Cardiac arrhythmias and conduction abnormalities in patients with type 2 diabetes

Rawshani, A. et al. (2023) Cardiac arrhythmias and conduction abnormalities in patients with type 2 diabetes. Scientific Reports, 13, 1192. (doi: 10.1038/s41598-023-27941-5) (PMID:36681691) (PMCID:PMC9867726)

Abstract

The association between type 2 diabetes (T2D) and the development of cardiac arrhythmias and conduction disturbances has not been extensively studied. Arrhythmia was defined as atrial fibrillation and flutter (AF/AFl), ventricular tachycardia (VT) and ventricular fibrillation (VF), and conduction abnormality as sinus node disease (SND), atrioventricular (AV) block or pacemaker implantation, and intraventricular conduction blocks (IVCB). Incidence rates and Cox regression were used to compare outcomes, and to assess optimal levels for cardiometabolic risk factors and risk associated with multifactorial risk factor control (i.e., HbA1c, LDL-C, systolic blood pressure (SBP), BMI and eGFR), between patients with versus without T2D. The analyses included data from 617,000 patients with T2D and 2,303,391 matched controls. Patients with diabetes and the general population demonstrated a gradual increase in rates for cardiac conduction abnormalities and virtually all age-groups for AF/AFI showed increased incidence during follow-up. For patients with versus without T2D, risks for cardiac arrhythmias were higher, including for AF/AFl (HR 1.17, 95% CI 1.16–1.18), the composite of SND, AV-block or pacemaker implantation (HR 1.40, 95% CI 1.37–1.43), IVCB (HR 1.23, 95% CI 1.18–1.28) and VT/VF (HR 1.08, 95% CI 1.04–1.13). For patients with T2D who had selected cardiometabolic risk factors within target ranges, compared with controls, risk of arrythmia and conduction abnormalities for T2D vs not were: AF/AFl (HR 1.09, 95% CI 1.05–1.14), the composite of SND, AV-block or pacemaker implantation (HR 1.06, 95% CI 0.94–1.18), IVCB (HR 0.80, 95% CI 0.60–0.98), and for VT/VF (HR 0.97, 95% CI 0.80–1.17). Cox models showed a linear risk increase for SBP and BMI, while eGFR showed a U-shaped association. Individuals with T2D had a higher risk of arrhythmias and conduction abnormalities than controls, but excess risk associated with T2D was virtually not evident among patients with T2D with all risk factors within target range. BMI, SBP and eGFR displayed significant associations with outcomes among patients with T2D.

• Item Type: Articles
• Additional Information: Open access funding provided by University of Gothenburg. This work was supported by grants from: the Swedish state under an agreement between the Swedish government and the county councils concerning economic support of research and education of doctors [ALFGBG-966187], the Swedish Heart and Lung Foundation [2019-0532], the Swedish Research Council [2019-02019].
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Sattar, Professor Naveed and McMurray, Professor John
• Authors: Rawshani, A., McGuire, D. K., Omerovic, E., Sattar, N., McMurray, J. J.V., Smith, U., Redfors, B., Bergfeldt, L., Eliasson, B., Borén, J., Bhatt, D. L., Bergstrom, G., and Rawshani, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Scientific Reports
• Publisher: Nature Research
• ISSN: 2045-2322
• ISSN (Online): 2045-2322
• Copyright Holders: Copyright © The Author(s) 2023
• First Published: First published in Scientific Reports 13:1192
• Publisher Policy: Reproduced under a Creative Commons licence