Associations of New-onset Atrial Fibrillation with Risks of Cardiovascular Disease, Chronic Kidney Disease and Mortality among Patients with Type 2 Diabetes
Objective: Atrial fibrillation (AF) frequently occurs in patients with type 2 diabetes (T2D); however, the longitudinal associations of new-onset AF with risks of adverse health outcomes in patients with T2D remains unclear. This study aimed to determine the associations of new-onset AF with subsequent risks of atherosclerotic cardiovascular disease (ASCVD), heart failure, chronic kidney disease (CKD), and mortality among patients with T2D.
Research design and methods: We included 16,551 adults with T2D, who were free of cardiovascular diseases (CVD) and CKD at recruitment from the UK Biobank study. Time-varying Cox regression models were used to assess the associations of incident AF with subsequent risks of incident ASCVD, heart failure, CKD, and mortality.
Results: Among the patients with T2D, 1394 developed AF and 15,157 remained free of AF during the follow-up. Over median follow-up of 10.7-11.0 years, we documented 2872 ASCVD, 852 heart failure, 1548 CKD, and 1776 total death (409 CVD deaths). Among patients with T2D, those with incident AF had higher risks of ASCVD (HR, 1.85; 95% CI, 1.59-2.16), heart failure (HR, 4.40; 95% CI, 3.67-5.28), CKD (HR, 1.68; 95% CI, 1.41-2.01),all-cause mortality (HR, 2.91; 95% CI, 2.53-3.34), and CVD mortality (HR, 3.75; 95% CI, 2.93-4.80) compared with those without incident AF.
Conclusion: Patients with T2D who developed AF had significantly increased risks of developing subsequent adverse cardiovascular events, CKD, and mortality. Our data underscore the importance of strategies of AF prevention to reduce macro- and microvascular complications in patients with T2D.