Cardiac arrhythmia risk elevated in type 1 diabetes
medwireNews: Patients with type 1 diabetes, particularly women, are at an increased risk for developing atrial fibrillation (AF), research shows.
However, “[t]he overall excess risk of atrial fibrillation in people with type 1 diabetes is fairly low compared with the excess risk of myocardial infarction and heart failure,” note researcher Marcus Lind (Uddevalla Hospital, Sweden) and colleagues in The Lancet Diabetes & Endocrinology.
The incidence of AF was just 2% in study participants with and without diabetes, but the incidence rate per 1000 person–years was 2.35 in patients and 1.76 in controls.
All study participants were drawn from the national registries in Sweden and included 36,258 type 1 diabetes patients who were matched for age, gender, and county to 179,980 controls without diabetes. The patients were aged an average of 35 years at baseline and were followed up for around 10 years.
Men comprised 55% of the cohort and had a generally higher incidence of AF than women, but their risk was only marginally affected by the presence of diabetes, at an incidence per 1000 person–years of 2.69 compared with 2.19 in controls. After accounting for age, baseline comorbidities, diabetes duration, educational level, and birthplace, this equated to a significant 13% increased risk.
Women’s risk, although generally lower, was more obviously influenced by diabetes, with corresponding incidence rates of 1.96 versus 1.26 per 1000 person–years, giving a significant 50% risk increase after accounting for confounders.
Glycated hemoglobin and kidney function were both important predictors of AF risk, with a “pronounced rise” in this risk from a glycated hemoglobin level of 9.7% and from chronic kidney disease stage 4 (estimated glomerular filtration rate 15–30 mL/min per 1.73 m2), in both men and women.
In a linked commentary, Kazuo Miyazawa and Gregory Lip, both from City Hospital in Birmingham, UK, suggest that “atrial fibrillation could be viewed as yet another manifestation of end-organ damage in diabetes.”
They stress that “good glycaemic control and careful monitoring of renal function is needed in individuals with type 1 diabetes on treatment, as well as vigilance for the development of incident atrial fibrillation.”
However, they do not see a need for specific clinical measures in type 1 diabetes patients, saying that cardiovascular disease risk management “should be basically similar to that for patients with type 2 diabetes.”
They say that stroke prevention is the “cornerstone” of managing atrial fibrillation, but, beyond this, “the holistic approach to atrial fibrillation management should simply be patient-centred and symptom-directed, and take into account risk factor management.”
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