Atrial fibrillation prevalence, incidence and risk of stroke and all-cause death among Chinese

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Abstract

Background

We investigated atrial fibrillation (AF) prevalence, incidence and the risk of stroke and all-cause death because little is known about AF risk among ethnic Chinese.

Methods

We conducted a community-based prospective cohort study among 3560 participants. Prevalent and incident AF was documented by using the 12-lead ECG in baseline and serial follow-ups, and the stroke and all-cause death events were ascertained.

Results

Overall prevalence rates of AF in the cohort were 1.4% in men and 0.7% in women. Incidence rates of AF were 1.68 per 1000 person-years for men and 0.76 per 1000 person-years for women. During a median 13.8 years' follow-up, we documented 208 cases of stroke and 776 deaths. As compared with those without AF, participants with AF had nearly 4 times the age, gender-adjusted risk of stroke (relative risk [RR], 3.87, 95% confidence interval [CI], 2.12–7.15), and twice the risk of death associated with all causes (RR, 2.23, 95% CI, 1.52–3.27). Further adjustment for body mass index, lifestyle factors, socioeconomic status and clinical diseases slightly attenuated these risks. In addition, after adjusting for echocardiographic measures, the following risks remained significant: the multivariate RRs were 2.90 (95% CI, 1.28–6.59) for risk of stroke and 2.05 (95% CI, 1.27–3.32) for risk of all-cause death among participants with AF.

Conclusion

Our data demonstrate that AF is a significant risk factor for stroke and all-cause death for the Chinese.

Introduction

Atrial fibrillation (AF) is associated with congestive heart failure and thromboembolic mortality and morbidity, and is highly prevalent among the elderly population [1], [2], [3]. The substantial clinical impact and potential curable disease of AF have made it mandatory for health professionals to understand the prevalence, incidence and associated factors of AF risk [1], [4]. Although AF data on the Caucasian and African-American populations are available [5], [6], less is known about Asians and other ethnicities, especially from the community-based general population [7], [8]. In addition, various risk factors associated with AF are also related to cardiovascular events and all-cause death in the general population and in specific clinical settings [9], such as older age, poor left ventricular function and hypertension [2], [10]. Previous studies, based on cohort follow-ups in the general population or hospital setting [11], [12], have demonstrated that AF was a significant predictor for stroke and all-cause death. In addition, AF as a predictor for stroke and all-cause death in the Chinese general population is still unknown. Therefore, we investigated the AF risk based on the Chin-Shan Community Cardiovascular Cohort (CCCC) study, which provided a unique opportunity to explore the new-onset AF using its serial follow-up and complete biochemical and anthropometric measurements of the adult participants living in the community.

Section snippets

Study design and study participants

Full details of the CCCC study can be found in other publications [13], [14], [15], [16]. Briefly, the CCCC Study began in 1990 by recruiting 1703 men and 1899 women ≥ 35 years old, homogeneous in Chinese ethnicity, and living in the Chin-Shan township 30 km north of metropolitan Taipei, Taiwan. Information about anthropometry, lifestyle, and medical conditions was assessed by interview questionnaires in two-year cycles, and the validity and reproducibility of the collected data and measurements

Results

Of the 3560 participants with available electrographic data at baseline, 38 had established AF rhythm. Table 1 shows the baseline characteristics of study participants specified by prevalent AF status. Participants with prevalent AF were more likely to be male, of older age, white collar or no job status, and smokers, and more likely to have hypertension, diabetes and poor left ventricular ejection fraction than those without prevalent AF. The lifestyle factors, including alcohol intake and

Discussion

In this prospective cohort of middle-aged to older ethnic Chinese, we clearly demonstrated AF as a significant predictor for stroke and all-cause death, after extensive adjustments. AF was also highly prevalent and incident among elderly Chinese adults.

Our findings are consistent with other population-based studies on the prevalence and incidence of AF risk [7], [27]. With regards to the prevalence rates, our data were consistent with a cross-sectional survey data in the US [5] wherein the AF

Acknowledgements

The authors thank the staff of the Department of Internal Medicine, National Taiwan University Hospital, and the participants of the CCCC study for their valuable contributions. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [47].

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    This study was partially supported by the National Science Council (grant number: NSC 96-2314-B-002-155).

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