Prediabetes independently associated with higher risk of atrial fibrillation

A new study by Jung-Chi Hsu and team suggests that prediabetes stage can increase risk of atrial fibrillation (AF). The findings of this study were published in BMC Cardiovascular Diabetology. 

The glycemic continuum frequently depicts a steady decrease in insulin sensitivity, which leads to a rise in glucose levels. Although prediabetes is a known risk factor for both macrovascular and microvascular illnesses, whether prediabetes is independently linked with the chance of developing atrial fibrillation (AF), specifically the onset time, has not been thoroughly investigated utilizing a high-quality study design in conjunction with statistical machine-learning methods.

A retrospective cohort research was conducted with 174,835 adult patients between 2014 and 2019 to evaluate the link between prediabetes and AF using data from electronic medical records gathered from the National Taiwan University Hospital, a tertiary medical institution in Taiwan. A propensity-score matching strategy was utilized to choose matched pairs of two groups with a 1:1 ratio to make patients with prediabetes comparable to those with normal glucose tests. The log-rank test was performed to examine the cumulative risk of AF between prediabetes and normal glucose tests using the Kaplan-Meier technique. By stratifying three levels of glycosylated hemoglobin, the multivariable Cox regression model was used to assess the adjusted hazard ratio (HR) for prediabetes vs normal glucose test (HbA1c).

The key findings of this study were:

A total of 14,309 individuals with prediabetes and normal glucose test results were chosen. 

Over a median follow-up period of 47.1 months, the incidence of AF was 11.6 cases per 1000 person-years. 

The Kaplan-Meier analysis found that individuals with prediabetes had a considerably increased incidence of AF. 

According to the multivariable Cox regression model, prediabetes was independently related with a significantly elevated risk of AF, especially in individuals with HbA1c levels over 5.5%. 

The RSF approach found increased N-terminal natriuretic peptide and changed left cardiac shape as the two most significant risk factors for AF in prediabetes individuals.

According to the findings of this study, alterations in left heart anatomy are a substantial factor to this increased risk of AF and may begin during the prediabetes stage.

Reference: 

Hsu, J.-C., Yang, Y.-Y., Chuang, S.-L., Lin, L.-Y., & Chen, T. H.-H. (2023). Prediabetes as a risk factor for new-onset atrial fibrillation: the propensity-score matching cohort analyzed using the Cox regression model coupled with the random survival forest. In Cardiovascular Diabetology (Vol. 22, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12933-023-01767-x