Type 2 Diabetes Mellitus and Risk of Incident Atrial Fibrillation in Women

Study Questions:

What factors are associated with both atrial fibrillation and type 2 diabetes (T2D)?

Methods:

Data from the Women’s Health Study were used for the present analysis. Women with no apparent history of cardiovascular disease or atrial fibrillation at baseline were followed over a median of 16.4 years. Cox proportional hazards models were constructed to assess the relationship between T2D and incident atrial fibrillation, using either information at baseline or time-varying covariates for both T2D and potential confounders. Women were excluded if they had a history of atrial fibrillation or cardiovascular disease (stroke, heart failure, or myocardial infarction) at baseline, or did not participate in the observational follow-up.

Results:

A total of 34,720 women were included in this study. At study entry, 937 women (2.7%) had T2D. Women with T2D were significantly older, had a higher body mass index, a higher prevalence of hypertension, a lower educational level, and exercised less frequently compared with women without T2D. Compared with women without T2D, women with T2D had an age-adjusted hazard ratio (HR) for new-onset atrial fibrillation of 1.95 (95% confidence interval [CI], 1.49-2.56). In multivariable analyses adjusting for baseline confounders, this HR was substantially attenuated, but baseline T2D remained a significant predictor of incident atrial fibrillation (HR, 1.37; 95% CI, 1.03-1.83). In models that adjusted for changes in atrial fibrillation risk factors and intercurrent cardiovascular events, the HR for T2D was attenuated further and became nonsignificant (HR, 1.14; 95% CI, 0.93-1.40).

Conclusions:

The authors concluded that risk factors for atrial fibrillation including cardiovascular disease events, development of hypertension, and weight gain account for most of the relationship between T2D and atrial fibrillation.

Perspective:

These results suggest that prevention of factors such as weight gain and elevated blood pressure would be associated with lower incidence of atrial fibrillation while at the same time lowering the risk for T2D.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Exercise, Hypertension

Keywords: Myocardial Infarction, Stroke, Follow-Up Studies, Exercise, Women's Health, Risk Factors, Weight Gain, Prevalence, Incidence, Proportional Hazards Models, Body Mass Index, Heart Failure, Cardiovascular Diseases, Atrial Fibrillation, Confidence Intervals, Hypertension, Diabetes Mellitus


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