Table 6.
Diabetes and risk of AF
| Study | Design | Subjects | FU | FBG or HbAlc levels/DM duration | AF | Risk (95% CI) |
|---|---|---|---|---|---|---|
| Incidence | ||||||
| Benjamin et al.85 Framingham Heart Study |
Cohort | 2090 men 2641 women |
38 yrs | FBG >140 mg/dL Non-fasting BG >200 mg/dL |
OR for AF Men 1.4 (10–2.0) Women 1.6 (11–2.2) After adjustment for valve disease Men 11 (0.8–17)Women 15 (10–2.3) |
|
| Alonso et al.98 | Meta-analysis of 3 cohorts: ARIC, CVH and FHS | 18 556 pts | HR 1.27 (110,146) for 5-year AF risk in pts with DM | |||
| Huxley et al.99 ARIC Study |
Cohort | 13 025 | 14.5 yrs | FBG >126 mg/dL or HbAlc >6.5% or use of diabetic meds | Diabetes is associated with increased incidence of AF: HR 135 (114–1.60) HbA1c levels are independently associated with AF:HR 1.13 (101–1.20) per 1% increase in HbA1c level |
|
| Ostgren et al.100 | Cohort | 171 HT + DM 147 DM only 597 HT only 825 no HT or DM |
FBG >6.6 mmol/L or 2 hr glucose after oral glucose tolerance test >11.0 mmol/L | HT+DM: OR 3.3 (16–6.7) DM only: OR 2.0 (0.9–4.7) HT only. OR 0.7 (0.3–1.5) Reference no HT or DM: ORR 10 |
||
| Pfister et al.101 | Analysis of development of new AF in the PROactive trial | 5233 pt with DM | 36 months | Incidence of new AF at: 12 months—0.8% 24 months—1.5% 36 months—2.4% |
||
| Schoen et al.102 Womens Health Study |
Cohort | 34 720 women health professionals | 16.4 yrs | At baseline 937 (2.75%) had DM | Compared with women without DM, women with DM had HR for new AF of 1.95 (1.49–2.56). In models that adjusted for HT, obesity (BMI) and inter-current cardiovascular events, HR for new AF decreased to 1.14 (0.93–1.40) |
|
| Dublin et al.103 | Case-control | 1410 new AF pts 2203 control pts |
21 yrs—AF pts 20 yrs— control pts |
HbA1c <7% HbA1c 7–8% HbA1c 8–9% HbA1c >9% |
252 (17.9%) AF pts had DM 311 (14.1%) control pts had DM |
OR for AF 1.40 (1.15–1.71) for pts with DM compared with those without DM Compared with pts without DM risk (OR): 1.06 (0.74–1.51) 1.48 (1.09–2.01) 1.46 (1.02–2.08) 1.96 (1.22–3.14) |
| Aksnes et al.104 VALUE Trial |
Prospective randomized trial comparing valsarían and amlodipine for treatment of htn | 15 245 total pts with htn 5250 diabetes at baseline 1298 developed diabetes during FU |
4.2 yrs | FBG >140 mg/dL | 551 pts developed AF during the trial | HR 1.49 (1.14,1.94) new onset diabetes for development of AF HR 1.19 (0.99,1.42) baseline diabetes for development of AF |
| Huxley et al.31 | Meta-analysis of cohort (7) and case control (4) studies | 1 686 097 subjects combined allstudies | RR of pts with DM for AF: 139 (1.10–1.75) Studies with adjustment for other risk factors, RR of pts with DM for AR 1.24 (1.06–1.44) |
|||
| Intervention trials | ||||||
| Chang et al.105 | Registry | 645710 pts with diabetes | 13 yrs | 9983 pts developed AF, incidence rate 1.5% (287/100 000 person/yrs) | Metformin use protected against the development of AF, HR 0.81 (0.76–0.86) |
|
| Overvad et al.106 | Registry | 137 222 pts with AF | No DM 120204 DM 0–4 yrs 7922 DM 5–9 yrs 4781 DM 10–14 yrs 2435 DM >15 yrs 1880 |
Risk of thromboembolism or death No DM reference 1.0 HR 1.24 (120–1.29) HR 1.42 (137–148) HR 145 (137–1.53) HR 172 (162–182) |
||
ARIC, Atherosclerotic Risk in Communities; CVH, Cardiovascular Health Study; FHS, Framingham Heart Study; VALUE, Valsarían Anti-hypertensive Long-term Use Evaluation Trial; AF, atrial fibrillation; BG, blood glucose; BMI.body mass index; DM, diabetes mellitus; FBG, fasting blood glucose; FU, follow-up; HbAlc, glycated haemoglobin; HR, hazard ratio; HT, hypertension; OR, odds ratio; pts, patients; yrs, years.