High risk factors of atrial fibrillation in type 2 diabetes: results from the Chinese Kailuan study

Hyperuricemia Is Associated With the Risk of Atrial Fibrillation Independent of Sex: A Dose-Response Meta-Analysis

Background:

Conflicting findings of the association between serum uric acid (SUA) and atrial fibrillation (AF) have been reported in both men and women. The sex-specific associations between SUA and the risk of AF are unclear, although hyperuricemia is independently associated with the risk of AF. We performed this meta-analysis to assess the sex-specific effect of SUA on the risk of AF.

Methods

The PubMed, EMBASE, and Cochrane Library databases were searched up to October 3, 2021, for studies that reported sex-specific associations of SUA levels with AF. Linear relationships were assessed by the generalized least squares trend estimation. This study was registered with PROSPERO (42020193013).

Results

Ten eligible studies with 814,804 participants (415,779 men and 399,025 women) were identified. In the category analysis, high SUA was associated with an increased risk of AF in both men (OR: 1.42; 95% CI, 1.18–1.71, I² = 34%) and women (OR: 2.02; 95% CI, 1.29–3.16, I² = 70%). In the dose-response analysis, for each 60 μmol/L (1 mg/dL) increase in the SUA level, the risk of AF increased by 15% (OR: 1.15; 95% CI, 1.07–1.25, I² = 74%) in men and 35% (OR: 1.35; 95% CI, 1.18–1.53, I² = 73%) in women. There was a borderline difference in the impact of SUA on the risk of AF between men and women (P for interaction = 0.05). A significant linear relationship between SUA and the risk of AF was observed in men (P for non-linearity = 0.91) and women (P for non-linearity = 0.92).

Conclusions

This study suggested that there was a significant linear relationship between SUA and the risk of AF among men and women, with a higher risk estimate for women. Additional trials are required to assess the effect of reduced SUA therapy on AF incidence.

Systematic Review Registration

https:www.crd.york.ac.uk/PROSPERO/, identifier: CRD 42020193013.

The Relationship between Uric Acid and the Development, Complication, and Prognosis of Atrial Fibrillation: The Views from a Clinical Study

A large number of studies suggest that uric acid (UA) is related to the occurrence, complications, and prognosis of atrial fibrillation (AF). However, the guidelines did not clearly elaborate on this issue. The current research results need to be summarized to analyze the association between UA and AF. This study found that in the current clinical research on the relationship between UA and AF, studies mainly focus on the development or complications of AF. A lot of repetitive work does not deepen awareness of this question. In contrast, studies investigating the effects of UA-lowering therapy on the management of AF are limited. The only reports deny the protective effect of UA-lowering therapy. For now, we suggest that UA is close to the occurrence and progression of AF; therefore, it may have important significance as a clinical marker. The role of UA-lowering therapy in the management of AF is one of the next key issues to be explored. It will be a meaningful topic to focus on the latest research on AF ablation and to conduct a secondary analysis to explore the prognostic impact of UA on the latest treatment methods for AF. Multiomics techniques may allow us to have a deeper understanding of the role of UA in AF management in the future.

Relationship between serum uric acid levels and different types of atrial fibrillation: An updated meta-analysis

AIM

Increasing evidence supports the hypothesis that high serum uric acid (SUA) levels are related to atrial fibrillation (AF). However, the incidence of AF in patients with hyperuricemia and SUA levels in different types of AF is not entirely clear. This meta-analysis was designed to evaluate the relationship between SUA and incidence of AF, and the variation in SUA levels in different types of AF.

DATA SYNTHESIS

Relevant reports were searched for in Embase, PubMed and the Cochrane Library. A fixed-effects model combining relative risk (RR) and the corresponding 95% confidence interval (95% CI) was used to evaluate the correlation between SUA and AF. The standardized mean differences (SMDs) of SUA values were calculated using a random-effects model to evaluate the differences in SUA levels among different types of AF. A total of 31 studies with 504,958 participants were included in this research. The results from 8 cohort studies showed that high SUA levels significantly increased the incidence of AF [RR (95% CI): 1.92 (1.68-2.20); P < 0.01]. The results from 29 studies revealed that SUA levels elevated in patients with AF [SMD (95% CI): 0.55 (0.43-0.66); P < 0.001]. Meanwhile, SUA levels in new-onset AF [SMD (95%CI): 0.24 (0.10-0.38); P = 0.001], paroxysmal AF [SMD (95%CI): 0.52 (0.33-0.72); P < 0.001] and persistent AF [SMD (95%CI): 1.23 (0.98-1.48); P < 0.001] were significantly higher than that in patients without AF.

CONCLUSIONS

High SUA levels had an obvious correlation with the occurrence rate of AF. In addition, SUA levels were significantly different among patients with new-onset, paroxysmal and persistent AF.

Serum uric acid and incident atrial fibrillation: A systematic review and dose-response meta-analysis

The exposure-effect association between serum uric acid and atrial fibrillationis not well known. We conduct a meta-analysis to quantitatively examine the exposure-effect relationship between serum uric acid and atrial fibrillation. Prospective studies (including cohort or nested case-control) that reported the serum uric acid and atrial fibrillation were identified through electronic searches using EMBASE, PubMed, and the Cochrane Library database. The exposure-effect analysis was performed using a stage robust error meta-regression. Eleven studies were included, with a total of 6831 cases of atrial fibrillation among 527 908 individuals. Both the highest (risk ratio (RR), 1.9; 95% confidence interval (CI), 1.64-2.23; I²  = 0%) and intermediate (RR, 1.36; 95% CI, 1.16-1.59; I²  = 36%) level of serum uric acid were associated with increased risks of atrial fibrillation compared to the patients with the lowest level of serum uric acid. In the exposure-effect analysis, for each 1 mg/dL increase in serum uric acid level, the incidence of atrial fibrillation increased by 21% (RR, 1.21; 95% CI, 1.12-1.32; I²  = 78%). Furthermore, a significant positive linear relationship between serum uric acid and the risk of atrial fibrillation, P_nonlinearity  = 0.47 was found. The exposure-effect analysis demonstrated that serum uric acid over 5.0 mg/dL significantly increased the risk of atrial fibrillation. There was a positive linear association between serum uric acid and risk of atrial fibrillation, both in subjects with noruricaemia and hyperuricaemia. More studies are needed to explore the impact of serum uric acid reduction on the incidence of atrial fibrillation.

Development of a Risk Score for Atrial Fibrillation in Adults With Diabetes Mellitus (from the ACCORD Study)

We aimed to develop a novel risk score predicting 5-year atrial fibrillation (AF) risk for diabetes mellitus (DM) patients. We included subjects from the Action to Control Cardiovascular Risk in Diabetes study cohort without AF at baseline. Potential risk factor and demographic predictors were collected at baseline and incident AF was defined from ECG during follow-up. A 5-year risk score for incident AF was developed using Cox regression with internal validation. We studied 9,240 subjects with DM (62% male, mean age 62.6 years) of which 1.8% (n = 165) developed AF over a median follow-up of 4.9 years. Subjects developing AF were more likely male, of white ethnicity and with more obesity and poorer kidney function, but with lower diastolic blood pressure and low density-lipoprotein cholesterol. In the risk prediction model, age, gender, race, body mass index, heart failure, diastolic blood pressure, triglycerides, hemoglobin A1c, duration of DM, serum creatinine and hypertension medication were included as important predictors. The Harrell's C-statistic was 0.79 with excellent internal calibration (goodness-of-fit test p = 0.99 and calibration slope = 1.01). Our risk model may be useful for assess future AF risk in DM patients.

Lipid Profile and New-Onset Atrial Fibrillation in Patients With Acute ST-Segment Elevation Myocardial Infarction (An Observational Study in Southwest of China)

In acute ST-segment elevation myocardial infarction (ASTEMI), new-onset atrial fibrillation (NOAF) was not only associated with worse short-term outcomes but also with higher long-term mortality. This study aimed to evaluate the effect of dyslipidemia on the incidence of NOAF. Among the 985 patients (2014 to 2017) with ASTEMI consecutively enrolled and followed-up for 31 months in this study, 81 patients (8.2%) developed NOAF during hospitalization. Fasting levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured using standard procedures. The study population was categorized into 3 groups based on tertiles of lipid profile. Multivariate regression analysis was adjusted for baseline characteristics, laboratory values, angiography findings, and medication. Inverse associations of TC (hazard ratio [HR] 0.54, 95% confidence interval [CI] 0.32 to 0.90) and LDL-C (hazard ratio 0.56, 95% confidence interval 0.31 to 1.00) with NOAF was observed in this study. In contrast, the levels of TG and HDL-C were not associated with NOAF in patients with ASTEMI. Moreover, the all-cause mortality in the NOAF group (19.8%) was apparently higher than that in sinus rhythm goup (6.1%) after a long term follow-up. In conclusion, plasma LDL-C and TC concentrations but neither TG nor HDL-C were inversely correlated to NOAF during hospitalization, which indicated a bad prognosis even after discharge.

Serum Uric Acid and Atrial Fibrillation: Meta-analysis

Hyperuricemia has been recently speculated to be associated with the development of atrial fibrillation (AF). A meta-analysis of observational studies was conducted to explore the relationship between serum uric acid (SUA) and AF. We searched the MEDLINE, EMBASE, and CINAHL databases and performed extensive bibliography search to identify studies with mean SUA level for patients with and without AF. Key search terms were "atrial fibrillation" and "uric acid." Under the random-effects model, the pooled standardized difference in means between patients with and without AF was calculated. A total of 24 studies with 30,609 patients were included for quantitative analyzation of the difference in SUA levels between the patients with and without AF. The SUA level of patients with atrial AF was found to be significantly higher compared with those without AF (standardized difference in means = 0.66; 95% confidence interval, 0.43-0.88; P < 0.0001). The mean SUA level of patients with AF significantly is higher than those without AF.

Lipid profile and incidence of atrial fibrillation: A prospective cohort study in China

BACKGROUND

The association between dyslipidemia, a major risk factor for cardiovascular diseases, and atrial fibrillation (AF) is not clear because of limited evidence.

HYPOTHESIS

Dyslipidemia may be associated with increased risk of AF in a Chinese population.

METHODS

A total of 88 785 participants free from AF at baseline (2006-2007) were identified from the Kailuan Study. Fasting levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were measured at baseline using standard procedures. The study population was stratified based on quartiles of lipid profile. Incident AF was ascertained from electrocardiograms at biennial follow-up visits (2008-2015). The associations between incident AF and the different lipid parameters (TC, LDL-C, HDL-C, and TG) were assessed by Cox proportional hazards regression analysis.

RESULTS

Over a mean follow-up period of 7.12 years, 328 subjects developed AF. Higher TC (hazard ratio [HR]: 0.60, 95% confidence interval [CI]: 0.43-0.84) and LDL-C (HR: 0.60, 95% CI: 0.43-0.83) levels were inversely associated with incident AF after multivariable adjustment. HDL-C and TG levels showed no association with newly developed AF. The results remained consistent after exclusion of individuals with myocardial infarction or cerebral infarction, or those on lipid-lowering therapy. Both TC/HDL-C and LDL-C/HDL-C ratios were inversely associated with risk of AF (per unit increment, HR: 0.88, 95% CI: 0.79-0.98 and HR: 0.77, 95% CI: 0.66-0.91, respectively).

CONCLUSIONS

TC and LDL-C levels were inversely associated with incident AF, whereas no significant association of AF with HDL-C or TG levels was observed.

Nonalcoholic Fatty Liver Disease and Associated Metabolic Risks of Hypertension in Type 2 Diabetes: A Cross-Sectional Community-Based Study

The mechanisms facilitating hypertension in diabetes still remain to be elucidated. Nonalcoholic fatty liver disease (NAFLD), which is a higher risk factor for insulin resistance, shares many predisposing factors with diabetes. However, little work has been performed on the pathogenesis of hypertension in type 2 diabetes (T2DM) with NAFLD. The aim of this study is to investigate the prevalence of hypertension in different glycemic statuses and to analyze relationships between NAFLD, metabolic risks, and hypertension within a large community-based population after informed written consent. A total of 9473 subjects aged over 45 years, including 1648 patients with T2DM, were enrolled in this cross-sectional study. Clinical and biochemical parameters of all participants were determined. The results suggested that the patients with prediabetes or T2DM were with higher risks to have hypertension. T2DM with NAFLD had significantly higher levels of blood pressure, triglyceride, uric acid, and HOMA-IR than those without NAFLD. Data analyses suggested that hypertriglyceridemia [OR = 1.773 (1.396, 2.251)], NAFLD [OR = 2.344 (1.736, 3.165)], hyperuricemia [OR = 1.474 (1.079, 2.012)], and insulin resistance [OR = 1.948 (1.540, 2.465)] were associated with the higher prevalence of hypertension independent of other metabolic risk factors in type 2 diabetes. Further studies are needed to focus on these associations.