title: Impact of intensive glycemic control on the incidence of atrial fibrillation and associated cardiovascular outcomes in patients with type 2 diabetes mellitus (from the Action to Control Cardiovascular Risk in Diabetes Study).
abstract: Atrial fibrillation (AF) is prevalent in patients with type 2 diabetes mellitus (DM) and is associated with markers of poor glycemic control; however, the impact of glycemic control on incident AF and outcomes is unknown. The aims of this study were to prospectively evaluate if intensive glycemic control in patients with DM affects incident AF and to evaluate morbidity and mortality in patients with DM and incident AF. A total of 10,082 patients with DM from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) cohort were studied in a randomized, double-blind fashion. Participants were randomized to an intensive therapeutic strategy targeting a glycated hemoglobin level of <6.0% or a standard strategy targeting a glycated hemoglobin level of 7.0% to 7.9%. Incident AF occurred in 159 patients (1.58%) over the follow-up period, at a rate of 5.9 per 1,000 patient-years in the intensive-therapy group and a rate of 6.37 per 1,000 patient-years in the standard-therapy group (p = 0.52). In a multivariate model, predictors of incident AF were age, weight, diastolic blood pressure, heart rate, and heart failure history. Patients with DM and new-onset AF had a hazard ratio of 2.65 for all-cause mortality (95% confidence interval 1.8 to 3.86, p <0.0001), a hazard ratio of 2.1 for myocardial infarction (95% confidence interval 1.33 to 3.31, p = 0.0015), and a hazard ratio of 3.80 for the development of heart failure (95% confidence interval 2.48 to 5.84, p <0.0001). In conclusion, intensive glycemic control did not affect the rate of new-onset AF. Patients with DM and incident AF had an increased risk for morbidity and mortality compared with those without AF.
authors.affiliation: Washington Hospital Center, Washington, District of Columbia; Georgetown University Hospital, Washington, District of Columbia; Washington DC Veteran's Medical Center, Washington, District of Columbia.
authors.forename: Omid
authors.initials: O
authors.lastname: Fatemi
authors.affiliation: Washington Hospital Center, Washington, District of Columbia; Georgetown University Hospital, Washington, District of Columbia; Washington DC Veteran's Medical Center, Washington, District of Columbia. Electronic address: eugene.yuriditsky@gmail.com.
authors.forename: Eugene
authors.initials: E
authors.lastname: Yuriditsky
authors.affiliation: Hippokration Hospital University of Athens, Athens, Greece.
authors.forename: Costas
authors.initials: C
authors.lastname: Tsioufis
authors.affiliation: Hippokration Hospital University of Athens, Athens, Greece.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Tsachris
authors.affiliation: Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
authors.forename: Timothy
authors.initials: T
authors.lastname: Morgan
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina; Ralph H. Johnson VA Medical Center, Charleston, South Carolina.
authors.forename: Jan
authors.initials: J
authors.lastname: Basile
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bigger
authors.affiliation: University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: William
authors.initials: W
authors.lastname: Cushman
authors.affiliation: Colorado School of Public Health, Aurora, Colorado.
authors.forename: David
authors.initials: D
authors.lastname: Goff
authors.affiliation: Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.affiliation: Henry Ford Health System, Detroit, Michigan.
authors.forename: Abraham
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Georgetown University Hospital, Washington, District of Columbia; Washington DC Veteran's Medical Center, Washington, District of Columbia.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Papademetriou
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D001786:Blood Glucose / Q000378:metabolism*; D002170:Canada / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000187:drug effects / Q000378:metabolism*; D038321:Glycemic Index / Q000502:physiology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents