Abstract
The relationship between serum hemoglobin A1c (HbA1c) and atrial fibrillation (AF) or postoperative AF (POAF) in coronary artery bypass (CABG) patients is still under debate. It is also unclear whether there is a dose-response relationship between circulating HbA1c and the risk of AF or POAF. The Cochrane Library, PubMed, and EMBASE databases were searched. A robust-error meta-regression method was used to summarize the shape of the dose-response relationship. The RR and 95%CI were using a random-effects model. In total, 14 studies were included, totaling 17,914 AF cases among 352,325 participants. The summary RR per 1% increase in HbA1c was 1.16 (95% CI: 1.07-1.27). In the subgroup analysis, the summary RR was 1.13 (95% CI: 1.08-1.19) or 1.12 (95% CI: 1.05-1.20) for patients with diabetes or without known diabetes, respectively. The nonlinear analysis showed a nonlinear (Pnonlinear = 0.04) relationship between HbA1c and AF, with a significantly increased risk of AF if HbA1c was over 6.3%. However, HbA1c (per 1% increase) was not associated with POAF in patients with diabetes (RR: 1.13, P = 0.34) or without known diabetes (RR: 0.91, P = 0.37) among patients undergoing CABG. Our results suggest that higher HbA1c was associated with an increased risk of AF, both in diabetes and in without diabetes or with unknown diabetes. However, no association was found between HbA1c and POAF in patients undergoing CABG. Further prospective studies with larger population sizes are needed to explore the association between serum HbA1c level and the risk of POAF.
Highlights
Atrial fibrillation (AF) is the most common cardiac arrhythmia found in clinical practice and is associated with an increased risk of morbidity [1]
Our results suggest that higher hemoglobin A1c (HbA1c) was associated with an increased risk of atrial fibrillation (AF), both in diabetes and in without diabetes or with unknown diabetes
No association was found between HbA1c and postoperative AF (POAF) in patients undergoing CABG
Summary
Atrial fibrillation (AF) is the most common cardiac arrhythmia found in clinical practice and is associated with an increased risk of morbidity [1]. Several new research articles have reported that a higher serum HbA1c could reduce new-onset AF after coronary artery bypass grafting (CABG) surgery [14, 15]. Given this background, we conducted a dose-response meta-analysis to i) quantitatively investigate the dose-specific relationship between HbA1c and AF. The relationship between serum hemoglobin A1c (HbA1c) and atrial fibrillation (AF) or postoperative AF (POAF) in coronary artery bypass (CABG) patients is still under debate. It is unclear whether there is a dose-response relationship between circulating HbA1c and the risk of AF or POAF
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