Background Little is known about the incidence of and risk factors for sick sinus syndrome (SSS), a common indication for pacemaker implantation. Objectives To describe the epidemiology of SSS. Methods This analysis included 20,572 participants (mean baseline age 59 years, 43% male) in the Atherosclerosis Risk in Communities (ARIC) study and the Cardiovascular Health Study (CHS), who at baseline were free of prevalent atrial fibrillation and pacemaker therapy, had a heart rate of ≥50 bpm unless using beta blockers, and were identified as white or black race. Incident SSS cases were identified by hospital discharge ICD-9-CM code 427.81 and validated by medical record review. Results During an average 17 years of follow-up, 291 incident SSS cases were identified (unadjusted rate 0.8 per 1,000 person-years). Incidence increased with age (HR 1.73, 95% CI: 1.47–2.05 per 5-year increment), and blacks had a 41% lower risk of SSS than whites (HR: 0.59, 95% CI: 0.37–0.98). Incident SSS was associated with greater baseline body mass index, height, NT-proBNP, and cystatin C, with longer QRS interval, with lower heart rate, and with prevalent hypertension, right bundle branch block, and cardiovascular disease. We project that the annual number of new SSS cases in the United States will increase from 78,000 in 2012 to 172,000 in 2060. Conclusions Blacks have a lower risk of SSS than whites, and several cardiovascular risk factors were associated with incident SSS. With the aging of the population, the number of Americans with SSS will increase dramatically over the next 50 years.

BackgroundProspective data examining the relationship between dietary protein intake and incident coronary heart disease (CHD) are inconclusive. Most evidence is derived from homogenous populations such as health professionals. Large community-based analyses in more diverse samples are lacking.MethodsWe studied the association of protein type and major dietary protein sources and risk for incident CHD in 12,066 middle-aged adults (aged 45–64 at baseline, 1987–1989) from four U.S. communities enrolled in the Atherosclerosis Risk in Communities (ARIC) Study who were free of diabetes mellitus and cardiovascular disease at baseline. Dietary protein intake was assessed at baseline and after 6 years of follow-up by food frequency questionnaire. Our primary outcome was adjudicated coronary heart disease events or deaths with following up through December 31, 2010. Cox proportional hazard models with multivariable adjustment were used for statistical analyses.ResultsDuring a median follow-up of 22 years, there were 1,147 CHD events. In multivariable analyses total, animal and vegetable protein were not associated with an increased risk for CHD before or after adjustment. In food group analyses of major dietary protein sources, protein intake from red and processed meat, dairy products, fish, nuts, eggs, and legumes were not significantly associated with CHD risk. The hazard ratios [with 95% confidence intervals] for risk of CHD across quintiles of protein from poultry were 1.00 [ref], 0.83 [0.70–0.99], 0.93 [0.75–1.15], 0.88 [0.73–1.06], 0.79 [0.64–0.98], P for trend  = 0.16). Replacement analyses evaluating the association of substituting one source of dietary protein for another or of decreasing protein intake at the expense of carbohydrates or total fats did not show any statistically significant association with CHD risk.ConclusionBased on a large community cohort we found no overall relationship between protein type and major dietary protein sources and risk for CHD.

BackgroundResults of observational and experimental studies investigating the association between intake of long-chain n-3 polyunsaturated fatty acids (PUFAs) and risk of atrial fibrillation (AF) have been inconsistent.MethodsWe studied the association of fish and the fish-derived n-3 PUFAs eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) with the risk of incident AF in individuals aged 45–64 from the Atherosclerosis Risk in Communities (ARIC) cohort (n = 14,222, 27% African Americans). Intake of fish and of DHA and EPA were measured via food frequency questionnaire. Plasma levels of DHA and EPA were measured in phospholipids in a subset of participants (n = 3,757). Incident AF was identified through the end of 2008 using ECGs, hospital discharge codes and death certificates. Cox proportional hazards regression was used to estimate hazard ratios of AF by quartiles of n-3 PUFAs or by fish intake.ResultsDuring the average follow-up of 17.6 years, 1,604 AF events were identified. In multivariable analyses, total fish intake and dietary DHA and EPA were not associated with AF risk. Higher intake of oily fish and canned tuna was associated with a nonsignificant lower risk of AF (p for trend = 0.09). Phospholipid levels of DHA+EPA were not related to incident AF. However, DHA and EPA showed differential associations with AF risk when analyzed separately, with lower risk of AF in those with higher levels of DHA but no association between EPA levels and AF risk.ConclusionsIn this racially diverse sample, dietary intake of fish and fish-derived n-3 fatty acids, as well as plasma biomarkers of fish intake, were not associated with AF risk.

Dietary factors might affect the risk of atrial fibrillation (AF), but available studies have provided inconsistent results. A review of published observational studies and randomized trials identified 4 dietary exposures that had been investigated regarding AF risk: alcohol, fish-derived n-3 polyunsaturated fatty acids, caffeine, and ascorbic acid. Though studies were highly heterogeneous in their design and results, they showed a consistently increased risk of AF in heavy alcohol drinkers, but no risk associated with moderate alcohol intake. High coffee intake was not clearly associated with an increased risk of AF, and a potential U-shaped association (lower AF risk in moderate drinkers) could exist. High intake of fish-derived n-3 polyunsaturated fatty acids from diet or supplements might prevent AF episodes following cardiovascular events, but no consistent evidence supports an effect in primary prevention. Additional large, well-conducted randomized experiments are necessary to address the role of diet in AF prevention. (Circ J 2010; 74: 2029 - 2038

This information allows for quantitative assessment of risk by MOS in combat situations.

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Objectives. Little is known about the epidemiology of sick sinus syndrome (SSS). The goals of this study were to determine the age and sex-specific incidence of SSS in white and black participants in the Atherosclerosis Risk In Communities (ARIC) study and the Cardiovascular Health Study (CHS), and to investigate associations of CV risk factors with incident SSS. Methods. From among ARIC (n=15,792) and CHS (n=5,888) participants, we included those who at baseline were free of prevalent atrial fibrillation and pacemaker, had a heart rate of ≥50bpm unless using beta blockers, and reported white or black race. Potential incident SSS cases were identified by ICD9 hospital discharge diagnosis code 427.81 and validated by medical record review. Incidence rates of SSS were calculated for each age-sex-race category. Age, sex, race, and clinic adjusted Cox models were used to assess associations of risk factors with incident SSS; estimates were combined across cohorts using fixed-effects meta-analysis. Results. At baseline, the average age of included participants (n=19,146) was 60 years. Traditional CV risk factors were more prevalent among blacks. During 324,505 person years of follow-up (mean 17 years), 291 incident SSS cases were identified, 246 in whites and 45 in blacks. Incidence estimates and associations with CV risk factors were similar in ARIC and CHS. SSS incidence increased with age (Table), and blacks had a 44% lower risk of SSS than whites (age, sex, and clinic adjusted HR: 0.56, 95%CI: 0.27, 1.20). In multivariate models, incident SSS was associated with greater BMI, height, NT-proBNP, cystatin C, and QRS interval, with lower heart rate and HDL cholesterol, and with prevalent hypertension, diabetes, right bundle branch block, CHD, and HF. Conclusions. The incidence of hospitalized SSS increased with age, and was lower for blacks than whites. Several modifiable CV risk factors were associated with incident hospitalized SSS.

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