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期刊来源：Nat Med

原文链接：https://doi.org/10.1038/s41591-024-03049-9

摘要内容如下：

房颤（AF）血栓栓塞的预防通常仅限于具有特定危险因素的患者，而忽视了血管性痴呆等结果。这项基于人群的队列研究使用了5，199，994名初级保健患者的电子医疗记录（英国；2005-2020）。共有290，525人（5.6%）被诊断为房颤，年龄在40-75岁之间，其中36，340人没有卒中病史，根据临床危险因素，卒中的感知风险较低，并且没有口服抗凝剂处方。将年龄、性别和地区与117，298名无房颤的对照者进行匹配。在5年的中位随访期间（831，005人-年），房颤组卒中发生率为3.8%，对照组为1.5%（校正风险比（HR）2.06，95%置信区间（CI）1.91-2.21；P<0.001），动脉血栓栓塞0.3%对0.1%（HR 2.39，95%CI 1.83-3.11；P<0.001），全因死亡率分别为8.9%和5.0%（HR 1.44，95%CI 1.38-1.50；P<0.001）。AF与全因痴呆相关（HR 1.17，95%CI 1.04-1.32；P=0.010），血管性痴呆（HR 1.68，95%CI 1.33-2.12；P<0.001）而不是阿尔茨海默病（HR 0.85，95%CI 0.70-1.03；P=0.09）。尽管缺乏传统的卒中危险因素，但房颤患者的死亡和血栓栓塞结局（包括血管性痴呆）显著增加。

英文原文如下：

Abstracts

The prevention of thromboembolism in atrial fibrillation (AF) is typically restricted to patients with specific risk factors and ignores outcomes such as vascular dementia. This population-based cohort study used electronic healthcare records from 5,199,994 primary care patients (UK; 2005-2020). A total of 290,525 (5.6%) had a diagnosis of AF and were aged 40-75 years, of which 36,340 had no history of stroke, a low perceived risk of stroke based on clinical risk factors and no oral anticoagulant prescription. Matching was performed for age, sex and region to 117,298 controls without AF. During 5 years median follow-up (831,005 person-years), incident stroke occurred in 3.8% with AF versus 1.5% control (adjusted hazard ratio (HR) 2.06, 95% confidence interval (CI) 1.91-2.21; P < 0.001), arterial thromboembolism 0.3% versus 0.1% (HR 2.39, 95% CI 1.83-3.11; P < 0.001), and all-cause mortality 8.9% versus 5.0% (HR 1.44, 95% CI 1.38-1.50; P < 0.001). AF was associated with all-cause dementia (HR 1.17, 95% CI 1.04-1.32; P = 0.010), driven by vascular dementia (HR 1.68, 95% CI 1.33-2.12; P < 0.001) rather than Alzheimer's disease (HR 0.85, 95% CI 0.70-1.03; P = 0.09). Death and thromboembolic outcomes, including vascular dementia, are substantially increased in patients with AF despite a lack of conventional stroke risk factors.

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