Pulse Pressure and Risk of New-Onset Atrial Fibrillation
CONTEXT Atrial fibrillation (AF) is responsible for considerable morbidity and mortality, making identification of modifiable risk factors a priority. Increased pulse pressure, a reflection of aortic stiffness, increases cardiac load and may increase AF risk. OBJECTIVE To examine relations between p...
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| Veröffentlicht in: | JAMA : the journal of the American Medical Association 2007-02, Vol.297 (7), p.709-715 |
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| creator | Mitchell, Gary F Vasan, Ramachandran S Keyes, Michelle J Parise, Helen Wang, Thomas J Larson, Martin G D’Agostino, Ralph B Kannel, William B Levy, Daniel Benjamin, Emelia J |
| description | CONTEXT Atrial fibrillation (AF) is responsible for considerable morbidity and mortality, making identification of modifiable risk factors a priority. Increased pulse pressure, a reflection of aortic stiffness, increases cardiac load and may increase AF risk. OBJECTIVE To examine relations between pulse pressure and incident AF. DESIGN, SETTING, AND PARTICIPANTS Prospective, community-based observational cohort in Framingham, Mass, including 5331 Framingham Heart Study participants aged 35 years and older and initially free from AF (median age, 57 years; 55% women). MAIN OUTCOME MEASURES Incident AF. RESULTS AF developed in 698 participants (13.1%) a median of 12 years after pulse pressure assessment. Cumulative 20-year AF incidence rates were 5.6% for pulse pressure of 40 mm Hg or less (25th percentile) and 23.3% for pulse pressure greater than 61 mm Hg (75th percentile). In models adjusted for age, sex, baseline and time-dependent change in mean arterial pressure, and clinical risk factors for AF (body mass index, smoking, valvular disease, diabetes, electrocardiographic left ventricular hypertrophy, hypertension treatment, and prevalent myocardial infarction or heart failure), pulse pressure was associated with increased risk for AF (adjusted hazard ratio [HR], 1.26 per 20-mm Hg increment; 95% confidence interval [CI], 1.12-1.43; P |
| doi_str_mv | 10.1001/jama.297.7.709 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_69032632</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>205664</ama_id><sourcerecordid>19572251</sourcerecordid><originalsourceid>FETCH-LOGICAL-a360t-d3279ebef25024b3086652c30e1d7659985cd848d110c499d654baa130bdce623</originalsourceid><addsrcrecordid>eNqF0UtLAzEQAOAgiq3Vq-BFFkFvWyfPTY6lWBWKLaLnJbvJQuo-NNlF_PdGWhW8mDnkkG-GmQlCpximGABfb3Sjp0Rl0xig9tAYcypTypXcR2MAJdOMSTZCRyFsIB5Ms0M0whnFhCgYI7ke6mCTtbchDN4mujXJowsvSVclD_Y9XbXB9sms907XycIV3tW17l3XHqODSsfUk909Qc-Lm6f5Xbpc3d7PZ8tUUwF9aijJlC1sRTgQVlCQQnBSUrDYZIIrJXlpJJMGYyiZUkZwVmiNKRSmtILQCbra1n313dtgQ583LpQ2dtHabgi5UECJoP9DrHhGCMcRXvyBm27wbRwiJxgzAKlUROc7NBSNNfmrd432H_n35iK43AEdSl1XXrelC79Ock5BfLmzrYsf9fNKgAvB6CdkIYHg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>211400899</pqid></control><display><type>article</type><title>Pulse Pressure and Risk of New-Onset Atrial Fibrillation</title><source>MEDLINE</source><source>American Medical Association Journals</source><creator>Mitchell, Gary F ; Vasan, Ramachandran S ; Keyes, Michelle J ; Parise, Helen ; Wang, Thomas J ; Larson, Martin G ; D’Agostino, Ralph B ; Kannel, William B ; Levy, Daniel ; Benjamin, Emelia J</creator><creatorcontrib>Mitchell, Gary F ; Vasan, Ramachandran S ; Keyes, Michelle J ; Parise, Helen ; Wang, Thomas J ; Larson, Martin G ; D’Agostino, Ralph B ; Kannel, William B ; Levy, Daniel ; Benjamin, Emelia J</creatorcontrib><description>CONTEXT Atrial fibrillation (AF) is responsible for considerable morbidity and mortality, making identification of modifiable risk factors a priority. Increased pulse pressure, a reflection of aortic stiffness, increases cardiac load and may increase AF risk. OBJECTIVE To examine relations between pulse pressure and incident AF. DESIGN, SETTING, AND PARTICIPANTS Prospective, community-based observational cohort in Framingham, Mass, including 5331 Framingham Heart Study participants aged 35 years and older and initially free from AF (median age, 57 years; 55% women). MAIN OUTCOME MEASURES Incident AF. RESULTS AF developed in 698 participants (13.1%) a median of 12 years after pulse pressure assessment. Cumulative 20-year AF incidence rates were 5.6% for pulse pressure of 40 mm Hg or less (25th percentile) and 23.3% for pulse pressure greater than 61 mm Hg (75th percentile). In models adjusted for age, sex, baseline and time-dependent change in mean arterial pressure, and clinical risk factors for AF (body mass index, smoking, valvular disease, diabetes, electrocardiographic left ventricular hypertrophy, hypertension treatment, and prevalent myocardial infarction or heart failure), pulse pressure was associated with increased risk for AF (adjusted hazard ratio [HR], 1.26 per 20-mm Hg increment; 95% confidence interval [CI], 1.12-1.43; P<.001). In contrast, mean arterial pressure was unrelated to incident AF (adjusted HR, 0.96 per 10-mm Hg increment; 95% CI, 0.88-1.05; P = .39). Systolic pressure was related to AF (HR, 1.14 per 20-mm Hg increment; 95% CI, 1.04-1.25; P = .006); however, if diastolic pressure was added, model fit improved and the diastolic relation was inverse (adjusted HR, 0.87 per 10-mm Hg increment; 95% CI, 0.78-0.96; P = .01), consistent with a pulse pressure effect. Among patients with interpretable echocardiographic images, the association between pulse pressure and AF persisted in models that adjusted for baseline left atrial dimension, left ventricular mass, and left ventricular fractional shortening (adjusted HR, 1.23; 95% CI, 1.09-1.39; P = .001). CONCLUSION Pulse pressure is an important risk factor for incident AF in a community-based sample. Further research is needed to determine whether interventions that reduce pulse pressure will limit the growing incidence of AF.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.297.7.709</identifier><identifier>PMID: 17312290</identifier><identifier>CODEN: JAMAAP</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Atrial Fibrillation - epidemiology ; Biological and medical sciences ; Blood Pressure ; Cardiac arrhythmia ; Cardiac dysrhythmias ; Cardiology. Vascular system ; Cohort Studies ; Female ; General aspects ; Heart ; Heart rate ; Humans ; Male ; Medical sciences ; Middle Aged ; Mortality ; Proportional Hazards Models ; Prospective Studies ; Pulse ; Risk Factors</subject><ispartof>JAMA : the journal of the American Medical Association, 2007-02, Vol.297 (7), p.709-715</ispartof><rights>2007 INIST-CNRS</rights><rights>Copyright American Medical Association Feb 21, 2007</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a360t-d3279ebef25024b3086652c30e1d7659985cd848d110c499d654baa130bdce623</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.297.7.709$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.297.7.709$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,776,780,3327,27901,27902,76232,76235</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18553060$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17312290$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mitchell, Gary F</creatorcontrib><creatorcontrib>Vasan, Ramachandran S</creatorcontrib><creatorcontrib>Keyes, Michelle J</creatorcontrib><creatorcontrib>Parise, Helen</creatorcontrib><creatorcontrib>Wang, Thomas J</creatorcontrib><creatorcontrib>Larson, Martin G</creatorcontrib><creatorcontrib>D’Agostino, Ralph B</creatorcontrib><creatorcontrib>Kannel, William B</creatorcontrib><creatorcontrib>Levy, Daniel</creatorcontrib><creatorcontrib>Benjamin, Emelia J</creatorcontrib><title>Pulse Pressure and Risk of New-Onset Atrial Fibrillation</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>CONTEXT Atrial fibrillation (AF) is responsible for considerable morbidity and mortality, making identification of modifiable risk factors a priority. Increased pulse pressure, a reflection of aortic stiffness, increases cardiac load and may increase AF risk. OBJECTIVE To examine relations between pulse pressure and incident AF. DESIGN, SETTING, AND PARTICIPANTS Prospective, community-based observational cohort in Framingham, Mass, including 5331 Framingham Heart Study participants aged 35 years and older and initially free from AF (median age, 57 years; 55% women). MAIN OUTCOME MEASURES Incident AF. RESULTS AF developed in 698 participants (13.1%) a median of 12 years after pulse pressure assessment. Cumulative 20-year AF incidence rates were 5.6% for pulse pressure of 40 mm Hg or less (25th percentile) and 23.3% for pulse pressure greater than 61 mm Hg (75th percentile). In models adjusted for age, sex, baseline and time-dependent change in mean arterial pressure, and clinical risk factors for AF (body mass index, smoking, valvular disease, diabetes, electrocardiographic left ventricular hypertrophy, hypertension treatment, and prevalent myocardial infarction or heart failure), pulse pressure was associated with increased risk for AF (adjusted hazard ratio [HR], 1.26 per 20-mm Hg increment; 95% confidence interval [CI], 1.12-1.43; P<.001). In contrast, mean arterial pressure was unrelated to incident AF (adjusted HR, 0.96 per 10-mm Hg increment; 95% CI, 0.88-1.05; P = .39). Systolic pressure was related to AF (HR, 1.14 per 20-mm Hg increment; 95% CI, 1.04-1.25; P = .006); however, if diastolic pressure was added, model fit improved and the diastolic relation was inverse (adjusted HR, 0.87 per 10-mm Hg increment; 95% CI, 0.78-0.96; P = .01), consistent with a pulse pressure effect. Among patients with interpretable echocardiographic images, the association between pulse pressure and AF persisted in models that adjusted for baseline left atrial dimension, left ventricular mass, and left ventricular fractional shortening (adjusted HR, 1.23; 95% CI, 1.09-1.39; P = .001). CONCLUSION Pulse pressure is an important risk factor for incident AF in a community-based sample. Further research is needed to determine whether interventions that reduce pulse pressure will limit the growing incidence of AF.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Atrial Fibrillation - epidemiology</subject><subject>Biological and medical sciences</subject><subject>Blood Pressure</subject><subject>Cardiac arrhythmia</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiology. Vascular system</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>General aspects</subject><subject>Heart</subject><subject>Heart rate</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Pulse</subject><subject>Risk Factors</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0UtLAzEQAOAgiq3Vq-BFFkFvWyfPTY6lWBWKLaLnJbvJQuo-NNlF_PdGWhW8mDnkkG-GmQlCpximGABfb3Sjp0Rl0xig9tAYcypTypXcR2MAJdOMSTZCRyFsIB5Ms0M0whnFhCgYI7ke6mCTtbchDN4mujXJowsvSVclD_Y9XbXB9sms907XycIV3tW17l3XHqODSsfUk909Qc-Lm6f5Xbpc3d7PZ8tUUwF9aijJlC1sRTgQVlCQQnBSUrDYZIIrJXlpJJMGYyiZUkZwVmiNKRSmtILQCbra1n313dtgQ583LpQ2dtHabgi5UECJoP9DrHhGCMcRXvyBm27wbRwiJxgzAKlUROc7NBSNNfmrd432H_n35iK43AEdSl1XXrelC79Ock5BfLmzrYsf9fNKgAvB6CdkIYHg</recordid><startdate>20070221</startdate><enddate>20070221</enddate><creator>Mitchell, Gary F</creator><creator>Vasan, Ramachandran S</creator><creator>Keyes, Michelle J</creator><creator>Parise, Helen</creator><creator>Wang, Thomas J</creator><creator>Larson, Martin G</creator><creator>D’Agostino, Ralph B</creator><creator>Kannel, William B</creator><creator>Levy, Daniel</creator><creator>Benjamin, Emelia J</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7U1</scope><scope>7U2</scope><scope>7X8</scope></search><sort><creationdate>20070221</creationdate><title>Pulse Pressure and Risk of New-Onset Atrial Fibrillation</title><author>Mitchell, Gary F ; Vasan, Ramachandran S ; Keyes, Michelle J ; Parise, Helen ; Wang, Thomas J ; Larson, Martin G ; D’Agostino, Ralph B ; Kannel, William B ; Levy, Daniel ; Benjamin, Emelia J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a360t-d3279ebef25024b3086652c30e1d7659985cd848d110c499d654baa130bdce623</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Atrial Fibrillation - epidemiology</topic><topic>Biological and medical sciences</topic><topic>Blood Pressure</topic><topic>Cardiac arrhythmia</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiology. Vascular system</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>General aspects</topic><topic>Heart</topic><topic>Heart rate</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Pulse</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mitchell, Gary F</creatorcontrib><creatorcontrib>Vasan, Ramachandran S</creatorcontrib><creatorcontrib>Keyes, Michelle J</creatorcontrib><creatorcontrib>Parise, Helen</creatorcontrib><creatorcontrib>Wang, Thomas J</creatorcontrib><creatorcontrib>Larson, Martin G</creatorcontrib><creatorcontrib>D’Agostino, Ralph B</creatorcontrib><creatorcontrib>Kannel, William B</creatorcontrib><creatorcontrib>Levy, Daniel</creatorcontrib><creatorcontrib>Benjamin, Emelia J</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>MEDLINE - Academic</collection><jtitle>JAMA : the journal of the American Medical Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mitchell, Gary F</au><au>Vasan, Ramachandran S</au><au>Keyes, Michelle J</au><au>Parise, Helen</au><au>Wang, Thomas J</au><au>Larson, Martin G</au><au>D’Agostino, Ralph B</au><au>Kannel, William B</au><au>Levy, Daniel</au><au>Benjamin, Emelia J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pulse Pressure and Risk of New-Onset Atrial Fibrillation</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>2007-02-21</date><risdate>2007</risdate><volume>297</volume><issue>7</issue><spage>709</spage><epage>715</epage><pages>709-715</pages><issn>0098-7484</issn><eissn>1538-3598</eissn><coden>JAMAAP</coden><abstract>CONTEXT Atrial fibrillation (AF) is responsible for considerable morbidity and mortality, making identification of modifiable risk factors a priority. Increased pulse pressure, a reflection of aortic stiffness, increases cardiac load and may increase AF risk. OBJECTIVE To examine relations between pulse pressure and incident AF. DESIGN, SETTING, AND PARTICIPANTS Prospective, community-based observational cohort in Framingham, Mass, including 5331 Framingham Heart Study participants aged 35 years and older and initially free from AF (median age, 57 years; 55% women). MAIN OUTCOME MEASURES Incident AF. RESULTS AF developed in 698 participants (13.1%) a median of 12 years after pulse pressure assessment. Cumulative 20-year AF incidence rates were 5.6% for pulse pressure of 40 mm Hg or less (25th percentile) and 23.3% for pulse pressure greater than 61 mm Hg (75th percentile). In models adjusted for age, sex, baseline and time-dependent change in mean arterial pressure, and clinical risk factors for AF (body mass index, smoking, valvular disease, diabetes, electrocardiographic left ventricular hypertrophy, hypertension treatment, and prevalent myocardial infarction or heart failure), pulse pressure was associated with increased risk for AF (adjusted hazard ratio [HR], 1.26 per 20-mm Hg increment; 95% confidence interval [CI], 1.12-1.43; P<.001). In contrast, mean arterial pressure was unrelated to incident AF (adjusted HR, 0.96 per 10-mm Hg increment; 95% CI, 0.88-1.05; P = .39). Systolic pressure was related to AF (HR, 1.14 per 20-mm Hg increment; 95% CI, 1.04-1.25; P = .006); however, if diastolic pressure was added, model fit improved and the diastolic relation was inverse (adjusted HR, 0.87 per 10-mm Hg increment; 95% CI, 0.78-0.96; P = .01), consistent with a pulse pressure effect. Among patients with interpretable echocardiographic images, the association between pulse pressure and AF persisted in models that adjusted for baseline left atrial dimension, left ventricular mass, and left ventricular fractional shortening (adjusted HR, 1.23; 95% CI, 1.09-1.39; P = .001). CONCLUSION Pulse pressure is an important risk factor for incident AF in a community-based sample. Further research is needed to determine whether interventions that reduce pulse pressure will limit the growing incidence of AF.</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>17312290</pmid><doi>10.1001/jama.297.7.709</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Atrial Fibrillation - epidemiology Biological and medical sciences Blood Pressure Cardiac arrhythmia Cardiac dysrhythmias Cardiology. Vascular system Cohort Studies Female General aspects Heart Heart rate Humans Male Medical sciences Middle Aged Mortality Proportional Hazards Models Prospective Studies Pulse Risk Factors |
| title | Pulse Pressure and Risk of New-Onset Atrial Fibrillation |
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