Sex, age, type of diabetes and incidence of atrial fibrillation in patients with diabetes mellitus: a nationwide analysis

Abstract

Background There remain uncertainties regarding diabetes mellitus and the incidence of atrial fibrillation (AF), in relation to type of diabetes, and the interactions with sex and age. We investigated whether diabetes confers higher relative rates of AF in women compared to men, and whether these sex-differences depend on type of diabetes and age. Methods All patients aged ≥ 18 seen in French hospitals in 2013 with at least 5 years of follow-up without a history of AF were identified and categorized by their diabetes status. We calculated overall and age-dependent incidence rates, hazard ratios, and women-to-men ratios for incidence of AF in patients with type 1 and type 2 diabetes (compared to no diabetes). Results In 2,921,407 patients with no history of AF (55% women), 45,389 had prevalent type 1 diabetes and 345,499 had prevalent type 2 diabetes. The incidence rates (IRs) of AF were higher in type 1 or type 2 diabetic patients than in non-diabetics, and increased with advancing age. Among individuals with diabetes, the absolute rate of AF was higher in men than in women. When comparing individuals with and without diabetes, women had a higher adjusted hazard ratio (HR) of AF than men: adjusted HR 1.32 (95% confidence interval 1.27–1.37) in women vs. 1.12(1.08–1.16) in men for type 1 diabetes, adjusted HR 1.17(1.16–1.19) in women vs. 1.10(1.09–1.12) in men for type 2 diabetes. Conclusion Although men have higher absolute rates for incidence of AF, the relative rates of incident AF associated with diabetes are higher in women than in men for both type 1 and type 2 diabetes.

Metabolically healthy obesity and cardiovascular events: A nationwide cohort study

“…The reliability of PMSI data has already been assessed and this database has previously been used to study patients with CV conditions. [9][10][11][12][13][14] Use of medication was identified from a 1/97 permanent random sample of the complete French nationwide claims database (Echantillon Généraliste de Bénéficiaires [general sample of healthcare beneficiaries]). This is another database, not linked to the PMSI database, and it has been used previously to study patients with diabetes in France.…”

Glucose-lowering drug use and new-onset atrial fibrillation in patients with diabetes mellitus

“…To the Editor: Diabetes mellitus and atrial fibrillation (AF) are increasing worldwide and are associated with an increased risk of morbidity and mortality. Patients with diabetes mellitus are at increased risk of incident AF [1,2], but it is currently debated whether the risk of new-onset AF may be affected by therapies used for the treatment of diabetes mellitus [3,4]. Currently there is no robust evidence that the different glucose-lowering therapies available either accelerate or decelerate the development of new-onset AF.…”

“…The analysis used the EGB ('Echantillon Généraliste des Bénéficiaires') database, a 1/97 representative sample of French nationwide claims and hospitalisation data [1]. The system contains individual anonymised information on each hospitalisation and outpatient claim, which are linked to create a longitudinal record of hospital stays and diagnoses using the ICD-10 for each patient.…”

Glycemic control and atrial fibrillation: an intricate relationship, yet under investigation

“…The accumulation of data from ensuing observational studies did not establish a direct causal relation between DM and AF, although it strengthened the notion that DM is an independent determinant for AF development [ 9 – 12 ]. The latter holds true for both type 1 and 2 DM, as well as pre-diabetes [ 13 , 14 ]. Of note, the prevalence of DM varies to a significant extent among recent AF cohorts; from 9 to 32% [ 15 – 21 ].…”

“…Remarkably among diabetic individuals, female gender has been consistently associated with higher risk for AF when compared to male gender [ 10 , 13 , 23 ]. This was replicated by a machine-learning aided meta-analysis, whereby women with DM were 24% more likely to develop AF than men [ 24 ].…”