title: Incidence of and risk factors for sick sinus syndrome in the general population.
abstract: BACKGROUND
  Little is known about the incidence of and risk factors for sick sinus syndrome (SSS), a common indication for pacemaker implantation.
  
  
  OBJECTIVE
  This study sought to describe the epidemiology of SSS.
  
  
  METHODS
  This analysis included 20,572 participants (mean baseline age 59 years, 43% male) in the ARIC (Atherosclerosis Risk In Communities) study and the CHS (Cardiovascular Health Study), who at baseline were free of prevalent atrial fibrillation and pacemaker therapy, had a heart rate of ≥ 50 beats/min unless using beta blockers, and were identified as of white or black race. Incident SSS cases were identified by hospital discharge International Classification of Disease-revision 9-Clinical Modification 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 (hazard ratio [HR]: 1.73; 95% confidence interval [CI]: 1.47 to 2.05 per 5-year increment), and blacks had a 41% lower risk of SSS than whites (HR: 0.59; 95% CI: 0.37 to 0.98). Incident SSS was associated with greater baseline body mass index, height, N-terminal pro-B-type natriuretic peptide, 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.
authors.affiliation: Cardiovascular Health Research Unit, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Jensen
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Noelle N
authors.initials: NN
authors.lastname: Gronroos
authors.affiliation: Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
authors.forename: Lin Y
authors.initials: LY
authors.lastname: Chen
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.affiliation: Department of Medicine, University of Maryland, Baltimore, Maryland.
authors.forename: Chris
authors.initials: C
authors.lastname: deFilippi
authors.affiliation: Cardiovascular Health Research Unit, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington; Department of Pharmacy, University of Washington, Seattle, Washington.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota. Electronic address: alonso@umn.edu.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000208:ethnology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D012804:Sick Sinus Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology*; D044465:White People / Q000208:ethnology*
keywords: epidemiology; pacemaker; sick sinus syndrome; tachy-brady syndrome
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