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Association of sick sinus syndrome with incident cardiovascular disease and mortality: the Atherosclerosis Risk in Communities study and Cardiovascular Health Study.
PLoS One. 2014; 9(10):e109662.Plos

Abstract

BACKGROUND

Sick sinus syndrome (SSS) is a common indication for pacemaker implantation. Limited information exists on the association of sick sinus syndrome (SSS) with mortality and cardiovascular disease (CVD) in the general population.

METHODS

We studied 19,893 men and women age 45 and older in the Atherosclerosis Risk in Communities (ARIC) study and the Cardiovascular Health Study (CHS), two community-based cohorts, who were without a pacemaker or atrial fibrillation (AF) at baseline. Incident SSS cases were validated by review of medical charts. Incident CVD and mortality were ascertained using standardized protocols. Multivariable Cox models were used to estimate the association of incident SSS with selected outcomes.

RESULTS

During a mean follow-up of 17 years, 213 incident SSS events were identified and validated (incidence, 0.6 events per 1,000 person-years). After adjustment for confounders, SSS incidence was associated with increased mortality (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.14-1.70), coronary heart disease (HR 1.72, 95%CI 1.11-2.66), heart failure (HR 2.87, 95%CI 2.17-3.80), stroke (HR 1.56, 95%CI 0.99-2.46), AF (HR 5.75, 95%CI 4.43-7.46), and pacemaker implantation (HR 53.7, 95%CI 42.9-67.2). After additional adjustment for other incident CVD during follow-up, SSS was no longer associated with increased mortality, coronary heart disease, or stroke, but remained associated with higher risk of heart failure (HR 2.00, 95%CI 1.51-2.66), AF (HR 4.25, 95%CI 3.28-5.51), and pacemaker implantation (HR 25.2, 95%CI 19.8-32.1).

CONCLUSION

Individuals who develop SSS are at increased risk of death and CVD. The mechanisms underlying these associations warrant further investigation.

Authors+Show Affiliations

Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America.Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America.Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America.Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America.Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington, United States of America; Group Health Research Institute, Group Health Cooperative, Seattle, Washington, United States of America.Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America.Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25285853

Citation

Alonso, Alvaro, et al. "Association of Sick Sinus Syndrome With Incident Cardiovascular Disease and Mortality: the Atherosclerosis Risk in Communities Study and Cardiovascular Health Study." PloS One, vol. 9, no. 10, 2014, pp. e109662.
Alonso A, Jensen PN, Lopez FL, et al. Association of sick sinus syndrome with incident cardiovascular disease and mortality: the Atherosclerosis Risk in Communities study and Cardiovascular Health Study. PLoS One. 2014;9(10):e109662.
Alonso, A., Jensen, P. N., Lopez, F. L., Chen, L. Y., Psaty, B. M., Folsom, A. R., & Heckbert, S. R. (2014). Association of sick sinus syndrome with incident cardiovascular disease and mortality: the Atherosclerosis Risk in Communities study and Cardiovascular Health Study. PloS One, 9(10), e109662. https://doi.org/10.1371/journal.pone.0109662
Alonso A, et al. Association of Sick Sinus Syndrome With Incident Cardiovascular Disease and Mortality: the Atherosclerosis Risk in Communities Study and Cardiovascular Health Study. PLoS One. 2014;9(10):e109662. PubMed PMID: 25285853.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of sick sinus syndrome with incident cardiovascular disease and mortality: the Atherosclerosis Risk in Communities study and Cardiovascular Health Study. AU - Alonso,Alvaro, AU - Jensen,Paul N, AU - Lopez,Faye L, AU - Chen,Lin Y, AU - Psaty,Bruce M, AU - Folsom,Aaron R, AU - Heckbert,Susan R, Y1 - 2014/10/06/ PY - 2014/07/07/received PY - 2014/09/08/accepted PY - 2014/10/7/entrez PY - 2014/10/7/pubmed PY - 2015/12/17/medline SP - e109662 EP - e109662 JF - PloS one JO - PLoS One VL - 9 IS - 10 N2 - BACKGROUND: Sick sinus syndrome (SSS) is a common indication for pacemaker implantation. Limited information exists on the association of sick sinus syndrome (SSS) with mortality and cardiovascular disease (CVD) in the general population. METHODS: We studied 19,893 men and women age 45 and older in the Atherosclerosis Risk in Communities (ARIC) study and the Cardiovascular Health Study (CHS), two community-based cohorts, who were without a pacemaker or atrial fibrillation (AF) at baseline. Incident SSS cases were validated by review of medical charts. Incident CVD and mortality were ascertained using standardized protocols. Multivariable Cox models were used to estimate the association of incident SSS with selected outcomes. RESULTS: During a mean follow-up of 17 years, 213 incident SSS events were identified and validated (incidence, 0.6 events per 1,000 person-years). After adjustment for confounders, SSS incidence was associated with increased mortality (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.14-1.70), coronary heart disease (HR 1.72, 95%CI 1.11-2.66), heart failure (HR 2.87, 95%CI 2.17-3.80), stroke (HR 1.56, 95%CI 0.99-2.46), AF (HR 5.75, 95%CI 4.43-7.46), and pacemaker implantation (HR 53.7, 95%CI 42.9-67.2). After additional adjustment for other incident CVD during follow-up, SSS was no longer associated with increased mortality, coronary heart disease, or stroke, but remained associated with higher risk of heart failure (HR 2.00, 95%CI 1.51-2.66), AF (HR 4.25, 95%CI 3.28-5.51), and pacemaker implantation (HR 25.2, 95%CI 19.8-32.1). CONCLUSION: Individuals who develop SSS are at increased risk of death and CVD. The mechanisms underlying these associations warrant further investigation. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/25285853/Association_of_sick_sinus_syndrome_with_incident_cardiovascular_disease_and_mortality:_the_Atherosclerosis_Risk_in_Communities_study_and_Cardiovascular_Health_Study_ L2 - https://dx.plos.org/10.1371/journal.pone.0109662 DB - PRIME DP - Unbound Medicine ER -