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Hyperglycemia, renal complications increase atrial fibrillation risk in type 1 diabetes
The risk for atrial fibrillation in both men and women with type 1 diabetes increases with deteriorating glycemic control and renal complications, with women at greater risk for the condition than men, according to published findings.
“Atrial fibrillation is more common in persons with type 1 diabetes than in the general population; however, the excess risk clearly differs compared to myocardial infarctions and heart failure,” Marcus Lind, MD, PhD, associate professor of diabetology at the University of Gothenburg, Sweden, told Endocrine Today. “For atrial fibrillation, the excess risk is clearly lower, and it is mainly evident in those with renal complications and hyperglycemia.”
In a prospective, case-control study, Lind and colleagues analyzed data from 36,258 patients with type 1 diabetes in the Swedish National Diabetes Registry (45% women; mean age, 36 years; mean diabetes duration, 20.3 years; mean baseline HbA1c, 8.2%) who were each matched with five controls for age, sex and county of residence randomly selected from the Swedish Population Register (n = 179,980; 45% women; mean age, 35 years). Researchers followed the cohort between 2001 and 2013, and assessed cases of atrial fibrillation using the Swedish National Patient Registry, stratifying by age, sex, glycemic control and renal function. Data on education level and county of birth were obtained from the Longitudinal Integration Database for Health Insurance and Labour Market Studies.
Median follow-up time was 9.7 years for patients and 10.2 years for controls.
During follow-up, 749 patients (2%) and 2,882 controls (2%) were diagnosed with atrial fibrillation. In Cox regression analyses, researchers observed an interaction between risk for atrial fibrillation and sex (P = .0019), and stratified further analyses by sex.
After adjustment for baseline comorbidities, diabetes duration, education level and birth place, HR for atrial fibrillation was 1.13 for men (95% CI, 1.01-1.25) and 1.5 for women (95% CI, 1.3-1.72) vs. controls, according to researchers.
Researchers also observed that excess risk for atrial fibrillation in individuals with type 1 diabetes increased with worsening glycemic control and renal complications. In patients with an HbA1c of at least 9.7%, HR for atrial fibrillation was 2.2 (95% CI, 1.6-3) for men and 2.62 (95% CI, 1.72-3.98) for women vs. controls.
Men with type 1 diabetes with normoalbuminuria or microalbuminuria had no excess risk for atrial fibrillation; however, women with type 1 diabetes with normoalbuminuria saw increased risk for atrial fibrillation (HR = 1.32; 95% CI, 1.1-1.57). For patients with type 1 diabetes with macroalbuminuria or chronic kidney disease stage 5, risk for atrial fibrillation was increased in both men and women relative to controls.
“Providers should be aware of screening for atrial fibrillation in persons with type 1 diabetes when there are clear risk factors, such as older age, long-term hyperglycemia and renal complications, as well as when comorbidities exist, such as heart failure,” Lind said. “Especially since screening is so easy by heart auscultation or checking the pulse as a first test.”
Lind said continued efforts to lower cardiovascular disease risk should include a combination of aggressive protection by lipid-lowering drugs, antihypertensive therapy, smoking avoidance and regular exercise when indicated, in addition to good glucose control.
“If other CVD conditions are reduced, atrial fibrillation will also be reduced,” Lind said. – by Regina Schaffer
For more information:
Marcus Lind, MD, PhD, can be reached at Uddevalla Hospital, Department of Medicine, Uddevalla 45180, Sweden; email: lind.marcus@telia.com.
Disclosures: Lind reports receiving grants from AstraZeneca, Dexcom and Novo Nordisk, and consulting for Astra Zeneca, Eli Lilly, Novo Nordisk and Rubin Medical. Please see the study for all other authors’ relevant financial disclosures.