Incidence of atrial fibrillation in elderly patients with type 2 diabetes mellitus

Abstract

Introduction: The incidence of atrial fibrillation (AF), a significant risk factor for cardiovascular disease (CVD), is increasing worldwide. Type 2 diabetes mellitus (T2D) and advanced age are recognized as major risk factors for AF, but herein, we evaluated the incidence of AF in elderly patients with T2D and compared the prognosis between these patients with/without AF.

Research design and methods: The Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes (JPAD2) study is a follow-up cohort study of the JPAD trial, a randomized controlled clinical trial initiated in 2002 in 2535 Japanese patients with T2D, to examine whether low-dose aspirin prevents CVD. After completion of that trial, we followed up the patients until 2019 and evaluated the incidence of AF. We also compared the incidence of cerebral cardiovascular events in elderly patients with T2D with/without AF.

Results: During the median follow-up period of 10.9 years, 132 patients developed AF (incidence rate: 5.14/1000 person-years). The adjusted HRs for cerebral cardiovascular events, stroke, coronary artery disease, heart failure, and all-cause death in elderly patients with T2D with versus without AF were 1.65 (95% CI 1.03 to 2.66), 1.54 (95% CI 0.81 to 2.93), 1.96 (95% CI 1.03 to 3.73), 5.17 (95% CI 2.46 to 10.89), and 1.82 (95% CI 1.24 to 2.67), respectively.

Conclusions: Annually, 1 in 200 elderly Japanese patients with T2D are estimated to develop AF. Because elderly patients with T2D with AF are at an elevated risk for CVD, careful follow-up of this patient subgroup is necessary.

Trial registration number: NCT00110448.

Keywords: atrial fibrillation.

Conflict of interest statement

Competing interests: CM reports research grants from Morinaga. HO reports lecturer’s fees from Bayer, Bristol-Myers Squibb, and Towa; manuscript fee from Novartis. YS reports research grants from Actelion, Astellas, Astellas Amgen Bio Pharma, Bayer, CMIC, Daiichi Sankyo, EP‐CRSU, Japan Lifeline, Kowa, Mebix, Meditrix, Novartis, Ono, Roche Diagnostics, and Terumo; non-purpose research grants from Astellas, Chugai, Daiichi Sankyo, Fuji Yakuhin, Kowa, Kyowa Hakko Kirin, Medtronic, Mitsubishi Tanabe, MSD, Nihon Medi-Physics, Ono, Otsuka, Sanofi, Shionogi, Sumitomo Dainippon, Takeda, and Teijin; lecturer’s fees from Alnylam, Asahi Kasei, AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly, Janssen, Kowa, Mitsubishi Tanabe, MSD, Novartis, Ono, Otsuka, Pfizer, Taisho Toyama, Takeda, and Toa Eiyo; manuscript fees from Asahi Kasei and Novartis; advisory boards for Amgen, Bayer, Boehringer Ingelheim, Mitsubishi Tanabe, Novartis, Ono, Pfizer, and Roche Diagnostics. SO reports lecturer’s fees from AstraZeneca, Eli Lilly, Mitsubishi Tanabe, Novartis, Ono, Sumitomo Dainippon, and Takeda. HS reports a manuscript fee from Mochida. IM reports lecturer’s fees from Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Kowa, Mitsubishi Tanabe, MSD, Ono, Shionogi, and Takeda. MN reports research grants from Bayer; lecturer’s fees from Astellas, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Eisai, Kowa, Nippon Shinyaku, Ono, Otsuka, Pfizer, Sumitomo Dainippon, and Takeda. ND reports lecturer’s fees from Abbott, Actelion, Astellas, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Kowa, Medtronic, Mitsubishi Tanabe, MSD, Nippon Shinyaku, Novartis, Otsuka, Pfizer, and Takeda. HJ reports research grants from Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Chugai, Daiichi Sankyo, Eli Lilly, GlaxoSmithKline, MSD, Novo Nordisk, Ono, Pfizer, Sanofi, Sanwa Kagaku Kenkyusho, Shionogi, Taisho Toyama, and Takeda; lecturer’s fees from Abbott, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly, Kyowa Hakko Kirin, Mitsubishi Tanabe, MSD, Novo Nordisk, Sanofi, Sanwa Kagaku Kenkyusho, Taisho Toyama, Takeda, Teijin, and Terumo; manuscript fees from Novo Nordisk and Taisho Toyama. MW reports research grants from AstraZeneca, Eli Lilly, and Sanofi; lecturer’s fees from Abbott, Astellas, Astellas Amgen Bio Pharma, AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly, Kowa, Kyowa Hakko Kirin, Mitsubishi Tanabe, MSD, Novartis, Novo Nordisk, Ono, Otsuka, Sanofi, Sanwa Kagaku Kenkyusho, Sumitomo Dainippon, Taisho Toyama, Takeda, and Teijin. TM reports lecturer’s fees from AstraZeneca, Bristol-Myers Squibb, Daiichi Sankyo, Japan Lifeline, Kowa, Toray and Tsumura; manuscript fees from Bristol-Myers Squibb and Kowa; advisory board for Novartis and Teijin.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

Cumulative incidence of atrial fibrillation (AF).

Figure 2

Risk of cardiovascular disease in the patient groups with and without atrial fibrillation (AF). (A) Cerebral cardiovascular events. (B) Stroke. (C) Coronary artery disease. (D) Heart failure. Adjusted HRs (95% CIs) were obtained using a multivariable Cox proportional hazards model with adjustments for age, sex (men), body mass index (BMI), HbA1c, smoking history (current or past), presence/absence of hypertension and/or dyslipidemia, use of aspirin, and duration of diabetes.