Associations between prediabetes, type 2 diabetes and incident atrial fibrillation in patients with hypertension: Results from the Swedish Primary Care Cardiovascular Database

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Aims: To study associations between prediabetes, type 2 diabetes (T2D) and insulin resistance with incident atrial fibrillation (AF) in patients with hypertension. Methods: Patients with hypertension but no AF between 2006 and 2010 were identified in the Swedish Primary Care Cardiovascular Database. Patients with type 1 diabetes or pre-existing cardiovascular disease were excluded. Patients were categorized into normoglycemia, prediabetes or T2D and followed until 2023 or incident AF. Insulin resistance was assessed using triglyceride-glucose (TyG) index and TyG-BMI index. Associations with incident AF and mortality were evaluated using multivariable models. Results: Among 15 715 patients (64 ± 11 years, 55 % women), 60 % were normoglycemic, 17 % had prediabetes and 23 % T2D. During a median follow-up of 14.7 years, AF occurred in 18 %, 21 % and 20 %, respectively. Neither prediabetes (HR 0.99, 95 % CI 0.87-1.13) nor T2D (HR 1.00, 95 % CI 0.89-1.11) was associated with incident AF compared with normoglycemia. In contrast, the TyG index demonstrated a U-shaped association with incident AF, whereas the TyG-BMI index showed a positive association. Both prediabetes and T2D were associated with increased all-cause mortality (HR 1.17, 95 % CI 1.06-1.30 and HR 1.62, 95 % CI 1.50-1.75, respectively). Conclusion: Prediabetes and T2D were not independently associated with AF in hypertensive patients. Our findings suggest a potential role for BMI and insulin resistance in AF risk, independent of glycemic category, warranting further prospective investigation.

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