Meta-Analysis of Cohort and Case–Control Studies of Type 2 Diabetes Mellitus and Risk of Atrial Fibrillation

• Published in: The American journal of cardiology Vol. 108; no. 1; pp. 56 - 62
• Main Authors: Huxley, Rachel R., Filion, Kristian B., Konety, Suma, Alonso, Alvaro
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2011; Elsevier; Elsevier Limited
• Subjects: Atrial Fibrillation - epidemiology; Atrial Fibrillation - etiology; Biological and medical sciences; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiology. Vascular system; Cardiovascular; Case-Control Studies; Cohort Studies; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Epidemiology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Heart; Humans; Incidence; Medical sciences; Meta-analysis; Risk Factors; United States - epidemiology; Endocrinopathy; Type 2 diabetes; Arrhythmia; Atrial fibrillation; Metabolic diseases; Cardiovascular disease; Risk; Case control study; Excitability disorder; Heart disease; Analysis; Cohort study; Risk factor; Circulatory system; Cardiology
• DOI: 10.1016/j.amjcard.2011.03.004
• ISSN: 0002-9149; 1879-1913

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.