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Abstract
Diabetes mellitus (DM) is considered an independent risk factor for atrial fibrillation (AF). The excess risk in relation to the presence of proteinuria has not been well elucidated. Our aim was to determine the association between the incidence of AF and proteinuria in diabetic population. A total of 240,499 individuals aged ≥ 60 years from the Korea National Health Insurance Service-Senior cohort from 2004 to 2014 were included. 4.2% of individuals with DM and 3.7% of controls were diagnosed with AF during a median follow-up period of 7.2 years. Amongst controls (participants without proteinuria and DM), DM only, proteinuria only, and DM with proteinuria groups, the crude incidences of AF were 0.58, 0.70, 0.96, 1.24 per 100 person-years respectively. Compared with controls, the weighted risk of AF was increased by 11% (hazard ratio = 1.11, 95% confidence interval = 1.02–1.20, P = .001), 48% (hazard ratio = 1.48, 95% confidence interval = 1.30–1.69, P < .001), and 66% (hazard ratio = 1.66, 95% confidence interval = 1.26–2.18, P < .001) in the DM only, proteinuria only, and DM with proteinuria groups, respectively (P for trend < .001). Degree of proteinuria in diabetic patients was associated with a significantly higher rate of incident AF in dose dependent manner. Thus, assessing proteinuria by a simple urine dipstick test could provide a useful adjunct to risk assessment for AF in elderly population with DM.
Highlights
Diabetes mellitus (DM) is considered an independent risk factor for atrial fibrillation (AF)
Our aim was to determine the association between the incidence of AF and proteinuria detected using a urine dipstick test and second, the implications for clinical outcomes in participants with DM from an elderly population cohort. We investigated these associations in an elderly population with and without DM using the nationwide population-based National Health Insurance Service (NHIS)-Senior cohort (NHIS-Senior) database
As quantified by the clinical variable-adjusted hazard ratios (HR), compared with controls, the risk of AF was increased by 5%, 47% (HR 1.47, 95% CI 1.29–1.67, P < 0.001), and 75% (HR 1.75, 95% CI 1.47–2.08, P < 0.001) in the DM only, proteinuria only, and DM with proteinuria groups, respectively (P for trend < 0.001)
Summary
Diabetes mellitus (DM) is considered an independent risk factor for atrial fibrillation (AF). Our aim was to determine the association between the incidence of AF and proteinuria in diabetic population. Degree of proteinuria in diabetic patients was associated with a significantly higher rate of incident AF in dose dependent manner. Some studies have reported that DM is not an independent risk factor for AF10,11. These discrepancies might result from heterogeneous groups included in DM patients, especially since the incidence of AF rises with increasing severity of microvascular complications In a community-based cohort study, proteinuria was independently associated with all-cause mortality and cardiovascular mortality[13]. The excess risk of AF in relation to proteinuria in patients with DM is less clear
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