They were followed prospectively from baseline years 2005–2007 to final year 2012 for the development of AF. We included 83,162 female and male patients with type 2 diabetes registered in the NDR, with data available for all analysed variables, without AF at study baseline. Linkage of registers was performed using the unique person identity number (PIN). We used AF diagnoses in Swedish national in-patient and mortality registers, kept by the National Board of Health and Welfare, as these registers have been shown to have good validity for AF classification indicating feasibility for use in prospective studies, compared with examination by electrocardiograms. Patients were treated in daily practice at primary healthcare clinics and hospitals. In this study, we assessed several risk factors for the development of AF in an observational study of patients with type 2 diabetes. Several reports concerning trends in risk factor control and risk prediction in the NDR have been published previously. The Regional Ethics Review Board at the University of Gothenburg approved this study. All included patients have agreed by informed consent to register before inclusion. Annual reporting to the NDR is carried out by trained physicians and nurses via the internet or via clinical records databases, with information collected during patient visits at hospital outpatient clinics and primary healthcare centres nationwide. The NDR was initiated in 1996 as a tool for quality assurance and improvement in diabetes care with local feedback. The aim of this study was to assess various risk factors associated with the development of AF in an observational cohort study of patients with type 2 diabetes obtained from the Swedish National Diabetes Register (NDR). To our knowledge, such studies have not been presented previously. With this background, it is a particularly important task to estimate risk factors for AF in patients with diabetes. įurther, AF has been shown to have a strong impact on risk for cardiovascular complications and mortality in patients with type 2 diabetes, who generally have risks of cardiovascular complications at least twice as high as in those without diabetes. However, a recent women’s health study found that the increased risk associated with type 2 diabetes was mainly mediated by changes in other AF risk factors. A meta-analysis found a smaller increased risk of 1.24 (1.06–1.40) for AF with diabetes than with no diabetes in studies adjusting for multiple risk factors. Risk factors for development of AF in the general population have been shown to be intrinsic cardiac causes like CHF and valve disease, and also cardiovascular risk factors like hypertension, obesity and smoking. It is a strong risk factor for stroke and cardiovascular mortality, and it is associated with congestive heart failure (CHF). CVD, advancing age and height were also associated with AF in type 2 diabetes.Ītrial fibrillation (AF) is one of the most common cardiac arrhythmias in the general population. The modifiable risk factors high BP, high BMI and albuminuria were strongly associated with AF in type 2 diabetes. The HRs for AF were (per 10 mmHg increase) 0.88 and 1.24, respectively. The risk of AF differed in the subgroups achieving or not achieving a target BP < 140/85 mmHg.
Among patients without history of CVD or CHF, significant predictors were similarly BMI, SBP, and cumulative microalbuminuria and CHF. HRs were 1.76 for a history of CHF and 2.56 for in-study CHF, while 1.32 for history of CVD and 1.38 for in-study CHD ( p < 0.001).
Male sex, increasing age and height were also significant predictors. Using Cox regression, cardiovascular risk factors associated with risk for AF were updated mean BMI (HR 1.31 per 5 kg/m 2) or obesity (HR 1.51), updated mean systolic BP (SBP HR 1.13 per 10 mmHg) or hypertension (HR 1.71), and cumulative microalbuminuria (HR 1.21), p < 0.001 for all analyses. A subgroup of 67,780 patients without history of CVD or CHF was also analysed. Observational study of 83,162 patients with type 2 diabetes, aged 30-79 years, with no baseline AF, 17% had history of cardiovascular disease (CVD) and 3.3% history of congestive heart failure (CHF), followed up for development of AF during mean 6.8 years from 2005–2007 to 2012. However, characteristics contributing to AF risk in diabetes remain speculative. Atrial fibrillation (AF) is more frequent in patients with diabetes than in the general population.
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