Heart：喝酒多可预测房颤患者血栓栓塞或死亡

　　英国一项前瞻性队列研究表明，即使对确定的临床危险因素进行校正之后，高酒精摄入量仍可预测血栓栓塞或死亡，并且有助于鉴别心房颤动高危人群。论文6月13日在线发表于《心脏》（Heart）杂志。

　　该研究纳入了3107例年龄在50—64岁之间的阵发性房颤患者，其中男、女性分别为1999例和1108例。主要评估指标为血栓栓塞和死亡的复合事件。

　　结果显示，在中位随访的4.9年间，发生死亡和血栓栓塞事件分别为608例和211例。那些发展为房颤的患者中，分别有690例男性（35%）和233例女性（21%）存在高酒精摄入量（男性>20杯/周，女性>13杯/周）。校正口服抗凝剂和CHA2DS2-VASc评分后，喝酒>27杯/周的男性血栓栓塞和死亡危险要高于 <14杯/周的男性；喝酒>20杯/周的女性上述危险也较高。喝酒多的男性死亡率较高（HR值为1.51），而喝酒多的女性血栓栓塞发生率较高（HR值为1.71）。

Alcohol intake and prognosis of atrial fibrillation patients
Abstract
Objective To assess alcohol intake as a risk factor for adverse events among patients with incident atrial fibrillation (AF).
Design Prospective cohort study.
Setting Population based cohort study and nationwide Danish registries.
Patients The Danish Diet, Cancer and Health study included 57 053 participants (27 178 men and 29 875 women) aged between 50 and 64 years. The study population for this study included the 3107 participants (1999 men, 1108 women) who developed incident AF after inclusion.
Main outcome measures A composite of thromboembolism or death.
Results During a median follow-up of 4.9 years 608 deaths and 211 thromboembolic events occurred. Of those who developed AF, 690 (35%) men and 233 (21%) women had a high intake of alcohol (>20 drinks/week for men and >13 drinks/week for women). After adjustment for use of oral anticoagulation and components of the CHA2DS2-VASc score, men with an intake of >27 drinks/week had a higher risk for thromboembolism or death (hazard ratio (HR) 1.33, 95% CI 1.08 to 1.63) than men with an intake of <14 drinks/week. Women with an intake of >20 drinks/week also had a higher risk (HR 1.23, 95% CI 0.78 to 1.96) than women in the low intake category. The higher risk among men was primarily driven by mortality (HR 1.51, 95% CI 1.20 to 1.89), whereas the risk found among women was driven by thromboembolism (HR 1.71, 95% CI 0.81 to 3.60).
Conclusions High alcohol intake predicts thromboembolism or death, even after adjustment for established clinical risk factors, and may help identify high risk AF patients who could be targeted for stroke and cardiovascular prevention strategies.