Aging, Diabetic Nephropathy and Multiple Macrovascular Involvement are Associated with Atrial Fibrillation in Type 2 Diabetes Mellitus

Background: Atrial fibrillation (AF) is the most common arrhythmia in the world and a recognized risk factor for stroke and death.
Aims: To establish the association between atrial fibrillation and markers of glucose homeostasis as well as anthropometric, laboratory and clinical variables in type 2 diabetes.
Study Design: Cross-sectional retrospective study.
Place and Duration of Study: Unit of Metabolic and Endocrine Diseases, “Centro Catanese di Medicina e Chirurgia” Clinic, Catania, Italy, between January 1, 2008, and January 1, 2014
Methods: We included 6,920 type 2 diabetic (T2D) patients (mean age 66.4±11.4 years, 50.4% men) treated in specialist diabetes center. Persistent AF was assessed by clinical history and confirmed (by a single cardiologist) by a resting 12-lead electrocardiogram. Demographic, clinical and laboratory parameters were included in the analyses, as well as vascular laboratory studies. Standardized procedures were used to assess microvascular complications and Metabolic Syndrome (MetS).
Results: In total, 6,455 (93.3%) patients had no evidence of atrial arrhythmia and the remaining 465 (6.7%) had AF. The prevalence of AF increased with age (peak of prevalence after 75 years in both sexes) and it was significantly greater in men (p=0.02). AF was significantly associated with hypercreatininemia, eGFR (and more advanced stage of Chronic Kidney Disease, CKD) and albuminuria (p<0.0001) as well as the diagnosis of cardio-vascular disease (CVD, p<0.0001). In a multivariate logistic regression analysis, age (OR 1.08, 95% CI 1.05-1.11, p<0.0001), male sex (OR 2.46, 95% CI 1.5-3.9, p=0.0002), estimated Glomerular Filtration Rate (eGFR) (OR 0.99, 95% CI 0.98-0.99, p=0.02) and the presence of CVD (OR 1.65, 95% CI 1.01-2.75, p=0.04) were all independent factors related to AF. When we subgrouped patients according to cardiovascular patterns, an adjusted analysis revealed a significant difference only in the poly-vascular subgroup (OR 2.24, 95% CI 1.26-3.99, p=0.006).
Conclusion: Aging, CKD and cardiovascular disease (particularly poly-vascular involvement) were the most significant AF-related factors. In T2D patients, the identification of factors predisposing individuals to AF may facilitate an early diagnosis and stroke prevention therapy.