title: Type 2 diabetes, glucose homeostasis and incident atrial fibrillation: the Atherosclerosis Risk in Communities study.
abstract: BACKGROUND
  Type 2 diabetes has been inconsistently associated with the risk of atrial fibrillation (AF) in previous studies that have frequently been beset by methodological challenges.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  The Atherosclerosis Risk in Communities (ARIC) study.
  
  
  METHODS
  Detailed medical histories were obtained from 13 025 participants. Individuals were categorised as having no diabetes, pre-diabetes or diabetes based on the 2010 American Diabetes Association criteria at study baseline (1990-2).
  
  
  METHODS
  Diagnoses of incident AF were obtained to the end of 2007. Associations between type 2 diabetes and markers of glucose homeostasis and the incidence of AF were estimated using Cox proportional hazards models after adjusting for possible confounders.
  
  
  RESULTS
  Type 2 diabetes was associated with a significant increase in the risk of AF (HR 1.35, 95% CI 1.14 to 1.60) after adjustment for confounders. There was no indication that individuals with pre-diabetes or those with undiagnosed diabetes were at increased risk of AF compared with those without diabetes. A positive linear association was observed between HbA1c and the risk of AF in those with and without diabetes (HR 1.13, 95% CI 1.07 to 1.20) and HR 1.05, 95% CI 0.96 to 1.15 per 1% point increase, respectively). There was no association between fasting glucose or insulin in those without diabetes, but a significant association with fasting glucose was found in those with the condition. The results were similar in white subjects and African-Americans.
  
  
  CONCLUSIONS
  Diabetes, HbA1c level and poor glycaemic control are independently associated with an increased risk of AF, but the underlying mechanisms governing the relationship are unknown and warrant further investigation.
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd Street, Minneapolis, MN 55454, USA. rhuxley@umn.edu
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Huxley
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.forename: Faye L
authors.initials: FL
authors.lastname: Lopez
authors.forename: Kristian B
authors.initials: KB
authors.lastname: Filion
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Agarwal
authors.forename: Laura R
authors.initials: LR
authors.lastname: Loehr
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.forename: James S
authors.initials: JS
authors.lastname: Pankow
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology*; D001786:Blood Glucose; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology* / Q000378:metabolism; D005260:Female; D006706:Homeostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D001786:Blood Glucose