The impact of body weight and diabetes on new-onset atrial fibrillation: a nationwide population based study

Abstract

Background Being 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. Methods This 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. Results During 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). Conclusions Patients 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.

Risk of atrial fibrillation in persons with type 2 diabetes and the excess risk in relation to glycaemic control and renal function: a Swedish cohort study

“…It has been hypothesized that metabolic syndrome causes a transformation of the epicardial adipose tissue leading to proinflammatory mediators causing endothelial dysfunction, and fibrosis, which in turn leads to the development of structural and electrical atrial remodelling [30][31][32][33]. In a nationwide populationbased study, body weight status and diabetes had synergistic effects on the risk of new-onset atrial fibrillation [34]. Animal studies confirms that insulin resistance was associated with various aspects of remodelling in the atria, proposing that these might share common electrical and structural remodelling processes in the atria [35].…”

The risk of new-onset atrial fibrillation in patients with type 2 diabetes mellitus treated with sodium glucose cotransporter 2 inhibitors versus dipeptidyl peptidase-4 inhibitors

“…Other studies have also reported adrenergic activation and heterogeneous sympathetic innervation in diabetic hearts, suggesting that neural remodeling may play a crucial role in diabetes-related atrial arrhythmia [ 28 ]. Furthermore, T2DM itself is associated with several chronic diseases including obesity, hypertension, chronic kidney disease, and heart failure, all of which further increase the risk of incident AF [ 6 , 7 , 29 , 30 ].…”

Waist circumference is associated with major adverse cardiovascular events in male but not female patients with type-2 diabetes mellitus

“…Obesity has become a major health problem worldwide and affects almost all of the major cardiovascular risk factors including hypertension, type-2 diabetes mellitus (T2DM), and hyperlipidemia [1][2][3][4][5]. Although obesity is associated with an increased risk of cardiovascular diseases (CVDs) and CVD-related risk factors [3], relevant epidemiologic studies have demonstrated obese or overweight T2DM patients may have better clinical outcomes compared with those at a normal weight [6,7]. Relevant studies have indicated that this phenomenon is partly attributed to the fact that body mass index (BMI) is an imperfect measure of obesity; additionally, BMI does not reflect body fat distribution and does not discriminate lean body mass from visceral adipose tissue [8,9].…”