Key result
Obesity significantly increased the risk of new-onset atrial fibrillation compared to normal weight (HR 1.327), with obese diabetic patients demonstrating the highest synergistic risk (HR 1.823).
Why the study?
It was unclear whether an interaction exists between body weight and diabetes regarding the development of new-onset AF.
Does maintaining optimal body weight and glucose homeostasis prevent new-onset atrial fibrillation in the general population?
Cohort (n=9,797,418)
Does maintaining optimal body weight and glucose homeostasis prevent new-onset atrial fibrillation in the general population?
Body weight status and diabetes are independently and synergistically associated with an increased risk of new-onset atrial fibrillation, highlighting the importance of weight management and glycemic control.
Supports weight and glycemic management to potentially lower AF risk; leaves open causality and intervention effects in trials.
BACKGROUND: Being obese or underweight, and having diabetes are important risk factors for new-onset atrial fibrillation (AF). However, it is unclear whether there is any interaction between body weight and diabetes in regard to development of new-onset AF. We aimed to evaluate the role of body weight status and various stage of diabetes on new-onset AF. METHODS: This was a nationwide population based study using National Health Insurance Service (NHIS) data. A total of 9,797,418 patients who underwent national health check-ups were analyzed. Patients were classified as underweight [body mass index (BMI) < 18.5], normal reference group (18.5 ≤ BMI < 23.0), upper normal (23.0 ≤ BMI < 25.0), overweight (25.0 ≤ BMI < 30.0), or obese (BMI ≥ 30.0) based on BMI. Diabetes were categorized as non-diabetic, impaired fasting glucose (IFG), new-onset diabetes, diabetes < 5 years, and diabetes ≥ 5 years. Primary outcome end point was new-onset AF. New-onset AF was defined as one inpatient or two outpatient records of International Classification of Disease, Tenth Revision (ICD-10) codes in patients without prior AF diagnosis. RESULTS: During 80,130,161 patient*years follow-up, a total of 196,136 new-onset AF occurred. Obese [hazard ration (HR) = 1.327], overweight (HR = 1.123), upper normal (HR = 1.040), and underweight (HR = 1.055) patients showed significantly increased risk of new-onset AF compared to the normal reference group. Gradual escalation in the risk of new-onset AF was observed along with advancing diabetic stage. Body weight status and diabetes were independently associated with new-onset AF and at the same time, had synergistic effects on the risk of new-onset AF with obese diabetic patients having the highest risk (HR = 1.823). CONCLUSIONS: Patients with obesity, overweight, underweight, and diabetes had significantly increased risk of new-onset AF. Body weight status and diabetes had synergistic effects on the risk of new-onset AF. The risk of new-onset AF increased gradually with advancing diabetic stage. This study suggests that maintaining optimal body weight and glucose homeostasis might prevent new-onset AF.
No takes yet. Share an insight, caveat, or question.
Kim et al. (2019) conducted a cohort in New-onset atrial fibrillation (n=9,797,418). Obesity (BMI ≥ 30.0) vs. Normal weight (18.5 ≤ BMI < 23.0) was evaluated on New-onset atrial fibrillation (HR 1.327, 95% CI 1.298-1.357, p=<0.001). Obesity significantly increased the risk of new-onset atrial fibrillation compared to normal weight (HR 1.327), with obese diabetic patients demonstrating the highest synergistic risk (HR 1.823).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: