title: Impact of new-onset diabetes mellitus on development of atrial fibrillation and heart failure in high-risk hypertension (from the VALUE Trial).
abstract: Hypertension and diabetes mellitus (DM) are known risk factors for atrial fibrillation (AF). We investigated the influence of new-onset DM on developing AF in the VALUE trial population of high-risk hypertensive patients. Five thousand two hundred fifty patients of the 15,245 participants in the VALUE trial had DM at baseline and 1,298 of the initially nondiabetic patients developed DM during the average 4.2-year follow-up. The presence of AF was determined by central analyzed electrocardiograms at baseline and changes were assessed yearly. Patients without AF at baseline and with any AF by later electrocardiograms were defined as patients with new-onset AF. Patients with new-onset and baseline DM were compared with patients without DM by a Cox regression model with adjustment for prespecified covariates. Five hundred fifty-one patients developed new-onset AF during the trial. Patients with new-onset DM had a significantly higher event rate of new-onset AF with a hazard ratio of 1.49 (1.14 to 1.94, p = 0.0031) compared with patients without DM, and there was a trend toward more AF in patients with DM at baseline. Patients with new-onset DM had also more persistent AF (hazard ratio 1.87, 1.28 to 2.74, p = 0.0014). Patients with new-onset DM and AF had a hazard ratio of 3.56 for heart failure (2.86 to 4.44, p <0.0001) compared with patients with new-onset DM without AF. In conclusion, hypertensive patients who developed DM during the VALUE trial had more AF than did patients without DM, and this may explain some of their concomitant high risk of hospitalization for heart failure.
authors.affiliation: Department of Cardiology, Ullevaal University Hospital, Oslo, Norway. TonjeAmb.Aksnes@ulleval.no
authors.forename: Tonje Amb
authors.initials: TA
authors.lastname: Aksnes
authors.forename: Roland E
authors.initials: RE
authors.lastname: Schmieder
authors.forename: Sverre Erik
authors.initials: SE
authors.lastname: Kjeldsen
authors.forename: Sajda
authors.initials: S
authors.lastname: Ghani
authors.forename: Tsushung Augie
authors.initials: TA
authors.lastname: Hua
authors.forename: Stevo
authors.initials: S
authors.lastname: Julius
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012189:Retrospective Studies