Association of diabetes with atrial fibrillation types: a systematic review and meta-analysis

Cardiovascular Diabetology

Matthias Wilhelm¹  Tobias Reichlin¹  Salman Razvi²  Taulant Muka³  Fadi Alijla³  Chepkoech Buttia³  Oscar H. Franco³  Arjola Bano⁴  Beatrice Minder⁵ 

[1] Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland;Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, UK;Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK;Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland;Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland;Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland;Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland;

关键词: Diabetes mellitus;    Paroxysmal;    Non-paroxysmal;    Persistent;    Permanent;    Atrial fibrillation;   

DOI  :  10.1186/s12933-021-01423-2

来源: Springer

【 摘 要 】

BackgroundAtrial fibrillation (AF) is a common arrhythmia classified as paroxysmal and non-paroxysmal. Non-paroxysmal AF is associated with an increased risk of complications. Diabetes contributes to AF initiation, yet its role in AF maintenance is unclear. We conducted a systematic review and meta-analysis to summarize the evidence regarding the association of diabetes with AF types.MethodsWe searched 5 databases for observational studies investigating the association of diabetes with the likelihood of an AF type (vs another type) in humans. Study quality was evaluated using the Newcastle–Ottawa Scale. Studies classifying AF types as paroxysmal (reference) and non-paroxysmal were pooled in a meta-analysis using random effects models.ResultsOf 1997 articles we identified, 20 were included in our systematic review. The population sample size ranged from 64 to 9816 participants with mean age ranging from 40 to 75 years and percentage of women from 24.8 to 100%. The quality of studies varied from poor (60%) to fair (5%) to good (35%). In the systematic review, 8 studies among patients with AF investigated the cross-sectional association of diabetes with non-paroxysmal AF (vs paroxysmal) of which 6 showed a positive association and 2 showed no association. Fourteen studies investigated the longitudinal association of diabetes with “more sustained” AF types (vs “less sustained”) of which 2 showed a positive association and 12 showed no association. In the meta-analysis of cross-sectional studies, patients with AF and diabetes were 1.31-times more likely to have non-paroxysmal AF than those without diabetes [8 studies; pooled OR (95% CI), 1.31 (1.13–1.51), I2 = 82.6%]. The meta-analysis of longitudinal studies showed that for patients with paroxysmal AF, diabetes is associated with 1.32-times increased likelihood of progression to non-paroxysmal AF [five studies; pooled OR (95% CI), 1.32 (1.07–1.62); I2 = 0%].ConclusionsOur findings suggest that diabetes is associated with an increased likelihood of non-paroxysmal AF rather than paroxysmal AF. However, further high quality studies are needed to replicate these findings, adjust for potential confounders, elucidate mechanisms linking diabetes to non-paroxysmal AF, and assess the impact of antidiabetic medications on AF types. These strategies could eventually help decrease the risk of non-paroxysmal AF among patients with diabetes.

【 授权许可】

CC BY