Associations between prediabetes and diabetes mellitus type 2 and incident atrial fibrillation in patients with hypertension; results from the Swedish Primary Care Cardiovascular Database

Le résumé fourni par la source

Abstract Background Type 2 diabetes (T2D) exists in one out of four patients with atrial fibrillation (AF). It is, however, unclear whether prediabetes or T2D are risk factors of incident AF. Purpose To study the impact of prediabetes and T2D on incident AF in patients with hypertension. Methods In this retrospective cohort study from the Swedish Primary Care Cardiovascular Database, all patients with a recorded diagnosis of hypertension but no AF from 1 January 2006 until 31 December 2010 were identified. Patients with type 1 diabetes or any pre-existing cardiovascular disease were excluded. Patients were categorized according to glycaemic status into: 1) normoglycaemia, 2) prediabetes defined as fasting glucose 6.1-6.9 mmol/L, or 3) T2D defined as a diagnosis code E11-E14 or a fasting glucose of ≥ 7.0 mmol/L. All patients were followed until 31 December 2023 for incident AF, defined as a diagnosis code I48. Triglyceride-glucose index (TyG-index), an indicator of insulin resistance, was calculated using this formula: ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. The associations between prediabetes, T2D, TyG-index and incident AF were assessed using Cox proportional hazards models. Results Among 15 715 patients (mean age 64 years, 55 % female), 9353 (60 %) were normoglycemic, 2689 (17%) had prediabetes and 3673 (23 %) were diagnosed with T2D. Mean follow-up time was 13 years and AF occurred in 1686 (18%), 553 (21%) and 752 (20%), respectively. Neither prediabetes nor T2D were associated with increased risk for incident AF compared to normoglycaemia, after adjusting for age, sex, body mass index, most recent systolic blood pressure and concomitant medication (hazard ratios [HR] and 95% confidence intervals [CI] 0.99 [0.87-1.13] for prediabetes and 1.00 [0.90-1.11] for T2D). Both high and low TyG-index values were associated with higher incidence AF compared to a nadir of 9.3 (HR 1.17 95% CI 1.05-1.30 for Tyg-index 10; HR 1.22 95% CI 1.04-1.44 for Tyg-index 8). Conclusion Neither prediabetes nor T2D are independently associated with incident AF in patients with hypertension. However, the triglyceride-glucose index shows a U-shaped association with incident AF, underscoring the complex role of insulin resistance in AF development.TyG-index association with incident AF

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.