Atrial fibrillation (AF) is 1 of the most clinically diagnosed cardiac disturbances
but little is known about its risk factors. Previous epidemiologic studies have reported
on the association between diabetes mellitus (DM) and subsequent risk of AF, with
inconsistent results. The aim of this study was to conduct a meta-analysis of published
studies to reliably determine the direction and magnitude of any association between
DM and AF. A systematic review and meta-analysis was conducted. PubMed and EMBASE
were searched to identify prospective cohort and case–control studies that had reported
on the association between DM and other measurements of glucose homeostasis with incident
AF by April 2010. Studies conducted in primarily high-risk populations and participants
in randomized controlled trials were excluded. Seven prospective cohort studies and
4 case–control studies with information on 108,703 cases of AF in 1,686,097 subjects
contributed to this analysis. The summary estimate indicated that patients with DM
had an approximate 40% greater risk of AF compared to unaffected patients (relative
risk [RR] 1.39, 95% confidence interval [CI] 1.10 to 1.75, p for heterogeneity <0.001).
After correcting for publication bias, the RR was 1.34 (1.07 to 1.68). Studies that
had adjusted for multiple risk factors reported a smaller effect estimate compared
to age-adjusted studies (RR 1.24, 95% CI 1.06 to 1.44, vs 1.70, 1.29 to 2.22, p for
heterogeneity = 0.053). The population-attributable fraction of AF owing to DM was
2.5% (95% CI 0.1 to 3.9). In conclusion, DM is associated with an increased risk of
subsequent AF but the mechanisms that may underpin the relation between DM and AF
remain speculative.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Impact of atrial fibrillation on the risk of death: the Framingham Heart Study.Circulation. 1998; 98: 946-952
- Incidence of and risk factors for atrial fibrillation in older adults.Circulation. 1997; 96: 2455-2461
- Hospitalizations for atrial fibrillation in the general male population: morbidity and risk factors.J Intern Med. 2001; 250: 382-389
- A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study.Am J Med. 2002; 113: 359-364
- Association of atrial fibrillation and aortic atherosclerosis: a population-based study.Mayo Clin Proc. 2001; 76: 252-259
- Meta-analysis of observational studies in epidemiology: a proposal for reporting.JAMA. 2000; 283: 2008-2012
- Quantifying heterogeneity in a meta-analysis.Stat Med. 2002; 21: 1539-1558
- Bias in location and selection of studies.BMJ. 1998; 316: 61-66
- Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis.Biometrics. 2000; 56: 455-463
- Use and misuse of population attributable fractions.Am J Public Health. 1998; 88: 15-19
- The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study.Am J Med. 1995; 98: 476-484
- Incidence of chronic atrial fibrillation in general practice and its treatment pattern.Clin Epidemiol. 2002; 55: 358-363
- Overweight and obesity as risk factors for atrial fibrillation or flutter: the Danish diet, cancer, and health study.Am J Med. 2005; 118: 489-495
- Big men and atrial fibrillation: effects of body size and weight gain on risk of atrial fibrillation in men.Eur Heart J. 2009; 30: 1113-1120
- Atrial fibrillation in the Malmö Diet and Cancer Study: a study of occurrence, risk factors and diagnostic validity.Eur J Epidemiol. 2010; 25: 95-102
- Metabolic syndrome and risk of development of atrial fibrillation: the Niigata preventive medicine study.Circulation. 2008; 117: 1255-1260
- Independent contribution of diabetes to increased prevalence and incidence of atrial fibrillation.Diabetes Care. 2009; 32: 1851-1856
- Diabetes mellitus, glycemic control, and risk of atrial fibrillation.J Gen Intern Med. 2010; 25: 853-858
- Diabetes mellitus is a strong, independent risk for atrial fibrillation and flutter in addition to other cardiovascular disease.Int J Cardiol. 2005; 105: 315-318
- Prevalence of abnormal glucose metabolism in atrial fibrillation: a case control study in 75-year old subjects.Cardiovasc Diabetol. 2008; 7: 28
- Transient atrial fibrillation precipitated by hypoglycaemia: two case reports.Postgrad Med J. 1987; 63: 895-897
- Possible molecular mechanisms by which angiotensin II type 1 receptor blockers (ARBs) prevent the development of atrial fibrillation in insulin resistant patients.Horm Metab Res. 2008; 40: 640-644
- Atrial fibrillation and its association with type 2 diabetes and hypertension in a Swedish community.Diabetes Obes Metab. 2004; 6: 367-374
- Impact of glucose intolerance and insulin resistance on cardiac structure and function: sex-related differences in the Framingham Heart Study.Circulation. 2003; 107: 448-454
- Histological substrate of atrial biopsies in patients with lone atrial fibrillation.Circulation. 1997; 96: 1180-1184
- C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation.Circulation. 2001; 104: 2886-2891
- Inflammation and activated innate immunity in the pathogenesis of type 2 diabetes.Diabetes Care. 2004; 27: 813-823
- Atrial fibrillation in healthy non-alcoholic people after an alcoholic binge.Lancet. 1984; 2: 1013-1015
- Alcohol and new onset atrial fibrillation: a case–control study of a current series.Br Heart J. 1987; 57: 468-743
- Clinical predictors of atrial fibrillation recurrence in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico–Atrial Fibrillation (GISSI-AF) trial.Am Heart J. 2010; 159: 857-863
Article info
Publication history
Published online: May 02, 2011
Accepted:
March 3,
2011
Received in revised form:
March 3,
2011
Received:
January 9,
2011
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
