title: Incidence of atrial fibrillation in a population with impaired glucose tolerance: the contribution of glucose metabolism and other risk factors. A post hoc analysis of the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research trial.
abstract: BACKGROUND
  The role of dysglycemia as an additional risk factor for atrial fibrillation (AF) is controversial. Therefore, it was of interest to assess risk factors for incident AF in a large, representative population of patients with cardiovascular risk factors and impaired glucose tolerance but not overt diabetes in NAVIGATOR.
  
  
  METHODS
  Predictors of incident AF were analyzed in 8,943 patients without AF at baseline by Cox proportional hazards regression. Study treatments (valsartan vs no valsartan and nateglinide vs no nateglinide) and the time-dependent covariate for progression to type 2 diabetes mellitus were added separately to the model.
  
  
  RESULTS
  The median age of the 8,943 patients included in the present analysis of the NAVIGATOR trial was 63 years. Half of those patients were men, 6,922 (77.4%) had a history of hypertension, and 255 (2.9%) had heart failure. The median glycated hemoglobin was 6%. During the study, 613 of the 8,943 patients without AF at baseline presented with at least 1 episode of AF (6.9% 5-year incidence). Besides established predictors of incident AF, a 1 mmol/L increment of baseline fasting glucose, but not progression to diabetes, was found to be associated with a 33% increased risk of incident AF. Neither valsartan nor nateglinide affected AF incidence.
  
  
  CONCLUSIONS
  In a trial population with impaired glucose tolerance, fasting plasma glucose and well-known risk factors (age, hypertension, and elevated body weight), but not progression to diabetes, predict risk of AF.
authors.affiliation: Department of Cardiovascular Research, IRCCS-Instituto Mario Negri, Milano, Italy. Electronic address: roberto.latini@marionegri.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Latini
authors.forename: Lidia
authors.initials: L
authors.lastname: Staszewsky
authors.forename: Jie-Lena
authors.initials: JL
authors.lastname: Sun
authors.forename: M Angelyn
authors.initials: MA
authors.lastname: Bethel
authors.forename: Marcello
authors.initials: M
authors.lastname: Disertori
authors.forename: Steven M
authors.initials: SM
authors.lastname: Haffner
authors.forename: Rury R
authors.initials: RR
authors.lastname: Holman
authors.forename: Futien
authors.initials: F
authors.lastname: Chang
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Giles
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Guy E H M
authors.initials: GE
authors.lastname: Rutten
authors.forename: Eberhard
authors.initials: E
authors.lastname: Standl
authors.forename: Laine
authors.initials: L
authors.lastname: Thomas
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000453:epidemiology*; D001786:Blood Glucose / Q000032:analysis*; D003510:Cyclohexanes / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D004311:Double-Blind Method; D005260:Female; D018149:Glucose Intolerance / Q000097:blood* / Q000150:complications; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D000077715:Nateglinide; D017063:Outcome Assessment, Health Care; D010649:Phenylalanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013777:Tetrazoles / Q000627:therapeutic use*; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D001786:Blood Glucose; D003510:Cyclohexanes; D007004:Hypoglycemic Agents; D013777:Tetrazoles; D000077715:Nateglinide; D010649:Phenylalanine; D000068756:Valsartan; D014633:Valine