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Journal of the American College of Cardiology

Clinical Articles, News & Views

Diabetes/AF link mediated by risk factor control

Strategies for atrial fibrillation (AF) prevention in diabetic patients should focus on the control of type 2 diabetes (T2D)-associated comorbidities, in particular weight maintenance and blood pressure control, according to a study1 published recently in the Journal of the American College of Cardiology.

The purpose of the study was to assess whether changes of major AF risk factors and/or intercurrent cardiovascular events could explain the relationship between T2D and incident AF.

A total of 34,720 female health professionals who participated in the Women’s Health Study, and who were free of cardiovascular disease and AF at baseline were followed for a median of 16.4 years. Cox proportional-hazards models were constructed to assess the relationship between T2D and incident AF, using either information at baseline or time-varying covariates for both T2D and potential confounders.

At baseline, 937 (2.7 %) women had T2D. Compared with women without T2D, women with T2D had an age-adjusted hazard ratio (HR) for new-onset AF of 1.95. In multivariable analyses adjusting for baseline confounders, this HR was substantially attenuated, but baseline T2D remained a significant predictor of incident AF (p = 0.03). In time-updated models that adjusted for changes in AF risk factors and intercurrent cardiovascular events, the HR for T2D was attenuated further and became nonsignificant (p = 0.20).

T2D at study entry was associated with a modest increase in risk of incident AF. Most of this increased risk seemed to be mediated through excess weight gain and a higher prevalence of hypertension among individuals with T2D, such that the impact of diabetes beyond these risk factors was less important, the authors found.

They said: “Although this study confirms a significant relationship between baseline T2D and incident AF, our data suggest that the increased risk associated with T2D is mainly mediated by changes of other AF risk factors”.


1. Schoen T, Pradhan AD, Albert CM, Conen D. Type 2 diabetes mellitus and risk of incident atrial fibrillation in women. JACC 2012.

Published on: October 19, 2012

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