into a simple clinical risk score. External application of the new score was performed in 451,199 subjects from the Korean National Health Insurance Service (external cohort). RESULTS: In the internal cohort, structural heart disease (SHD), heart failure (HF), age ≥ 75 years, coronary artery disease (CAD), hyperthyroidism, COPD, and hypertension were associated with incident AF. Given the low prevalence and the strong association of SHD with incident AF (hazard ratio, 26.07; 95% CI, 18.22-37.30; P < .001), these patients should be independently considered as high risk for AF and were excluded from the analysis. The remaining predictors were combined into the new simple C2HEST score: C2: CAD/COPD (1 point each); H: hypertension (1 point); E: elderly (age ≥ 75 years, 2 points); S: systolic HF (2 points); and T: thyroid disease (hyperthyroidism, 1 point). The C2HEST score showed good discrimination with the area under the curve (AUC) of 0.75 (95% CI, 0.73-0.77) and had good calibration (P = .774). The score was internally validated by bootstrap sampling procedure, giving an AUC of 0.75 (95% CI, 0.73-0.77). External application gave an AUC of 0.65 (95% CI, 0.65-0.66). The C2HEST score was superior to CHADS2 and CHA2DS2-VASc scores in both cohorts in predicting incident AF. CONCLUSIONS: We have developed and validated the C2HEST score as a simple clinical tool to assess the individual risk of developing AF in the Asian population without SHD.


Assuntos
Grupo com Ancestrais do Continente Asiático , Fibrilação Atrial , Medição de Risco , Fatores Etários , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/etnologia , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Estudos de Coortes , Comorbidade , Feminino , Humanos , Hipertireoidismo/epidemiologia , Incidência , Masculino , Prognóstico , Modelos de Riscos Proporcionais , Reprodutibilidade dos Testes , República da Coreia , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco
12.
Int J Cardiol ; 275: 89-94, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30340851

RESUMO

BACKGROUND: Contribution of modifiable risk factors for the risk of new onset atrial fibrillation (AF) in minority populations is poorly understood. Our objective was to compare the population attributable risk (PAR) of various risk factors for incident AF between Hispanic, African American and non-Hispanic Whites. METHODS: An ECG/EMR database was interrogated for individuals free of AF for development of subsequent AF from 2000 to 2013. Cox regression analysis controlled for age > 65, male gender, body mass index > 40 kg/m2, systolic blood pressure > 140 mm Hg, diabetes mellitus, heart failure, socioeconomic status less than the first percentile in New York State, and race/ethnicity. PAR was calculated as (prevalence of X) ∗ (HR - 1)/HR, where HR is the hazard ratio, and X is the risk factor. RESULTS: 47,722 persons free of AF (43% Hispanic, 37% Black and 20% White) were followed for subsequent incident AF. Hypertension in African Americans and Hispanics had a 7.93% and 7.66% greater PAR compared with non-Hispanics Whites. Similar findings existed for the presence of heart failure, with a higher PAR in non-Whites compared to Whites. CONCLUSION: In conclusion, modifiable risk factors play an important role in the risk of incident AF. Higher PAR estimates in African Americans and Hispanics were observed for elevated systolic blood pressure and heart failure. Identification of these modifiable risk factors for atrial fibrillation in non-White minorities may assist in targeting better prevention therapies and planning from a public health perspective. No funding sources were used for this study.


Assuntos
Afro-Americanos , Fibrilação Atrial/etnologia , Grupo com Ancestrais do Continente Europeu , Hispano-Americanos , Hipertensão/complicações , Vigilância da População , Medição de Risco/métodos , Idoso , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Eletrocardiografia , Feminino , Seguimentos , Humanos , Hipertensão/etnologia , Hipertensão/fisiopatologia , Incidência , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco
13.
Heart Lung Circ ; 28(4): 615-622, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29685716

RESUMO

BACKGROUND: Although many studies have investigated the association of blood homocysteine with major cardiovascular diseases such as coronary heart disease and stroke, research on its association with atrial fibrillation (AF) is scarce. METHODS: We analysed data from Atherosclerosis Risk in Communities (ARIC) Study (n=492, age 45-64 years) and Multi-Ethnic Study of Atherosclerosis (MESA) (n=6,641, age 45-84 years). RESULTS: During the 10,106 and 67,613 person-years of follow-up, we identified 85 and 351 AF events in ARIC and MESA, respectively. An age-, sex-, and race-adjusted model showed dose-response relations between plasma homocysteine concentrations and AF incidence in both ARIC and MESA. Further adjustments for other AF risk factors did not change the associations. In the fully adjusted model, a meta-analysis of both studies showed a significant association between homocysteine and AF [hazard ratio (95% confidence interval) per 1 unit increment in log2(homocysteine), 1.27 (1.01-1.61)]. Individuals with higher levels of all three B vitamins (vitamin B6 and B12, and folate) had a lower risk of AF, but those associations were not statistically significant. In the full ARIC cohort [n=12,686 (2079 AF events)], there was no association between the C677T methylenetetrahydrofolate reductase (MTHFR) mutation and AF. CONCLUSIONS: In the prospective population-based ARIC and MESA cohorts, elevated homocysteine was modestly associated with an increased risk of incident AF, but the C677T MTHFR mutation was not associated with AF risk, suggesting that homocysteine may be a novel risk marker for AF rather than a causal risk factor.


Assuntos
Aterosclerose/sangue , Fibrilação Atrial/etnologia , Grupos Étnicos , Homocisteína/sangue , Vigilância da População/métodos , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/complicações , Aterosclerose/etnologia , Fibrilação Atrial/sangue , Fibrilação Atrial/etiologia , Biomarcadores/sangue , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco
14.
J Electrocardiol ; 51(6): 997-1002, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30497763

RESUMO

BACKGROUND: Patch electrocardiographic (ECG) monitors permit extended noninvasive ambulatory monitoring. To guide use of these devices, information is needed about their performance. We sought to determine in a large general population sample the acceptability of patch ECG monitors, the yield of arrhythmia detection, and the consistency of findings in participants monitored twice. METHODS: In the Multi-Ethnic Study of Atherosclerosis, 1122 participants completed one or two monitoring episodes using the Zio Patch XT, a single-channel ECG patch monitor capable of recording for 14 days. Recordings were analyzed for atrial fibrillation (AF), atrial flutter, atrioventricular block, pauses, and supraventricular and ventricular ectopy. RESULTS: The mean(SD) age at the time of monitoring was 75(8) years, 52% were men, and 15% had a prior history of clinically-recognized AF/flutter. The median monitoring duration was 13.8 days. Among 804 participants with no prior clinical history of AF/flutter and at least 12 days of monitoring on a single device, AF/flutter was detected in 32 (4.0%); in 38% of these, AF/flutter was first detected during days 3 through 12 of monitoring. In participants monitored twice, findings from the two devices showed excellent agreement for supraventricular and ventricular ectopic beats per hour, but only fair agreement for high-grade atrioventricular block and pauses of >3 s duration. CONCLUSIONS: In a general population of older individuals, new diagnoses of AF/flutter were made in 4.0% of participants without a prior history. A single monitoring episode accurately estimated rates of supraventricular and ventricular ectopy.


Assuntos
Fibrilação Atrial/diagnóstico , Flutter Atrial/diagnóstico , Bloqueio Atrioventricular/diagnóstico , Eletrocardiografia Ambulatorial/instrumentação , Complexos Ventriculares Prematuros/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/etnologia , Fibrilação Atrial/etnologia , Flutter Atrial/etnologia , Bloqueio Atrioventricular/etnologia , Feminino , Humanos , Masculino , Programas de Rastreamento/instrumentação , Pessoa de Meia-Idade , Estados Unidos , Complexos Ventriculares Prematuros/etnologia
15.
JAMA Cardiol ; 3(12): 1174-1182, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30484833

RESUMO

Importance: Black and Hispanic patients are less likely than white patients to use oral anticoagulants for atrial fibrillation. Little is known about racial/ethnic differences in use of direct-acting oral anticoagulants (DOACs) for atrial fibrillation. Objective: To assess racial/ethnic differences in the use of oral anticoagulants, particularly DOACs, in patients with atrial fibrillation. Design, Setting, and Participants: This cohort study used data from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II, a prospective, US-based registry of outpatients with nontransient atrial fibrillation 21 years and older who were followed up from February 2013 to July 2016. Data were analyzed from February 2017 to February 2018. Exposures: Self-reported race/ethnicity as white, black, or Hispanic. Main Outcomes and Measures: The primary outcome was use of any oral anticoagulant, particularly DOACs. Secondary outcomes included the quality of anticoagulation received and oral anticoagulant discontinuation at 1 year. Results: Of 12 417 patients, 11 100 were white individuals (88.6%), 646 were black individuals (5.2%), and 671 were Hispanic individuals (5.4%) with atrial fibrillation. After adjusting for clinical features, black individuals were less likely to receive any oral anticoagulant than white individuals (adjusted odds ratio [aOR], 0.75 [95% CI, 0.56, 0.99]) and less likely to receive DOACs if an anticoagulant was prescribed (aOR, 0.63 [95% CI, 0.49-0.83]). After further controlling for socioeconomic factors, oral anticoagulant use was no longer significantly different in black individuals (aOR, 0.78 [95% CI, 0.59-1.04]); among patients using oral anticoagulants, DOAC use remained significantly lower in black individuals (aOR, 0.73 [95% CI, 0.55-0.95]). There was no significant difference between white and Hispanic groups in use of oral anticoagulants. Among patients receiving warfarin, the median time in therapeutic range was lower in black individuals (57.1% [IQR, 39.9%-72.5%]) and Hispanic individuals (51.7% [interquartile range {IQR}, 39.1%-66.7%]) than white individuals (67.1% [IQR, 51.8%-80.6%]; P < .001). Black and Hispanic individuals treated with DOACs were more likely to receive inappropriate dosing than white individuals (black patients, 61 of 394 [15.5%]; Hispanic patients, 74 of 409 [18.1%]; white patients, 1003 of 7988 [12.6%]; P = .01). One-year persistence on oral anticoagulants was the same across groups. Conclusions and Relevance: After controlling for clinical and socioeconomic factors, black individuals were less likely than white individuals to receive DOACs for atrial fibrillation, with no difference between white and Hispanic groups. When atrial fibrillation was treated, the quality of anticoagulant use was lower in black and Hispanic individuals. Identifying modifiable causes of these disparities could improve the quality of care in atrial fibrillation.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Grupos de Populações Continentais , Grupos Étnicos , Sistema de Registros , Acidente Vascular Cerebral/prevenção & controle , Varfarina/administração & dosagem , Administração Oral , Idoso , Anticoagulantes/administração & dosagem , Fibrilação Atrial/complicações , Fibrilação Atrial/etnologia , Eletrocardiografia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Acidente Vascular Cerebral/etnologia , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Estados Unidos/epidemiologia
16.
Circ Arrhythm Electrophysiol ; 11(10): e006557, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30354407

RESUMO

BACKGROUND: Atrial fibrosis is a hallmark of structural remodeling in atrial fibrillation (AF). Plasma procollagen type III N-terminal propeptide (PIIINP) reflects collagen synthesis and degradation while collagen type I carboxy-terminal telopeptide (ICTP) reflects collagen degradation. We aimed to study baseline plasma PIIINP and ICTP and their associations with incident AF in participants initially free of overt cardiovascular disease. METHODS: In a stratified sample of the Multi-Ethnic Study of Atherosclerosis, initially aged 45-84 years, 3071 participants had both PIIINP and ICTP measured at baseline. Incident AF in 10-year follow-up was based on a hospital International Classification of Diseases code for AF or atrial flutter, in- or outpatient Medicare claims through 2011 (primarily in those aged 65-84 years), or ECG 10 years after baseline (n=357). The associations of PIIINP and ICTP with incident AF were estimated using Poisson regression with follow-up time offset. RESULTS: Baseline PIIINP (5.50±1.55 µg/L) and ICTP (mean±SD, 3.41±1.37 µg/L) were positively related (both P<0.0001) to incident AF in a model adjusting for age, race/ethnicity, and sex, with an apparent threshold (relative incidence density 2.81 [1.94-4.08] for PIIINP ≥8.5 µg/L [3.5% of the sample] and 3.46 [2.36-5.07] for ICTP ≥7 µg/L [1.7% of the sample]). Findings were attenuated but remained statistically significant after further adjustment for systolic blood pressure, height, body mass index, smoking, and renal function. Additional adjustment for other risk factors and biomarkers of inflammation did not alter conclusions. CONCLUSIONS: Plasma collagen biomarkers, particularly at elevated levels, were associated with excess risk for AF.


Assuntos
Fibrilação Atrial/sangue , Fibrilação Atrial/etnologia , Flutter Atrial/sangue , Flutter Atrial/etnologia , Colágeno Tipo I/sangue , Fragmentos de Peptídeos/sangue , Peptídeos/sangue , Pró-Colágeno/sangue , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Flutter Atrial/diagnóstico , Biomarcadores/sangue , Eletrocardiografia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologia , Regulação para Cima
18.
Pacing Clin Electrophysiol ; 41(12): 1600-1605, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30267542

RESUMO

BACKGROUND: South Asians have a lower prevalence of atrial fibrillation (AF) compared with Caucasians despite higher rates of conventional risk factors and a higher incidence of stroke. It is not clear whether South Asians truly experience less AF or whether this is due to underdetection of the arrhythmia. Therefore, we aimed to determine whether South Asian patients with pacemakers have a lower incidence of device-detected subclinical episodes of AF compared with Caucasian controls. METHODS: We performed a retrospective cohort study of South Asian and Caucasian patients who underwent pacemaker implantation between 2006 and 2016. Subclinical AF episodes, detected during subsequent device clinic follow-up visits, were identified and the occurrence of clinical AF, cerebrovascular events, and all-cause mortality was recorded. RESULTS: A total of 5 648 patients underwent pacemaker implantation at the Yorkshire Heart Centre, UK, during the study period. Of these, 169 were South Asian and 72 met the eligibility criteria. The cumulative incidence of subclinical AF was significantly lower in South Asians compared with Caucasians (logrank P  =  0.002) with an annual event rate of 6.9% versus 13.9%, and South Asian ethnicity was an independent predictor of a lower incidence of subclinical AF (odds ratio =  0.43; 95% confidence interval  =  1.01-5.38). CONCLUSIONS: South Asians with an implanted pacemaker have a lower rate of subclinical AF compared with Caucasians.


Assuntos
Fibrilação Atrial/etnologia , Fibrilação Atrial/epidemiologia , Idoso , Ásia Sudeste/etnologia , Fibrilação Atrial/terapia , Inglaterra , Feminino , Humanos , Incidência , Masculino , Marca-Passo Artificial , Estudos Retrospectivos
19.
Adv Ther ; 35(11): 2069-2080, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30219991

RESUMO

INTRODUCTION: Anticoagulants are effective for stroke prevention in atrial fibrillation (AF). Data on population health-related cardiovascular outcomes by race/ethnicity and gender are not well described. The aim was to assess the impact of patient diversity on associated cardiovascular outcomes related to warfarin anticoagulation in Medicare beneficiaries with AF. METHODS: Medicare administrative claims data for years 2000-2010 were used to calculate AF prevalence and rates of new AF cases. Three 20% sample cohorts of new AF beneficiaries for years 2000, 2005, and 2007 were extracted and analyzed in a longitudinal study design. The impact of warfarin on associated cardiovascular outcomes was measured with respect to race/ethnicity and gender. Measured outcomes included the risk of stroke, mortality and hospitalization after adjusting for age, gender, race/ethnicity, CHADS2 score and warfarin. RESULTS: AF prevalence and warfarin use increased while stroke and mortality rates declined across race/ethnicity and gender from 2000 to 2010. Analyses comparing Whites to non-Whites highlighted several disparities: (1) Blacks were 40% (p < 0.0001) more likely to have a stroke even after adjustment for warfarin; (2) in 2007, Hispanics had a 35% (p < 0.01) higher prevalence of stroke and warfarin did not reduce the risk; and (3) Asians had better outcomes. Warfarin reduced stroke less well in women who had a lower risk of death and hospitalization. Despite a > 70% (p < 0.0001) reduction in mortality for warfarin users, Blacks had a 25% (p < 0.0001) higher mortality risk than Whites. CONCLUSIONS: Differences in population health metrics across race/ethnicity and gender exist in AF. Across all metrics, Blacks had comparatively worse outcomes. Patient diversity should be a focus for future investigations in AF to improve outcomes in the whole population. FUNDING: National Minority Quality Forum.


Assuntos
Fibrilação Atrial , Grupos Étnicos/estatística & dados numéricos , Acidente Vascular Cerebral , Varfarina/uso terapêutico , Idoso , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/etnologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Saúde da População , Prevalência , Fatores de Risco , Acidente Vascular Cerebral/etnologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Estados Unidos/epidemiologia
20.
Clin Cardiol ; 41(10): 1379-1385, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30144123

RESUMO

BACKGROUND: South Asians have a low prevalence of atrial fibrillation (AF) compared with Caucasians despite having a higher prevalence of conventional risk factors for the arrhythmia. The reason for this disparity is uncertain but may be due to ethnic differences in atrial morphology. This study examines the association between ethnicity and left atrial (LA) size and function in South Asian and Caucasian subjects using the reference technique of cardiovascular magnetic resonance imaging (MRI). HYPOTHESIS: South Asians have smaller LA size and therefore increased LA function. METHODS: Retrospective case-control study of 60 South Asian and 60 Caucasian patients who had undergone a clinically indicated MRI between April 2010 and October 2017 and had been found to have a structurally normal heart. LA and left ventricular (LV) volume and function were assessed and compared between the ethnicities. RESULTS: In comparison with Caucasians, South Asians had significantly lower minimum (27.7 ± 11.1 mL vs 34.9 ± 12.3 mL, P = 0.002) and maximum LA volumes (64.7 ± 21.1 mL vs 80.9 ± 22.5 mL, P < 0.001), lower LV end-diastolic volume (P < 0.001), lower LV stroke volume (P < 0.001), and lower LV mass (P = 0.022) and these values remained significant after correcting for body surface area. Further analysis revealed that LA volume was independently associated with South Asian ethnicity. There was no difference in LA function between the ethnic groups. CONCLUSIONS: South Asians have reduced LA volumes and a proportionally smaller heart size in comparison to Caucasians. Smaller LA size may protect against the development of AF by reducing the risk of reentrant circuit formation and atrial fibrosis development.


Assuntos
Grupo com Ancestrais do Continente Asiático/etnologia , Fibrilação Atrial/etnologia , Volume Cardíaco/fisiologia , Átrios do Coração/diagnóstico por imagem , Medição de Risco/métodos , Adolescente , Adulto , Idoso , Fibrilação Atrial/diagnóstico , Bangladesh/etnologia , Estudos de Casos e Controles , Feminino , Seguimentos , Átrios do Coração/fisiopatologia , Humanos , Incidência , Índia/etnologia , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paquistão/etnologia , Estudos Retrospectivos , Fatores de Risco , Reino Unido/epidemiologia , Adulto Jovem
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