Diabetes Mellitus, Glycemic Control, and Risk of Atrial Fibrillation

Abstract

BACKGROUND

Diabetes may be an independent risk factor for atrial fibrillation. However, results from prior studies are in conflict, and no study has examined diabetes duration or glycemic control.

OBJECTIVE

To examine the association of diabetes with risk of atrial fibrillation and to describe risk according to diabetes duration and glycemic control.

DESIGN

A population-based case-control study.

PARTICIPANTS

Within a large, integrated healthcare delivery system, we identified 1,410 people with newly-recognized atrial fibrillation from ICD-9 codes and validated cases by review of medical records. 2,203 controls without atrial fibrillation were selected from enrollment lists, stratified on age, sex, hypertension, and calendar year.

MAIN MEASURES

Information on atrial fibrillation, diabetes and other characteristics came from medical records. Diabetes was defined based on physician diagnoses recorded in the medical record, and pharmacologically treated diabetes was defined as receiving antihyperglycemic medications. Information about hemoglobin A1c levels came from computerized laboratory data.

KEY RESULTS

Among people with atrial fibrillation, 252/1410 (17.9%) had pharmacologically treated diabetes compared to 311/2203 (14.1%) of controls. The adjusted OR for atrial fibrillation was 1.40 (95% CI 1.15-1.71) for people with treated diabetes compared to those without diabetes. Among those with treated diabetes, the risk of developing atrial fibrillation was 3% higher for each additional year of diabetes duration (95% CI 1-6%). Compared to people without diabetes, the adjusted OR for people with treated diabetes with average hemoglobin A1c ≤7 was 1.06 (95% CI 0.74-1.51); for A1c >7 but ≤8, 1.48 (1.09-2.01); for A1c >8 but ≤9, 1.46 (1.02-2.08); and for A1c >9, 1.96 (1.22–3.14).

CONCLUSIONS

Diabetes was associated with higher risk of developing atrial fibrillation, and risk was higher with longer duration of treated diabetes and worse glycemic control. Future research should identify and test approaches to reduce the risk of atrial fibrillation in people with diabetes.

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Funding

This research was funded by grants HL 68986, HL 43201, HL 73410, and HL 68639 from the National Heart, Lung and Blood Institute. Dr. Dublin was funded through a Veterans’ Affairs Health Services Research & Development fellowship, a Paul Beeson Career Development Award from the National Institute on Aging (K23AG028954), and Group Health Research Institute internal funds. The Beeson Award is also supported in part by the American Federation for Aging Research, the Hartford Foundation, the Atlantic Philanthropies and the Starr Foundation.

Prior presentations

This work was presented at the American Heart Association 47th Annual Conference on Cardiovascular Disease Epidemiology and Prevention in Orlando, Florida, on February 28, 2007 (poster), and the 13th Annual HMO Research Network Conference in Portland, Oregon, on March 21, 2007 (oral presentation).

Disclaimer

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Conflict of interest statement

Dr. Dublin has received a Merck/American Geriatrics Society New Investigator Award. Dr. Page has consulted for Sanofi-Aventis and Astellas. Dr. Psaty has served as an unpaid consultant for AVIIR, a proteomics company, about its plans for an ancillary study within the MultiEthnic Study of Atherosclerosis. Other authors have no potential conflicts to disclose.

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Correspondence to Sascha Dublin MD, PhD.

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Dublin, S., Glazer, N.L., Smith, N.L. et al. Diabetes Mellitus, Glycemic Control, and Risk of Atrial Fibrillation. J GEN INTERN MED 25, 853–858 (2010). https://doi.org/10.1007/s11606-010-1340-y

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KEY WORDS

  • arrhythmia
  • atrial fibrillation
  • diabetes mellitus
  • glycemic control
  • diabetes complications