Type 2 diabetes, glucose homeostasis and incident atrial fibrillation: the Atherosclerosis Risk in Communities study.
Type 2 diabetes, glucose homeostasis and incident atrial fibrillation: the Atherosclerosis Risk in Communities study.
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DOI：
10.1136/heartjnl-2011-300503
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发表时间：
2012-01
期刊：
影响因子：
--
通讯作者：
Selvin E
中科院分区：
文献类型：
--
作者：
Huxley RR;Alonso A;Lopez FL;Filion KB;Agarwal SK;Loehr LR;Soliman EZ;Pankow JS;Selvin E
在以前的研究中，2型糖尿病与房颤（AF）的风险不一致，这些研究经常受到方法学挑战的困扰。前瞻性队列研究。社区研究中的动脉粥样硬化风险。获得了13025名参与者的详细病史。根据研究基线（1990-92）的2010年美国糖尿病协会标准，将个体分类为无糖尿病、糖尿病前期或糖尿病。2007年获得了房颤事件的诊断。在调整可能的混杂因素后，使用考克斯比例风险模型估计2型糖尿病和葡萄糖稳态标志物与AF发生率之间的关系。调整混杂因素后，2型糖尿病与AF风险显著增加相关（HR 1.35，95%置信区间[CI]：1.14-1.60）。没有迹象表明糖尿病前期或未确诊糖尿病的个体与无糖尿病的个体相比，AF的风险增加。我们观察到，在糖尿病患者和非糖尿病患者中，HbA 1c与AF风险之间存在正线性相关：每增加1%，分别为1.13（1.07-1.20）和1.05（0.96-1.15）。在无糖尿病的患者中，空腹血糖和胰岛素之间没有相关性（p>0.05），但在有糖尿病的患者中，空腹血糖和胰岛素之间有显著相关性（p=0.0002）。结果在白人和非裔美国人中相似。糖尿病、HbA 1c水平和血糖控制不良与房颤风险增加独立相关，但控制这种关系的潜在机制尚不清楚，需要进一步研究。
Type 2 diabetes has been inconsistently associated with risk of atrial fibrillation (AF) in previous studies that have frequently been beset by methodological challenges. Prospective cohort study. The Atherosclerosis Risk in Communities Study. Detailed medical histories were obtained on 13025 participants. Individuals were categorized as having no diabetes, pre-diabetes or diabetes based on the 2010 American Diabetes Association criteria at study baseline (1990–92). Diagnoses of incident AF were obtained through 2007. Associations between type 2 diabetes and markers of glucose homeostasis with the incidence of AF were estimated using Cox proportional hazards models after adjusting for possible confounders. Type 2 diabetes was associated with a significant increase in risk of AF (HR 1.35, 95% confidence interval [CI]: 1.14–1.60) after adjustment for confounders. There was no indication that individuals with pre-diabetes or those with undiagnosed diabetes were at increased risk of AF compared to those without diabetes. We observed a positive linear association between HbA1c and risk of AF in those with and without diabetes: 1.13 (1.07–1.20) and 1.05 (0.96–1.15) per 1% point increase, respectively. There was no association between fasting glucose or insulin (p>0.05) in those without diabetes but a significant association with fasting glucose in those with the condition (p=0.0002). Results were similar in whites and African Americans. Diabetes, HbA1c level and poor glycemic control are independently associated with increased risk of AF, but the underlying mechanisms governing the relationship are unknown and warrant further investigation.
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