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Endurance exercise and atrial fibrillation. Atrial fibrillation among Norwegian veteran endurance athletes and the association between endurance exercise and risk of atrial fibrillation

机译：耐力运动和心房颤动。挪威退伍军人耐力运动员心房颤动与耐力运动与心房颤动风险之间的关系

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Background Atrial fibrillation (AF) is the most common clinically relevant cardiac arrhythmia. AF is associated with reduced functional capacity and other symptoms, drug use, poor subjective health, increased risk of ischemic stroke and increased mortality. Physical activity (PA) reduces the risk of cardiovascular diseases and has multiple beneficial health effects, but male endurance athletes seem to have an increased risk of AF. Few studies, however, have investigated the association between prolonged endurance exercise and the risk of AF, and this association has not been studied in women previously. The number of individuals aged >40 years that engage in endurance sports events is increasing, but few studies have investigated the association between endurance sport practice and risk of AF in veteran athletes. Furthermore, AF and its consequences have been just sporadically described in veteran athletes previously. The main aims of this thesis were 1) to investigate endurance sport practice as a risk factor for AF in veteran athletes (paper I), 2) to investigate the association between prolonged regular endurance exercise and risk of AF in men (paper II), 3) to investigate the association between prolonged regular endurance exercise and risk of AF in women (paper III), and 4) to characterize AF and investigate PA, endurance exercise, symptoms, drug use and subjective health in veteran athletes with AF (paper IV).Methods Paper I is based on the Birkebeiner Ageing Study. In this cross-sectional study, 509 out of 607 invited men (84%) aged =65 years who took part in the 54-kilometer Birkebeiner cross-country ski race in 2009 or 2010 participated. These veteran athletes were compared to 1768 out of 2757 invited men aged =65 years (68%) participating in a population-based health study. The main outcome AF was self-reported by questionnaires. The main exposure was endurance sport practice, defined as participating in the Birkebeiner race. We calculated adjusted risk differences (aRDs) for AF with 95% confidence intervals (CIs) using a linear regression model. In the papers II and III, we investigated the association between prolonged regular endurance exercise and the risk of AF in men and women, respectively. These papers are based on a second study, the Birkebeiner Atrial Fibrillation Study. The study population of this retrospective cohort study comprised two distinct cohorts: 1) Veteran athletes aged =53 years who had participated in the Birkebeiner race in 1999, and 2) participants in the same group in a population-based health study. In total, 5390 out of 7500 invited men and women (72%) took part in the Birkebeiner Atrial Fibrillation Study. In the study of men (paper II), the main outcome was AF and atrial flutter (AFL) confirmed by electrocardiograms (ECGs) in a review of medical records. Due to the low number of confirmed AF cases among female participants, self-reported AF was the main outcome in the analysis of women (paper III). The main exposure, years of regular endurance exercise was self-reported by questionnaires. Regular endurance exercise was defined as exercise for at least 30 minutes =3 times per week with the purpose of increasing physical endurance capacity. Adjusted odds ratios (aORs) for AF with CIs were calculated using weighted logistic regression models. Also paper IV is based on the Birkebeiner Atrial Fibrillation Study. In this study, we characterized AF in detail among 140 veteran skiers and 118 individuals from the general population with confirmed AF. Furthermore, we investigated engagement in PA and endurance exercise after the onset of AF, palpitations, functional capacity, drug-use and subjective health in veteran athletes with AF and in the general AF population.Results The prevalence of self-reported AF in the Birkebeiner Ageing Study was 13.2% in the veteran athletes and 11.6% in the men from the general population. After multivariable adjustment for age, height, body mass index (BMI), coronary heart disease (CHD), hypertension, diabetes mellitus, smoking, alcohol consumption, leisure-time PA during the past year and education, endurance sport practice was associated with an added risk of AF of 6 percent points (pp) (aRD 6.0 (CI 0.8-11.1)), corresponding to an aOR of 1.90 (CI 1.14-3.18). In the Birkebeiner Atrial Fibrillation Study, the prevalence of self-reported AF was 12.5% among the male veteran athletes. After multivariable adjustment for age, height, concomitant heart disease, hypertension, diabetes mellitus and cohort affiliation, years of regular endurance exercise was associated with a gradually increased risk of both AF and AFL. Per 10 years of exercise, the aOR was 1.16 (CI 1.06-1.29) for AF and 1.42 (CI 1.20-1.69) for AFL. In stratified analyses, the associations were significant both in the veteran athletes and in the men from the general population. Men who had exercised regularly for =40 years had an aOR for AF of 1.94 (CI 1.19-3.14)) compared to men who had never exercised regularly. The prevalence of self-reported AF among female veteran skiers was 8%. After multivariable adjustment for age, BMI, concomitant heart disease, hypertension, diabetes mellitus and cohort affiliation, women who had exercised regularly for =40 years had an increased risk of AF of borderline significance (aOR 2.18 (CI 0.94-5.06)) compared to women who had never exercised regularly. Among veteran athletes with AF, 52% had paroxysmal, 23% had persistent and 24% had permanent AF. AF was associated with poor subjective health, but 89% of the veteran athletes were physically active and 64% engaged in regular endurance exercise after the onset of AF. While 59% had experienced palpitations during the past year, 32% reported reduced functional capacity. Two out of three with AF and an estimated CHA2DS2-VASc score =2 used oral anticoagulants (OACs).Conclusions In conclusion, 1) endurance sport practice seemed to be a risk factor for AF in men aged =65 years, 2) years of regular endurance exercise was associated with a gradually increased risk of both AF and AFL in men, 3) our study indicated that prolonged endurance exercise might be associated with AF also in women, and 4) AF was associated with poor subjective health, but the vast majority of veteran athletes engaged in regular PA and endurance exercise also after the onset of AF.
机译：背景心房颤动（AF）是最常见的临床相关心律不齐。 AF与功能能力下降和其他症状，药物使用，主观健康状况不佳，缺血性中风的风险增加和死亡率增加相关。进行体育锻炼（PA）可以降低罹患心血管疾病的风险，并具有多种有益健康的作用，但是耐力较强的男性运动员患AF的风险似乎也增加了。然而，很少有研究调查长时间的耐力运动与房颤风险之间的关系，而且以前没有在女性中研究这种关系。从事耐力运动项目的年龄> 40岁的人数在增加，但是很少有研究调查耐力运动实践与资深运动员房颤风险之间的关系。此外，以前在资深运动员中偶而描述了AF及其后果。本论文的主要目的是：1）研究耐力运动习惯作为老龄运动员房颤的危险因素（论文I），2）研究长期耐力运动与男性房颤风险之间的关系（论文II）， 3）调查长期定期耐力运动与女性房颤风险之间的关系（论文III），以及4）表征房颤的特征并调查患有房颤的退役运动员的PA，耐力运动，症状，药物使用和主观健康状况（论文IV方法论文I基于Birkebeiner老化研究。在这项横断面研究中，在2009年或2010年参加过54公里Birkebeiner越野滑雪比赛的607名受邀男子中，其中509名年龄在= 65岁以下（占84％）参加了比赛。将这些资深运动员与参加基于人群健康研究的2757名受邀年龄= 65岁（68％）的男性中的1768名进行了比较。 AF的主要结局是通过问卷调查自我报告的。主要的接触是耐力运动实践，被定义为参加Birkebeiner比赛。我们使用线性回归模型计算了具有95％置信区间（CIs）的房颤的校正风险差（aRDs）。在论文II和III中，我们分别研究了长期定期耐力运动与男女房颤风险之间的关系。这些论文基于第二项研究，即Birkebeiner心房颤动研究。这项回顾性队列研究的研究人群包括两个截然不同的队列：1）年龄= 53岁的退役运动员参加了1999年的比克贝纳竞赛，以及2）参加基于人群的健康研究的同一组。在7500名受邀男女中，有5390名（占72％）参加了Birkebeiner心房颤动研究。在男性研究（论文II）中，主要结果是心电图（ECG）在回顾病历中证实了房颤和房扑（AFL）。由于女性参与者中确诊的AF病例较少，自我报告的AF是分析女性的主要结果（论文III）。主要的暴露，定期的耐力锻炼的年限是通过问卷调查自我报告的。定期耐力运动的定义是每周至少锻炼30分钟= 3次，目的是增加身体耐力。使用加权逻辑回归模型计算具有CI的AF的调整后优势比（aOR）。论文IV也是基于Birkebeiner心房颤动研究。在这项研究中，我们对140名经验丰富的滑雪者和118名已确诊AF的普通人群中的AF进行了详细描述。此外，我们调查了AF退伍军人和普通AF人群中AF发作后的PA和耐力运动的参与程度，心capacity，功能能力，药物使用和主观健康状况。结果Birkebeiner中自我报告的AF流行老龄运动员的老龄化研究占总人口的13.2％，男性占11.6％。在对年龄，身高，体重指数（BMI），冠心病（CHD），高血压，糖尿病，吸烟，饮酒，休闲时间PA和过去一年的教育进行多变量调整后，耐力运动习惯与房颤的风险增加了6％（pp）（aRD 6.0（CI 0.8-11.1）），相当于aOR为1.90（CI 1.14-3.18）。在Birkebeiner心房颤动研究中，男性退伍军人运动员中自我报告的AF患病率为12.5％。在对年龄，身高，伴随心脏病，高血压，糖尿病和队列隶属关系进行多变量调整后，多年的定期耐力运动与AF和AFL的风险逐渐增加有关。每运动10年，房颤的aOR为1.16（CI 1.06-1.29），而AFL为1.42（CI 1.20-1.69）。在分层分析中，这种关系对于资深运动员和普通人群中的男性都是重要的。定期运动= 40年的男性与未曾定期运动的男性相比，房颤的aOR为1.94（CI 1.19-3.14）。资深女性滑雪者自我报告的房颤患病率为8％。在对年龄，BMI，伴发的心脏病，高血压，糖尿病和队列隶属关系进行多变量调整之后，定期运动= 40年的女性发生房颤的危险性升高（aOR 2.18（CI 0.94-5.06）），高于临界值从未定期锻炼的女性。在患有AF的资深运动员中，阵发性为52％，持续性为23％，永久性AF为24％。 AF与主观健康状况不佳有关，但在AF发作后，有89％的资深运动员身体活跃，有64％的人定期进行耐力运动。在过去的一年中，有59％的人感到心pal，而32％的人表示其功能下降。三分之二的房颤患者，CHA2DS2-VASc得分估计为2，使用口服抗凝剂（OAC）。结论：1）耐力运动似乎是65岁男性房颤的危险因素，2）定期的耐力运动与男性患AF和AFL的风险逐渐增加有关，3）我们的研究表明，长期耐力运动可能与女性的AF有关，并且4）AF与主观健康状况不佳相关，但是在AF发作后，大多数资深运动员也会进行常规的PA和耐力运动。

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    Myrstad, Marius;

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