Burden of microvascular disease elevates atrial fibrillation risk in T2D patients

The presence and the burden of microvascular disease in adults with type 2 diabetes (T2D) independently contribute to an increased risk of incident atrial fibrillation (AF), suggests a recent study.

A team of investigators evaluated a total of 7,603 participants with T2D and without AF for diabetic kidney disease, retinopathy, or neuropathy at baseline in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. They used follow-up electrocardiograms to resolve incident AF events and modified Poisson regression to generate risk ratios (RRs) for AF.

Of the participants (mean age 62.5 years, 38.0 percent women, 63.4 percent White), 4,816 (63.3 percent) had microvascular disease, which was characterized by the presence of diabetic kidney disease, retinopathy, or neuropathy at baseline. One hundred thirty-seven (1.8 percent) AF events occurred over a median of 7 years.

Participants with microvascular disease showed a 1.9-fold higher risk of incident AF than those without (RR, 1.88, 95 percent confidence interval [CI], 1.20‒2.95). Individuals with 1 and ≥2 microvascular territories affected had RRs of 1.62 (95 percent CI, 1.01‒2.61) and 2.47 (95 percent CI, 1.46‒4.16) for AF, respectively, compared with those without.

Moreover, the RRs for AF by type of microvascular disease were as follows: 1.57 (95 percent CI, 1.09‒2.26) for neuropathy, 0.95 (95 percent CI, 0.53‒1.70) for retinopathy, and 1.67 (95 percent CI, 1.15‒2.44) for diabetic kidney disease.