Correlates and consequences of atrial fibrillation in a prospective study of 25 000 participants in the China Kadoorie Biobank
Authors: Turnbull Iain , Camm Christian Fielder , Halsey Jim , Du Huaidong , Bennett Derrick A , Chen Yiping , Yu Canqing , Sun Dianyianji , Liu Xiaohong , Li Liming , Chen Zhengming , Clarke Robert ,   China Kadoorie Biobank Study Group, Chen Junshi , Chen Zhengming , Clarke Robert , Collins Rory , Li Liming , Lv Jun , Peto Richard , Walters Robin , Avery Daniel , Bennett Derrick , Boxall Ruth , Chan Ka Hung , Chen Yiping , Chen Zhengming , Clarke Charlotte , Clarke Johnathan , Clarke Robert , Du Huaidong , Ma Geoffrey , Mohamed Ahmed Edris , Fry Hannah , Gilbert Simon , Im Pek Kei , Iona Andri , Kakkoura Maria , Kartsonaki Christiana , Lam Hubert , Lin Kuang , Liu James , Mazidi Mohsen , Millwood Iona , Morris Sam , Nie Qunhua , Pozarickij Alfred , Rahmati Maryam , Ryder Paul , Schmidt Dan , Stevens Becky , Turnbull Iain , Walters Robin , Wang Baihan , Wang Lin , Wright Neil , Yang Ling , Yang Xiaoming , Yao Pang , Han Xiao , Hou Can , Xia Qingmei , Liu Chao , Lv Jun , Pei Pei , Sun Dianjianyi , Yu Canqing , Pan Lang , Chen Naying , Liu Duo , Tang Zhenzhu , Chen Ningyu , Jiang Qilian , Lan Jian , Li Mingqiang , Liu Yun , Meng Fanwen , Meng Jinhuai , Pan Rong , Qin Yulu , Wang Ping , Wang Sisi , Wei Liuping , Zhou Liyuan , Dong Caixia , Ge Pengfei , Ren Xiaolan , Li Zhongxiao , Mao Enke , Wang Tao , Zhang Hui , Zhang Xi , Chen Jinyan , Hu Ximin , Wang Xiaohuan , Guo Zhendong , Li Huimei , Li Yilei , Weng Min , Wu Shukuan , Yan Shichun , Zou Mingyuan , Zhou Xue , Guo Ziyan , Kang Quan , Li Yanjie , Yu Bo , Xu Qinai , Chang Liang , Fan Lei , Feng Shixian , Zhang Ding , Zhou Gang , Gao Yulian , He Tianyou , He Pan , Hu Chen , Sun Huarong , Zhang Xukui , Chen Biyun , Fu Zhongxi , Huang Yuelong , Liu Huilin , Xu Qiaohua , Yin Li , Long Huajun , Xu Xin , Zhang Hao , Zhang Libo , Su Jian , Tao Ran , Wu Ming , Yang Jie , Zhou Jinyi , Zhou Yonglin , Hu Yihe , Hua Yujie , Jin Jianrong , Liu Fang , Liu Jingchao , Lu Yan , Ma Liangcai , Tang Aiyu , Zhang Jun , Cheng Liang , Du Ranran , Gao Ruqin , Li Feifei , Li Shanpeng , Liu Yongmei , Ning Feng , Pang Zengchang , Sun Xiaohui , Tian Xiaocao , Wang Shaojie , Zhai Yaoming , Zhang Hua , Hou Wei , Lv Silu , Wang Junzheng , Chen Xiaofang , Wu Xianping , Zhang Ningmei , Zhou Weiwei , Chen Xiaofang , Li Jianguo , Liu Jiaqiu , Luo Guojin , Sun Qiang , Zhong Xunfu , Gong Weiwei , Hu Ruying , Wang Hao , Wang Meng , Yu Min , Chen Lingli , Gu Qijun , Pan Dongxia , Wang Chunmei , Xie Kaixu , Zhang Xiaoyi 
Published: March 2024

Abstract

Aims
The prevalence of atrial fibrillation (AF) is positively correlated with prior cardiovascular diseases (CVD) and CVD risk factors but is lower in Chinese than Europeans despite their higher burden of CVD. We examined the prevalence and prognosis of AF and other electrocardiogram (ECG) abnormalities in the China Kadoorie Biobank.

Methods and results
A random sample of 25 239 adults (mean age 59.5 years, 62% women) had a 12-lead ECG recorded and interpreted using a Mortara VERITAS™ algorithm in 2013–14. Participants were followed up for 5 years for incident stroke, ischaemic heart disease, heart failure (HF), and all CVD, overall and by CHA2DS2-VASc scores, age, sex, and area. Overall, 1.2% had AF, 13.6% had left ventricular hypertrophy (LVH), and 28.1% had ischaemia (two-thirds of AF cases also had ischaemia or LVH). The prevalence of AF increased with age, prior CVD, and levels of CHA₂DS₂-VASc scores (0.5%, 1.3%, 2.1%, 2.9%, and 4.4% for scores &lt;2, 2, 3, 4, and ≥5, respectively). Atrial fibrillation was associated with two-fold higher hazard ratios (HR) for CVD (2.15; 95% CI, 1.71–2.69) and stroke (1.88; 1.44–2.47) and a four-fold higher HR for HF (3.79; 2.21–6.49). The 5-year cumulative incidence of CVD was comparable for AF, prior CVD, and CHA₂DS₂-VASc scores ≥ 2 (36.7% vs. 36.2% vs. 37.7%, respectively) but was two-fold greater than for ischaemia (19.4%), LVH (18.0%), or normal ECG (14.1%), respectively.

Conclusion
The findings highlight the importance of screening for AF together with estimation of CHA₂DS₂-VASc scores for prevention of CVD in Chinese adults.