Postload glucose levels tied to incident AF in older women
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In older adults, elevated postload glucose levels were associated with incident atrial fibrillation, particularly in women, researchers reported in Heart.
“While diabetes and metabolic syndrome are established risk factors for development of AF in middle-aged and older adults, glycemic measures themselves have not shown a clear relationship with incident AF in general population samples or cohorts free of diabetes,” Cara N. Pellegrini, MD, professor of medicine at the University of California, San Francisco, associate program director of the UCSF Cardiology Fellowship and director of cardiac electrophysiology at the San Francisco VA, and colleagues wrote. “Further, most evaluations of dysglycemia and AF have centered on fasting glucose or glycated hemoglobin and have not focused on adults late in life, the group at highest risk of both disorders.”
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The researchers analyzed the relationship between levels of fasting and postload glucose and nonesterified fatty acids and incident AF in 1,876 older participants from the Cardiovascular Health Study (mean age, 77.7 years).
The researchers determined there were 717 cases of incident AF during a median follow-up of 11.4 years.
After adjusting for potential confounders, Pellegrini and colleagues found that postload glucose levels were associated with incident AF (HR per 1-standard deviation increase = 1.11; 95% CI, 1.02-1.21; P = .017).
Specifically, both glucose measures were associated with higher P wave terminal force in V1, and both nonesterified fatty acids measures were not, but when both glucose measures were entered together, the association remained significant only for postload glucose (beta per 1-SD increment = 138 µV x ms; 95% CI, 15-260; P = .028), the researchers wrote.
The association between postload glucose and incident AF was significant in women but not men (P for interaction = .015), and there was a trend toward an association between fasting nonesterified fatty acids and incident AF in women but not in men (P for interaction = .044), Pellegrini and colleagues wrote.
“The basis for the observed association with AF may relate to postload glucose levels acting as a marker of more adverse homeostatic dysregulation or themselves inducing greater cellular damage,” they wrote. “Whereas fasting glucose is chiefly a consequence of hepatic insulin resistance, postload glucose is primarily determined by skeletal muscle insulin resistance and impaired pancreatic beta-cell secretory capacity. Declining skeletal muscle and pancreatic beta-cell health could signal more profound homeostatic disruption, greater systemic inflammation and oxidative stress and heightened impairments in cardiovascular structure and function.”
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