Top

Published in:

24-01-2022 | Macroalbuminuria | Original Article

Factors associated with atrial fibrillation in Japanese patients with type 2 diabetes mellitus: a cross-sectional study

Authors: Natsuki Honda, Akinobu Ochi, Sadahiko Uchimoto, Yoshinori Kakutani, Yuko Yamazaki, Tomoaki Morioka, Tetsuo Shoji, Masaaki Inaba, Masanori Emoto

Published in: Diabetology International | Issue 3/2022

Abstract

Aims

Atrial fibrillation (AF) increases cardiovascular complications and mortality in patients with diabetes. Diabetes is a risk factor for AF; however, risk factors for AF among patients with type 2 diabetes (T2D) remain unknown, especially among Asian people. We clarified the prevalence of AF, regardless of type (i.e., paroxysmal, persistent, or permanent) in Japanese patients with T2D and clarified factors associated with AF.

Methods

This cross-sectional study was conducted at Fujiidera Municipal Hospital (Osaka, Japan). Patients with T2D (n = 899: 518 men and 381 women with a mean age ± SD of 69.0 ± 12.1 years) were included. Their electrocardiographs were checked during routine examinations between January 2017 and January 2018. A diagnosis of AF was determined from single time-point standard 12-lead electrocardiographic findings. We analyzed clinical parameters (e.g., age, sex, diabetes duration, glycated hemoglobin, body mass index, estimated glomerular filtration rate, albuminuria or proteinuria, use of biguanide, and presence of hypertension) between patients with and without AF.

Results

The prevalence of AF among patients with T2D was 5.9%; it became higher as age increased and tended to be higher in men than in women. The prevalence became higher as albuminuria or proteinuria progressed and as the eGFR decreased. Multiple logistic regression analyses revealed that older age, male sex, and reduced eGFR were independently and significantly associated with the coexistence of AF. However, multiple logistic regression analysis revealed no significant relationships between AF and the presence of albuminuria or proteinuria.

Conclusions

Older age, male sex, and reduced eGFR were associated with AF in Japanese patients with T2D.

Available only for authorised users

Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129(8):837–47. https://doi.org/10.1161/CIRCULATIONAHA.113.005119.CrossRefPubMed

Inoue H, Fujiki A, Origasa H, Ogawa S, Okumura K, Kubota I, et al. Prevalence of atrial fibrillation in the general population of Japan: an analysis based on periodic health examination. Int J Cardiol. 2009;137(2):102–7. https://doi.org/10.1016/j.ijcard.2008.06.029.CrossRefPubMed

Krahn AD, Manfreda J, Tate RB, Mathewson FA, Cuddy TE. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba follow-up study. Am J Med. 1995;98(5):476–84. https://doi.org/10.1016/S0002-9343(99)80348-9.CrossRefPubMed

Dublin S, Glazer NL, Smith NL, Psaty BM, Lumley T, Wiggins KL, et al. Diabetes mellitus, glycemic control, and risk of atrial fibrillation. J Gen Intern Med. 2010;25(8):853–8. https://doi.org/10.1007/s11606-010-1340-y.CrossRefPubMedPubMedCentral

Huxley RR, Filion KB, Konety S, Alonso A. Meta-analysis of cohort and case-control studies of type 2 diabetes mellitus and risk of atrial fibrillation. Am J Cardiol. 2011;108(1):56–62. https://doi.org/10.1016/j.amjcard.2011.03.004.CrossRefPubMedPubMedCentral

Benjamin EJ, Levy D, Vaziri SM, D’Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994;271(11):840–4.CrossRef

Du X, Ninomiya T, de Galan B, Abadir E, Chalmers J, Pillai A, et al. Risks of cardiovascular events and effects of routine blood pressure lowering among patients with type 2 diabetes and atrial fibrillation: results of the ADVANCE study. Eur Heart J. 2009;30(9):1128–35. https://doi.org/10.1093/eurheartj/ehp055.CrossRefPubMed

Zethelius B, Eliasson B, Eeg-Olofsson K, Svensson AM, Gudbjornsdottir S, Cederholm J, et al. A new model for 5-year risk of cardiovascular disease in type 2 diabetes, from the Swedish National Diabetes Register (NDR). Diabetes Res Clin Pract. 2011;93(2):276–84. https://doi.org/10.1016/j.diabres.2011.05.037.CrossRefPubMed

Movahed MR, Hashemzadeh M, Jamal MM. Diabetes mellitus is a strong, independent risk for atrial fibrillation and flutter in addition to other cardiovascular disease. Int J Cardiol. 2005;105(3):315–8. https://doi.org/10.1016/j.ijcard.2005.02.050.CrossRefPubMed

10.

Suzuki S, Sagara K, Otsuka T, Matsuno S, Funada R, Uejima T, et al. A new scoring system for evaluating the risk of heart failure events in Japanese patients with atrial fibrillation. Am J Cardiol. 2012;110(5):678–82. https://doi.org/10.1016/j.amjcard.2012.04.049.CrossRefPubMed

11.

Zethelius B, Gudbjornsdottir S, Eliasson B, Eeg-Olofsson K, Svensson AM, Cederholm J. Risk factors for atrial fibrillation in type 2 diabetes: report from the Swedish National Diabetes Register (NDR). Diabetologia. 2015;58(10):2259–68. https://doi.org/10.1007/s00125-015-3666-9.CrossRefPubMed

12.

Committee of the Japan Diabetes Society on the Diagnostic Criteria of Diabetes M, Seino Y, Nanjo K, Tajima N, Kadowaki T, Kashiwagi A, et al. Report of the committee on the classification and diagnostic criteria of diabetes mellitus. J Diabetes Investig. 2010;1(5):212–28. https://doi.org/10.1111/j.2040-1124.2010.00074.x.CrossRef

13.

Shimamoto K, Ando K, Fujita T, Hasebe N, Higaki J, Horiuchi M, et al. The Japanese Society of hypertension guidelines for the management of hypertension (JSH 2014). Hypertens Res. 2014;37(4):253–390. https://doi.org/10.1038/hr.2014.20.CrossRefPubMed

14.

Vaughan Williams EM. A classification of antiarrhythmic actions reassessed after a decade of new drugs. J Clin Pharmacol. 1984;24(4):129–47. https://doi.org/10.1002/j.1552-4604.1984.tb01822.x.CrossRefPubMed

15.

Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53(6):982–92. https://doi.org/10.1053/j.ajkd.2008.12.034.CrossRefPubMed

16.

Haneda M, Utsunomiya K, Koya D, Babazono T, Moriya T, Makino H, et al. A new classification of Diabetic Nephropathy 2014: a report from Joint Committee on Diabetic Nephropathy. Clin Exp Nephrol. 2015;19(1):1–5. https://doi.org/10.1007/s10157-014-1057-z.CrossRefPubMed

17.

Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001;285(22):2864–70. https://doi.org/10.1001/jama.285.22.2864.CrossRefPubMed

18.

Iguchi Y, Kimura K, Kobayashi K, Aoki J, Terasawa Y, Sakai K, et al. Relation of atrial fibrillation to glomerular filtration rate. Am J Cardiol. 2008;102(8):1056–9. https://doi.org/10.1016/j.amjcard.2008.06.018.CrossRefPubMed

19.

Chapter 1: definition and classification of CKD. Kidney Int Suppl. 2013;3(1):19–62. https://doi.org/10.1038/kisup.2012.64.

20.

Seyed Ahmadi S, Svensson AM, Pivodic A, Rosengren A, Lind M. 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. Cardiovasc Diabetol. 2020;19(1):9. https://doi.org/10.1186/s12933-019-0983-1.CrossRefPubMedPubMedCentral

21.

Zhang Q, Liu T, Ng CY, Li G. Diabetes mellitus and atrial remodeling: mechanisms and potential upstream therapies. Cardiovasc Ther. 2014;32(5):233–41. https://doi.org/10.1111/1755-5922.12089.CrossRefPubMed

22.

Sun Y, Hu D. The link between diabetes and atrial fibrillation: cause or correlation? J Cardiovasc Dis Res. 2010;1(1):10–1. https://doi.org/10.4103/0975-3583.59978.CrossRefPubMedPubMedCentral

23.

Tadic M, Cuspidi C. Type 2 diabetes mellitus and atrial fibrillation: From mechanisms to clinical practice. Arch Cardiovasc Dis. 2015;108(4):269–76. https://doi.org/10.1016/j.acvd.2015.01.009.CrossRefPubMed

24.

Lim HS, MacFadyen RJ, Lip GY. Diabetes mellitus, the renin-angiotensin-aldosterone system, and the heart. Arch Intern Med. 2004;164(16):1737–48. https://doi.org/10.1001/archinte.164.16.1737.CrossRefPubMed

25.

Jeong JH. Prevalence of and risk factors for atrial fibrillation in Korean adults older than 40 years. J Korean Med Sci. 2005;20(1):26–30. https://doi.org/10.3346/jkms.2005.20.1.26.CrossRefPubMedPubMedCentral

26.

Bohm M, Thoenes M, Neuberger HR, Graber S, Reil JC, Bramlage P, et al. Atrial fibrillation and heart rate independently correlate to microalbuminuria in hypertensive patients. Eur Heart J. 2009;30(11):1364–71. https://doi.org/10.1093/eurheartj/ehp124.CrossRefPubMed

27.

McManus DD, Corteville DC, Shlipak MG, Whooley MA, Ix JH. Relation of kidney function and albuminuria with atrial fibrillation (from the Heart and Soul Study). Am J Cardiol. 2009;104(11):1551–5. https://doi.org/10.1016/j.amjcard.2009.07.026.CrossRefPubMedPubMedCentral

28.

Parikh NI, Hwang SJ, Larson MG, Meigs JB, Levy D, Fox CS. Cardiovascular disease risk factors in chronic kidney disease: overall burden and rates of treatment and control. Arch Intern Med. 2006;166(17):1884–91. https://doi.org/10.1001/archinte.166.17.1884.CrossRefPubMed

29.

Alonso A, Lopez FL, Matsushita K, Loehr LR, Agarwal SK, Chen LY, et al. Chronic kidney disease is associated with the incidence of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study. Circulation. 2011;123(25):2946–53. https://doi.org/10.1161/CIRCULATIONAHA.111.020982.CrossRefPubMedPubMedCentral

30.

Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation. 2003;108(17):2154–69. https://doi.org/10.1161/01.CIR.0000095676.90936.80.CrossRefPubMed

31.

Vaziri SM, Larson MG, Benjamin EJ, Levy D. Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation. 1994;89(2):724–30. https://doi.org/10.1161/01.cir.89.2.724.CrossRefPubMed

32.

Siragy HM, Carey RM. Role of the intrarenal renin-angiotensin-aldosterone system in chronic kidney disease. Am J Nephrol. 2010;31(6):541–50. https://doi.org/10.1159/000313363.CrossRefPubMedPubMedCentral

33.

Qi W, Zhang N, Korantzopoulos P, Letsas KP, Cheng M, Di F, et al. Serum glycated hemoglobin level as a predictor of atrial fibrillation: a systematic review with meta-analysis and meta-regression. PLoS ONE. 2017;12(3): e0170955. https://doi.org/10.1371/journal.pone.0170955.CrossRefPubMedPubMedCentral

34.

Chang SH, Wu LS, Chiou MJ, Liu JR, Yu KH, Kuo CF, et al. Association of metformin with lower atrial fibrillation risk among patients with type 2 diabetes mellitus: a population-based dynamic cohort and in vitro studies. Cardiovasc Diabetol. 2014;13:123. https://doi.org/10.1186/s12933-014-0123-x.CrossRefPubMedPubMedCentral

35.

Bansal N, Xie D, Tao K, Chen J, Deo R, Horwitz E, et al. Atrial fibrillation and risk of ESRD in adults with CKD. Clin J Am Soc Nephrol. 2016;11(7):1189–96. https://doi.org/10.2215/CJN.10921015.CrossRefPubMedPubMedCentral

Title: Factors associated with atrial fibrillation in Japanese patients with type 2 diabetes mellitus: a cross-sectional study
Authors: Natsuki Honda
Akinobu Ochi
Sadahiko Uchimoto
Yoshinori Kakutani
Yuko Yamazaki
Tomoaki Morioka
Tetsuo Shoji
Masaaki Inaba
Masanori Emoto
Publication date: 24-01-2022
Publisher: Springer Nature Singapore
Keywords: Macroalbuminuria
Biguanide
Atrial Fibrillation
Microalbuminuria
Albuminuria
Type 2 Diabetes
Published in: Diabetology International / Issue 3/2022
Print ISSN: 2190-1678
Electronic ISSN: 2190-1686
DOI: https://doi.org/10.1007/s13340-021-00563-w

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Aims

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2022

The effectiveness of psychological interventions on mental health and quality of life in people living with type 1 diabetes: a systematic review and meta-analysis

Continuity of diabetes care among elderly Japanese patients: a medical record review study in a specialized diabetes clinic

Eighteen-year trends in the management of patients with diabetes in the Shiga Diabetes Clinical Survey: overall trends and differences by age group

Incidence of interventions for diabetic retinopathy and serious lower-limb complications and its related factors in patients with type 2 diabetes using a real-world large claims database

Development of a hyperosmolar-hyperglycemic state and possible fulminant type 1 diabetes mellitus during the treatment of a case of adenocarcinoma of the lung and interstitial pneumonia

Illness perception, medication adherence and glycemic control among primary health-care patients with type 2 diabetes mellitus at Port Said City, Egypt

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials