Abstract
Background
Epidemiological data on the associations of microvascular disease with atrial fibrillation
are scarce. We evaluated the associations of diabetes-related microvascular disease
in multiple vascular beds and its burden with incident atrial fibrillation among adults
with type 2 diabetes.
Methods
A total of 7603 participants with type 2 diabetes and without atrial fibrillation
were assessed for diabetic kidney disease, retinopathy, or neuropathy at baseline
in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. Incident
atrial fibrillation events were adjudicated using follow-up electrocardiograms. Modified
Poisson regression was used to generate risk ratios (RRs) and 95% confidence intervals
(CIs) for atrial fibrillation.
Results
Of the 7603 participants (mean age 62.5 years, 38.0% women, 63.4% white), 63.3% (n = 4816)
had microvascular disease—defined as the presence of ≥1 of: diabetic kidney disease,
retinopathy, or neuropathy at baseline. Over a median of 7 years, there were 137 atrial
fibrillation events (1.8%). Participants with microvascular disease had a 1.9-fold
higher risk of incident atrial fibrillation compared with those without microvascular
disease (RR 1.88; 95% CI, 1.20-2.95). Compared with no microvascular disease, the
RRs for atrial fibrillation were 1.62 (95% CI, 1.01-2.61) and 2.47 (95% CI, 1.46-4.16)
for those with 1 and ≥2 microvascular territories affected, respectively. The RRs
for atrial fibrillation by type of microvascular disease were 1.57 (95% CI, 1.09-2.26),
0.95 (95% CI, 0.53-1.70), and 1.67 (95% CI, 1.15-2.44) for neuropathy, retinopathy,
and diabetic kidney disease, respectively.
Conclusions
In a large cohort of adults with type 2 diabetes, the presence of microvascular disease
and its burden were independently associated with higher risk of incident atrial fibrillation.
Keywords
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References
- Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study.JAMA. 2001; 285: 2370-2375
- Meta-analysis of cohort and case-control studies of type 2 diabetes mellitus and risk of atrial fibrillation.Am J Cardiol. 2011; 108: 56-62
- Diabetes mellitus, glycemic control, and risk of atrial fibrillation.J Gen Intern Med. 2010; 25: 853-858
- A comparison of risk stratification schemes for stroke in 79,884 atrial fibrillation patients in general practice.J Thromb Haemost. 2011; 9: 39-48
- Care patterns and outcomes in atrial fibrillation patients with and without diabetes: ORBIT-AF Registry.J Am Coll Cardiol. 2017; 70: 1325-1335
- Atrial fibrillation, type 2 diabetes, and non-vitamin K antagonist oral anticoagulants: a review.JAMA Cardiol. 2017; 2: 442-448
- AGEs-RAGE system mediates atrial structural remodeling in the diabetic rat.J Cardiovasc Electrophysiol. 2008; 19: 415-420
- Role of atrial endothelial cells in the development of atrial fibrosis and fibrillation in response to pressure overload.Cardiovasc Pathol. 2017; 27: 18-25
- Risk of atrial fibrillation in persons with type 2 diabetes and the excess risk in relation to glycaemic control and renal function: a Swedish cohort study.Cardiovasc Diabetol. 2020; 19: 9
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.Ann Intern Med. 2007; 147: 573-577
- Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial: design and methods.Am J Cardiol. 2007; 99: 21i-33i
- Rationale, design, and methods of the Action to Control Cardiovascular Risk in Diabetes Eye Study (ACCORD-EYE).Am J Cardiol. 2007; 99: 103i-111i
- Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial.Lancet. 2010; 376: 419-430
- A new equation to estimate glomerular filtration rate.Ann Intern Med. 2009; 150: 604-612
- Use of the Michigan Neuropathy Screening Instrument as a measure of distal symmetrical peripheral neuropathy in Type 1 diabetes: results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications.Diabet Med. 2012; 29: 937-944
- Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12. Early Treatment Diabetic Retinopathy Study Research Group.Ophthalmology. 1991; 98: 823-833
- The Minnesota Code Manual of Electrocardiographic Findings.Springer Science & Business Media, Heidelberg, Germany2009
- eGFR and albuminuria in relation to risk of incident atrial fibrillation: a meta-analysis of the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study.Clin J Am Soc Nephrol. 2017; 12: 1386-1398
- Association of proteinuria and incident atrial fibrillation in patients with intact and reduced kidney function.J Am Heart Assoc. 2017; 6e005685
- Relationship between increased left atrial volume and microvascular complications in patients with type 2 diabetes.J Diabetes Complications. 2015; 29: 822-828
- Changes in left atrial volume in diabetes mellitus: more than diastolic dysfunction?.Eur Heart J Cardiovasc Imaging. 2012; 13: 1016-1023
- Cardiac autonomic dysfunction and incidence of atrial fibrillation: results from 20 years follow-up.J Am Coll Cardiol. 2017; 69: 291-299
- Evaluation of the association between diabetic retinopathy and the incidence of atrial fibrillation: a nationwide population-based study.Int J Cardiol. 2016; 223: 953-957
- Relationship between macular and retinal diseases with prevalent atrial fibrillation - an analysis of the Australian Heart Eye Study.Int J Cardiol. 2015; 178: 96-98
- Diabetic cardiomyopathy: understanding the molecular and cellular basis to progress in diagnosis and treatment.Heart Fail Rev. 2012; 17: 325-344
- Clinical update: cardiovascular disease in diabetes mellitus: atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus - mechanisms, management, and clinical considerations.Circulation. 2016; 133: 2459-2502
- Oxidative stress and redox signalling in cardiac hypertrophy and heart failure.Heart. 2007; 93: 903-907
- Association between diastolic dysfunction and future atrial fibrillation in the Tromsø Study from 1994 to 2010.Heart. 2015; 101: 1302-1308
- Current controversies in determining the main mechanisms of atrial fibrillation.J Intern Med. 2016; 279: 428-438
- Atrial fibrillation and diabetes mellitus: JACC review topic of the week.J Am Coll Cardiol. 2019; 74: 1107-1115
- Electrophysiological, electroanatomical, and structural remodeling of the atria as consequences of sustained obesity.J Am Coll Cardiol. 2015; 66: 1-11
- Influences of autonomic nervous system on atrial arrhythmogenic substrates and the incidence of atrial fibrillation in diabetic heart.Int Heart J. 2009; 50: 627-641
- Performance of atrial fibrillation risk prediction models in over 4 million individuals.Circ Arrhythm Electrophysiol. 2021; 14e008997
Article Info
Publication History
Published online: April 25, 2022
Footnotes
Funding: Dr. Echouffo Tcheugui was supported by NIH/NHLBI grant K23 HL153774
Conflicts of Interest: GCF reports consulting for Abbott, Amgen, AstraZeneca, Bayer, Cytokinetics, Janssen, Medtronic, Merck, and Novartis. Other authors have no potential conflicts of interest relevant to this article.
Authorship: A.K.D. performed the statistical analyses, interpreted the results, and wrote the first draft. M.F.Y and G.C.F contributed to the study design, interpreted the results, participated in the discussion, revised the draft of the manuscript, and approved the final version. J.B.E.-T. conceived the idea and designed the study, performed the statistical analysis, interpreted the results, drafted and revised the manuscript, and approved the final version. J.B.E.-T. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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