Type 2 diabetes, glucose homeostasis and incident atrial fibrillation: the Atherosclerosis Risk in Communities study. Issue 2 (19th September 2011)

• Record Type: Journal Article
• Authors: Huxley, Rachel R; Alonso, Alvaro; Lopez, Faye L; Filion, Kristian B; Agarwal, Sunil K; Loehr, Laura R; Soliman, Elsayed Z; Pankow, James S; Selvin, Elizabeth
• Is Part Of: Heart. Volume 98:Issue 2(2012)
• Page Start: 133
• Page End: 138
• Publication Date: 2011-09-19
• Subjects: Atrial fibrillation -- risk factors -- macrovascular disease -- smoking -- metabolic medicine -- epidemiology -- arrhythmias -- brugada -- QT interval -- heart rate variability -- sudden cardiac death; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2011-300503
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Background: Type 2 diabetes has been inconsistently associated with the risk of atrial fibrillation (AF) in previous studies that have frequently been beset by methodological challenges. Design: Prospective cohort study. Setting: The Atherosclerosis Risk in Communities (ARIC) study. Participants: Detailed medical histories were obtained from 13 025 participants. Individuals were categorised as having no diabetes, pre-diabetes or diabetes based on the 2010 American Diabetes Association criteria at study baseline (1990–2). Main outcome measures: Diagnoses of incident AF were obtained to the end of 2007. Associations between type 2 diabetes and markers of glucose homeostasis and the incidence of AF were estimated using Cox proportional hazards models after adjusting for possible confounders. Results: Type 2 diabetes was associated with a significant increase in the risk of AF (HR 1.35, 95% CI 1.14 to 1.60) after adjustment for confounders. There was no indication that individuals with pre-diabetes or those with undiagnosed diabetes were at increased risk of AF compared with those without diabetes. A positive linear association was observed between HbA1c and the risk of AF in those with and without diabetes (HR 1.13, 95% CI 1.07 to 1.20) and HR 1.05, 95% CI 0.96 to 1.15 per 1% point increase, respectively). There was no association between fasting glucose or insulin in those without diabetes, but a significant association with fasting glucose was found in those with the condition. The results were similar in white subjects and African-Americans. Conclusions: Diabetes, HbA1c level and poor glycaemic control are independently associated with an increased risk of AF, but the underlying mechanisms governing the relationship are unknown and warrant further investigation.