Article

Type 2 diabetes, glucose homeostasis and incident atrial fibrillation: the Atherosclerosis Risk in Communities study.

Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd Street, Minneapolis, MN 55454, USA.
Heart (British Cardiac Society) (impact factor: 4.22). 09/2011; 98(2):133-8. DOI:10.1136/heartjnl-2011-300503
Source: PubMed

ABSTRACT 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.
Prospective cohort study.
The Atherosclerosis Risk in Communities (ARIC) study.
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).
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.
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.
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.

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Keywords

1% point increase
 
African-Americans
 
Associations
 
Atherosclerosis Risk
 
Cox proportional hazards models
 
Detailed medical histories
 
fasting glucose
 
glucose homeostasis
 
incident AF
 
increased risk
 
methodological challenges
 
poor glycaemic control
 
positive linear association
 
possible confounders
 
pre-diabetes
 
previous studies
 
significant association
 
study baseline
 
Type 2 diabetes
 
undiagnosed diabetes