Abstract
BackgroundBeing obese or underweight, and having diabetes are important risk factors for new-onset atrial fibrillation (AF). However, it is unclear whether there is any interaction between body weight and diabetes in regard to development of new-onset AF. We aimed to evaluate the role of body weight status and various stage of diabetes on new-onset AF.MethodsThis was a nationwide population based study using National Health Insurance Service (NHIS) data. A total of 9,797,418 patients who underwent national health check-ups were analyzed. Patients were classified as underweight [body mass index (BMI) < 18.5], normal reference group (18.5 ≤ BMI < 23.0), upper normal (23.0 ≤ BMI < 25.0), overweight (25.0 ≤ BMI < 30.0), or obese (BMI ≥ 30.0) based on BMI. Diabetes were categorized as non-diabetic, impaired fasting glucose (IFG), new-onset diabetes, diabetes < 5 years, and diabetes ≥ 5 years. Primary outcome end point was new-onset AF. New-onset AF was defined as one inpatient or two outpatient records of International Classification of Disease, Tenth Revision (ICD-10) codes in patients without prior AF diagnosis.ResultsDuring 80,130,161 patient*years follow-up, a total of 196,136 new-onset AF occurred. Obese [hazard ration (HR) = 1.327], overweight (HR = 1.123), upper normal (HR = 1.040), and underweight (HR = 1.055) patients showed significantly increased risk of new-onset AF compared to the normal reference group. Gradual escalation in the risk of new-onset AF was observed along with advancing diabetic stage. Body weight status and diabetes were independently associated with new-onset AF and at the same time, had synergistic effects on the risk of new-onset AF with obese diabetic patients having the highest risk (HR = 1.823).ConclusionsPatients with obesity, overweight, underweight, and diabetes had significantly increased risk of new-onset AF. Body weight status and diabetes had synergistic effects on the risk of new-onset AF. The risk of new-onset AF increased gradually with advancing diabetic stage. This study suggests that maintaining optimal body weight and glucose homeostasis might prevent new-onset AF.
Highlights
IntroductionHaving diabetes are important risk factors for new-onset atrial fibril‐ lation (AF)
Being obese or underweight, and having diabetes are important risk factors for new-onset atrial fibril‐ lation (AF)
The major findings of this study are summarized as follows: (1) body weight status and diabetes were both independently associated with the occurrence of new-onset AF; (2) Being underweight, obese or overweight were associated with an increased risk of new-onset AF with obesity showing the highest risk; (3) the presence of diabetes and its stage was associated with new-onset AF; (4) impaired fasting glucose (IFG) was an independent risk factor for development of new-onset AF; (5) A synergistic effect was observed between body weight and diabetes, with obese diabetic patients showing the highest risk of developing AF
Summary
Having diabetes are important risk factors for new-onset atrial fibril‐ lation (AF). It is unclear whether there is any interaction between body weight and diabetes in regard to development of new-onset AF. Its efficacy in preventing AF recurrence is shown by improved quality of life, reduced stroke risk, preserved heart function, and even reduced all-cause mortality in a subgroup of patients [1, 9–11]. A powerful risk factor for ischemic heart disease, is known to increase the risk of new-onset AF [12–14]. Obesity is another risk factor for AF [15, 16]. The underlying mechanism of such an association between new-onset AF and diabetes/ obesity is not clear but it is proposed that increased left atrial size and pressure might contribute to the development of AF in these patients [20]
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