What is the clinical evidence from this study?

Study design: Cohort. Population: New-onset atrial fibrillation (n=9797418). Intervention: Obesity (BMI ≥ 30.0) vs. Normal weight (18.5 ≤ BMI < 23.0). Primary outcome: New-onset atrial fibrillation (HR 1.327, 95% CI 1.298-1.357, p=<0.001).

October 1, 2019Open Access

The impact of body weight and diabetes on new-onset atrial fibrillation: a nationwide population based study

Q: What are the key findings of this study?

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).

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).

Study Design

Type

Cohort (n=9,797,418)

Structured PICO

Does maintaining optimal body weight and glucose homeostasis prevent new-onset atrial fibrillation in the general population?

Population

9,797,418 patients who underwent a national health check-up in 2009 in the Republic of Korea, mean age 47.02, 54.68% male.

Intervention

Body weight status (underweight, normal, upper normal, overweight, obese based on BMI) and diabetes stage (non-diabetic, impaired fasting glucose, new-onset, <5 years, >=5 years)

Comparator

Normal reference body weight (BMI 18.5 to <23.0) and non-diabetic patients

Outcome

New-onset atrial fibrillation (defined as one inpatient or two outpatient records of ICD-10 codes in patients without prior AF diagnosis)

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.

Main Result

Effect estimate: HR 1.327 (95% CI 1.298-1.357)

Absolute Event Rate: 3.348% vs 1.989%

p-value: p=<0.001

Limitations

Based on an administrative database, potentially susceptible to coding inaccuracies
Unable to classify AF type such as paroxysmal and non-paroxysmal
Based on East Asian patients, requiring caution when applying results to other ethnic groups
Unable to include factors like drug abuse, prior cardiac surgery, and heart valve disease
Unable to obtain follow-up body weight data to assess if weight loss reduces new-onset AF

Abstract

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.

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Cite This Study

Kim et al. (Tue,) 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).

synapsesocial.com/papers/6a11c09d0b2fd5f9c6c9026d https://doi.org/https://doi.org/10.1186/s12933-019-0932-z

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