@article {7917, title = {Modifiable Predictors of Ventricular Ectopy in the Community.}, journal = {J Am Heart Assoc}, volume = {7}, year = {2018}, month = {2018 Nov 20}, pages = {e010078}, abstract = {

Background Premature ventricular contractions (PVCs) predict heart failure and death. Data regarding modifiable risk factors for PVCs are scarce. Methods and Results We studied 1424 Cardiovascular Health Study participants randomly assigned to 24-hour Holter monitoring. Demographics, comorbidities, habits, and echocardiographic measurements were examined as predictors of PVC frequency and, among 845 participants, change in PVC frequency 5~years later. Participants exhibited a median of 0.6 (interquartile range, 0.1-7.1) PVCs per hour. Of the more directly modifiable characteristics and after multivariable adjustment, every SD increase in systolic blood pressure was associated with 9\% more PVCs (95\% confidence interval [CI], 2\%-17\%; P=0.01), regularly performing no or low-intensity exercise compared with more physical activity was associated with ≈15\% more PVCs (95\% CI, 3-25\%; P=0.02), and those with a history of smoking exhibited an average of 18\% more PVCs (95\% CI, 3-36\%; P=0.02) than did never smokers. After 5~years, PVC frequency increased from a median of 0.5 (IQR, 0.1-4.7) to 1.2 (IQR, 0.1-13.8) per hour ( P<0.0001). Directly modifiable predictors of 5-year increase in PVCs, described as the odds per each quintile increase in PVCs, included increased diastolic blood pressure (odds ratio per SD increase, 1.16; 95\% CI, 1.02-1.31; P=0.02) and a history of smoking (OR, 1.31; 95\% CI, 1.02-1.68; P=0.04). Conclusions Enhancing physical activity, smoking cessation, and aggressive control of blood pressure may represent fruitful strategies to mitigate PVC frequency and PVC-associated adverse outcomes.

}, issn = {2047-9980}, doi = {10.1161/JAHA.118.010078}, author = {Kerola, Tuomas and Dewland, Thomas A and Vittinghoff, Eric and Heckbert, Susan R and Stein, Phyllis K and Marcus, Gregory M} } @article {8006, title = {Predictors of atrial ectopy and their relationship to atrial fibrillation risk.}, journal = {Europace}, year = {2019}, month = {2019 Mar 06}, abstract = {

AIMS: Premature atrial contractions (PACs) are known to trigger and predict atrial fibrillation (AF). We sought to identify the determinants of PACs and the degree to which PACs mediate the effects of established risk factors for AF.

METHODS AND RESULTS: Predictors of baseline PAC frequency were examined using a Holter Study among 1392 participants in the Cardiovascular Health Study, a community-based cohort of individuals aged >=65 years. Participants were then followed for their first diagnosis of AF. Independent predictors of PACs were identified, and the extent to which PACs might mediate the relationship between those predictors and AF was determined. The median hourly frequency of PACs was 2.7 (interquartile range 0.8-12.1). After multivariable adjustment, increasing age, increasing height, decreasing body mass index, and a history of myocardial infarction were each associated with more PACs. Regarding modifiable predictors, participants using beta-blockers had 21\% less [95\% confidence interval (95\% CI) 9-30\%, P = 0.001] and those performing at least moderate intensity exercise vs. lower intensity exercisers had 10\% less (95\% CI 1-18\%, P = 0.03) PACs. Higher PAC frequency explained 34\% (95\% CI 22-57\%, P < 0.0001) of the relationship between increasing age and AF risk and 27\% (95\% CI 10-75\%, P = 0.004) of the relationship between taller height and AF risk.

CONCLUSION: Enhancing physical activity and use of beta-blockers may represent fruitful strategies to mitigate PAC frequency. A substantial proportion of the excess risk of AF due to increasing age and taller height may be explained by an increase in PAC frequency.

}, issn = {1532-2092}, doi = {10.1093/europace/euz008}, author = {Kerola, Tuomas and Dewland, Thomas A and Vittinghoff, Eric and Heckbert, Susan R and Stein, Phyllis K and Marcus, Gregory M} }