Статья
Факторы риска развития фибрилляции предсердий у больных артериальной гипертензией с сохраненной систолической функцией левого желудочка
Артериальная гипертензия (АГ) является наиболее частой причиной фибрилляции предсердий (ФП). В мире наблюдается сдвиг парадигмы с лечения на профилактику факторов риска (ФР) развития ФП. Цель. Анализ основных ФР, ассоциированных с ФП, у больных АГ с сохраненной систолической функцией ЛЖ.Материалы и методы. В одномоментное исследование последовательно включены 273 больных АГ с сохраненной систолической функцией ЛЖ. Было сформировано 2 группы: первая – 60 пациентов с пароксизмальной и персистирующей формами ФП (33,3% мужчины, средний возраст 62,3±10 года), вторая – 213 пациентов без ФП (32,9% мужчины, средний возраст 59,4±8,3 лет). Ассоциации между наличием ФП и потенциальными факторами риска изучались с использованием пошагового многофакторного логистического регрессионного анализа.Результаты. Прием ≥7 порций алкоголя в неделю (отношение шансов (OШ) 4,12; 95% доверительный интервал (ДИ): 1,04–16,35), физическая активность < 150 мин в неделю (OШ 3,18; 95% ДИ: 1,32–7,68), окружность бедер (OШ 1,19; 95% ДИ: 1,08–1,31), длительность АГ (OШ 1,10; 95%ДИ: 1,04–1,17) были значимо связаны с наличием ФП, обратная ассоциация наблюдалась с индексом массы тела (ИМТ) (OШ 0,75; 95% ДИ: 0,61–0,91).Заключение. В нашем исследовании наблюдалась прямая связь между наличием ФП и длительностью АГ, приемом ≥7 порций алкоголя в неделю, физической активностью
1. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129(8):837– 47. DOI: 10.1161/CIRCULATIONAHA.113.005119
2. Ball J, Carrington MJ, McMurray JJV, Stewart S. Atrial fibrillation: Profile and burden of an evolving epidemic in the 21st century. International Journal of Cardiology. 2013;167(5):1807–24. DOI: 10.1016/j.ijcard.2012.12.093
3. Mahajan R, Pathak RK, Thiyagarajah A, Lau DH, Marchlinski FE, Dixit S et al. Risk Factor Management and Atrial Fibrillation Clinics: Saving the Best for Last? Heart, Lung and Circulation. 2017;26(9):990–7. DOI: 10.1016/j.hlc.2017.05.123
4. Odutayo A, Wong CX, Hsiao AJ, Hopewell S, Altman DG, Emdin CA. Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis. BMJ (Clinical research ed.). 2016;354:i4482. DOI: 10.1136/bmj.i4482
5. Wong CX, Brooks AG, Lau DH, Leong DP, Sun MT, Sullivan T et al. Factors Associated With the Epidemic of Hospitalizations Due to Atrial Fibrillation. The American Journal of Cardiology. 2012;110(10):1496–9. DOI: 10.1016/j.amjcard.2012.07.011
6. Pathak RK, Middeldorp ME, Lau DH, Mehta AB, Mahajan R, Twomey D et al. Aggressive Risk Factor Reduction Study for Atrial Fibrillation and Implications for the Outcome of Ablation. Journal of the American College of Cardiology. 2014;64(21):2222–31. DOI: 10.1016/j.jacc.2014.09.028
7. Steinberg JS, Palekar R, Sichrovsky T, Arshad A, Preminger M, Musat D et al. Very long-term outcome after initially successful catheter ablation of atrial fibrillation. Heart Rhythm. 2014;11(5):771– 6. DOI: 10.1016/j.hrthm.2014.02.003
8. Lau DH, Nattel S, Kalman JM, Sanders P. Modifiable Risk Factors and Atrial Fibrillation. Circulation. 2017;136(6):583–96. DOI: 10.1161/CIRCULATIONAHA.116.023163
9. Gorenek B, Pelliccia A, Benjamin EJ, Boriani G, Crijns HJ, Fogel RI et al. European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Europace. 2017;19(2):190–225. DOI:
10. 1093/europace/euw242 10. Benjamin EJ, Levy D, Vaziri SM, D’Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994;271(11):840–4. PMID: 8114238
11. Gallagher C, Hendriks JML, Elliott AD, Wong CX, Rangnekar G, Middeldorp ME et al. Alcohol and incident atrial fibrillation – A systematic review and meta-analysis. International Journal of Cardiology. 2017;246:46–52. DOI: 10.1016/j.ijcard.2017.05.133
12. Mitchell GF, Vasan RS, Keyes MJ, Parise H, Wang TJ, Larson MG et al. Pulse Pressure and Risk of New-Onset Atrial Fibrillation. JAMA. 2007;297(7):709–15. DOI: 10.1001/jama.297.7.709
13. Huxley RR, Misialek JR, Agarwal SK, Loehr LR, Soliman EZ, Chen LY et al. Physical Activity, Obesity, Weight Change, and Risk of Atrial Fibrillation: The Atherosclerosis Risk in Communities Study. Circulation: Arrhythmia and Electrophysiology. 2014;7(4):620–5. DOI: 10.1161/CIRCEP.113.001244
14. Abed HS, Samuel CS, Lau DH, Kelly DJ, Royce SG, Alasady M et al. Obesity results in progressive atrial structural and electrical remodeling: Implications for atrial fibrillation. Heart Rhythm. 2013;10(1):90–100. DOI: 10.1016/j.hrthm.2012.08.043
15. Wanahita N, Messerli FH, Bangalore S, Gami AS, Somers VK, Steinberg JS. Atrial fibrillation and obesity — results of a metaanalysis. American Heart Journal. 2008;155(2):310–5. DOI: 10.1016/j.ahj.2007.10.004
16. Gami AS, Hodge DO, Herges RM, Olson EJ, Nykodym J, Kara T et al. Obstructive Sleep Apnea, Obesity, and the Risk of Incident Atrial Fibrillation. Journal of the American College of Cardiology. 2007;49(5):565–71. DOI: 10.1016/j.jacc.2006.08.060
17. Bapat A, Anderson CD, Ellinor PT, Lubitz SA. Genomic basis of atrial fibrillation. Heart. 2018;104(3):201–6. DOI: 10.1136/heartjnl-2016-311027
18. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al. 2016 ESC Guidelines for the Management of Atrial Fibrillation Developed in Collaboration With EACTS. Revista Española de Cardiología (English Edition). 2017;70(1):50. DOI: 10.1016/j.rec.2016.11.033
19. Voskoboinik A, Prabhu S, Ling L, Kalman JM, Kistler PM. Alcohol and Atrial Fibrillation. Journal of the American College of Cardiology. 2016;68(23):2567–76. DOI: 10.1016/j.jacc.2016.08.074
20. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL et al. 2016 European Guidelines on cardiovascular disease preven tion in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by rep resentatives of 10 societies and by invited experts). European Journal of Preventive Cardiology. 2016;23(11):NP1–96. DOI: 10.1177/2047487316653709
21. World Health Organization. Guide to Physical Measurements (Step 2). WHO STEPS Surveillance.
22. Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA et al. Harmonizing the Metabolic Syndrome: A Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640–5. DOI: 10.1161/CIRCULATIONAHA.109.192644
23. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hyper tension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Journal of Hypertension. 2013;31(7):1281–357. DOI: 10.1097/01.hjh.0000431740.32696. cc
24. Verbeke F, Lindley E, Van Bortel L, Vanholder R, London G, Cochat P et al. A European Renal Best Practice (ERBP) position statement on the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Management of Blood Pressure in Non-dialysis-dependent Chronic Kidney Disease: an endorsement with some caveats for real-life application. Nephrology Dialysis Transplantation. 2014;29(3):490–6. DOI: 10.1093/ndt/gft321
25. International Diabetes Federation Guideline Development Group. Global Guideline for Type 2 Diabetes. Diabetes Research and Clinical Practice. 2014;104(1):1–52. DOI: 10.1016/j.diabres.2012.10.001
26. Hancock EW, Deal BJ, Mirvis DM, Okin P, Kligfield P, Gettes LS. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram: Part V: Electrocardiogram Changes Associated With Cardiac Chamber Hypertrophy: A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: Endorsed by the International Society for Computerized Electrocardiology. Circulation. 2009;119(10):e251–61. DOI: 10.1161/CIRCULATIONAHA.108.191097
27. Marwick TH, Gillebert TC, Aurigemma G, Chirinos J, Derumeaux G, Galderisi M et al. Recommendations on the use of echocardiography in adult hypertension: a report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). European Heart Journal Cardiovascular Imaging. 2015;16(6):577–605. DOI: 10.1093/ehjci/jev076
28. Макаров Л.М., Комолятова В.Н., Куприянова О.О., Первова Е.В., Рябыкина Г.В., Соболев А.В. и др. Национальные российские рекомендации по применению методики холтеровского мони торирования в клинической практике. Российский кардиоло гический журнал. 2014;19(2):6–71
29. Parati G, Stergiou G, O’Brien E, Asmar R, Beilin L, Bilo G et al. European Society of Hypertension practice guidelines for ambu latory blood pressure monitoring. Journal of Hypertension. 2014;32(7):1359–66. DOI: 10.1097/HJH.0000000000000221
30. Steinberg JS, Varma N, Cygankiewicz I, Aziz P, Balsam P, Baranchuk A et al. 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry. Heart Rhythm. 2017;14(7):e55–96. DOI: 10.1016/j. hrthm.2017.03.038
31. Al-Falahi Z, Williamson J, Dimitri H. Atrial Fibrillation and Sleep Apnoea: Guilt by Association? Heart, Lung and Circulation. 2017;26(9):902–10. DOI: 10.1016/j.hlc.2017.05.127
32. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care. 1992;30(6):473–83. PMID: 1593914
33. Olssøn I, Mykletun A, Dahl AA. The hospital anxiety and depression rating scale: A cross-sectional study of psychometrics and case finding abilities in general practice. BMC Psychiatry. 2005;5(1):46. DOI: 10.1186/1471-244X-5-46
34. Лукина Ю.В., Марцевич С.Ю., Загребельный А.В., Трипкош С.Г., Айду Ф.А., Деев А.Д. Исследование приверженности лечению у пациентов амбулаторно-поликлинического звена (по данным регистра ПРОФИЛЬ). Кардиоваскулярная терапия и профилактика. 2013;12(5):56-61. DOI: 10.15829/1728-8800-2013-5-56-61
35. Larsson SC, Drca N, Wolk A. Alcohol Consumption and Risk of Atrial Fibrillation. Journal of the American College of Cardiology. 2014;64(3):281–9. DOI: 10.1016/j.jacc.2014.03.048
36. Шальнова С.А., Деев А.Д., Баланова Ю.А., Капустина А.В., Имаева А.Э., Муромцева Г.А. и др. Двадцатилетние тренды ожи рения и артериальной гипертонии и их ассоциации в России. Кардиоваскулярная терапия и профилактика. 2017;16(4):4-10. DOI: 10.15829/1728-8800-2017-4-4-10
37. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in Obesity Among Adults in the United States, 2005 to 2014. JAMA. 2016;315(21):2284–91. DOI: 10.1001/jama.2016.6458
38. Aune D, Sen A, Schlesinger S, Norat T, Janszky I, Romundstad P et al. Body mass index, abdominal fatness, fat mass and the risk of atrial fibrillation: a systematic review and dose–response metaanalysis of prospective studies. European Journal of Epidemiology. 2017;32(3):181–92. DOI: 10.1007/s10654-017-0232-4
39. Verdecchia P, Dagenais G, Healey J, Gao P, Dans AL, Chazova I et al. Blood pressure and other determinants of new-onset atrial fibrillation in patients at high cardiovascular risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease studies: Journal of Hypertension. 2012;30(5):1004–14. DOI: 10.1097/HJH.0b013e3283522a51
40. Wang Z, Nakayama T. Inflammation, a Link between Obesity and Cardiovascular Disease. Mediators of Inflammation. 2010;2010:535918. DOI: 10.1155/2010/535918
41. Lavie CJ, De Schutter A, Parto P, Jahangir E, Kokkinos P, Ortega FB et al. Obesity and Prevalence of Cardiovascular Diseases and Prognosis – The Obesity Paradox Updated. Progress in Cardiovascular Diseases. 2016;58(5):537–47. DOI: 10.1016/j. pcad.2016.01.008
42. Heymsfield SB, Cefalu WT. Does Body Mass Index Adequately Convey a Patient’s Mortality Risk? JAMA. 2013;309(1):87. DOI: 10.1001/jama.2012.185445
43. Primeau V, Coderre L, Karelis AD, Brochu M, Lavoie M-E, Messier V et al. Characterizing the profile of obese patients who are metabolically healthy. International Journal of Obesity. 2011;35(7):971–81. DOI: 10.1038/ijo.2010.216
44. Rosenberg MA, Patton KK, Sotoodehnia N, Karas MG, Kizer JR, Zimetbaum PJ et al. The impact of height on the risk of atrial fibrillation: the Cardiovascular Health Study. European Heart Journal. 2012;33(21):2709–17. DOI: 10.1093/eurheartj/ehs301
45. Mehta NK, Chang VW. Secular Declines in the Association Between Obesity and Mortality in the United States. Population and Development Review. 2011;37(3):435–51. DOI: 10.1111/j.17284457.2011.00429.x
46. Esler M, Lambert G, Schlaich M, Dixon J, Sari CI, Lambert E. Obesity Paradox in Hypertension: Is This Because Sympathetic Activation in Obesity-Hypertension Takes a Benign Form? Hypertension. 2018;71(1):22–33. DOI: 10.1161/HYPERTENSIONAHA.117.09790
47. Qureshi WT, Alirhayim Z, Blaha MJ, Juraschek SP, Keteyian SJ, Brawner CA et al. Cardiorespiratory Fitness and Risk of Incident Atrial Fibrillation: Results from the Henry Ford Exercise Testing (FIT) Project. Circulation. 2015;131(21):1827–34. DOI: 10.1161/CIRCULATIONAHA.114.014833
48. Sawada SS, Lee I-M, Naito H, Kakigi R, Goto S, Kanazawa M et al. Cardiorespiratory fitness, body mass index, and cancer mortality: a cohort study of Japanese men. BMC Public Health. 2014;14(1):1012. DOI: 10.1186/1471-2458-14-1012
49. Morseth B, Graff-Iversen S, Jacobsen BK, Jørgensen L, Nyrnes A, Thelle DS et al. Physical activity, resting heart rate, and atrial fibrillation: the Tromsø Study. European Heart Journal. 2016;37(29):2307–13. DOI: 10.1093/eurheartj/ehw059
50. Drca N, Wolk A, Jensen-Urstad M, Larsson SC. Atrial fibrillation is associated with different levels of physical activity levels at different ages in men. Heart. 2014;100(13):1037–42. DOI: 10.1136/heartjnl-2013-305304
51. Conen D, Ridker PM, Everett BM, Tedrow UB, Rose L, Cook NR et al. A multimarker approach to assess the influence of inflammation on the incidence of atrial fibrillation in women. European Heart Journal. 2010;31(14):1730–6. DOI: 10.1093/eurheartj/ehq146
52. Погосова Н.В., Оганов Р.Г., Бойцов С.А., Аушева А.К., Соколова О.Ю., Курсаков А.А. и др. Эффективность первичной профилактики заболеваний, обусловленных атеросклерозом, у пациентов с высоким сердечно-сосудистым риском в России и других странах Европы (часть 1). Кардиология. 2017;57(S1):333-44. DOI: 10.18087/cardio.2411
53. Погосова Н.В., Оганов Р.Г., Бойцов С.А., Аушева А.К., Соколова О.Ю., Курсаков А.А. и др. Эффективность первичной профилактики заболеваний, обусловленных атеросклерозом, у пациентов с высоким сердечно-сосудистым риском в России и других странах Европы (часть 2). Кардиология. 2017;57(S3):5-16. DOI: 10.18087/cardio.2412
54. Åkesson A, Larsson SC, Discacciati A, Wolk A. Low-Risk Diet and Lifestyle Habits in the Primary Prevention of Myocardial Infarction in Men. Journal of the American College of Cardiology. 2014;64(13):1299–306. DOI: 10.1016/j.jacc.2014.06.1190