title: Risk of atrial fibrillation in diabetes mellitus: A nationwide cohort study.
abstract: OBJECTIVE
  Diabetes has been associated with atrial fibrillation but the current evidence is conflicting. In particular knowledge regarding young diabetes patients and the risk of developing atrial fibrillation is sparse. The aim of our study was to investigate the risk of atrial fibrillation in patients with diabetes compared to the background population in Denmark.
  
  
  RESULTS
  Through Danish nationwide registries we included persons above 18 years of age and without prior atrial fibrillation and/or diabetes from 1996 to 2012. The study cohort was divided into a background population without diabetes and a diabetes group. The absolute risk of developing atrial fibrillation was calculated and Poisson regression models adjusted for sex, age and comorbidities were used to calculate incidence rate ratios of atrial fibrillation. The total study cohort included 5,081,087 persons, 4,827,713 (95%) in the background population and 253,374 (5%) in the diabetes group. Incidence rates of atrial fibrillation per 1000 person years were stratified in four age groups from 18 to 39, 40 to 64, 65 to 74 and 75 to 100 years giving incidence rates (95% confidence intervals) of 0.02 (0.02-0.02), 0.99 (0.98-1.01), 8.89 (8.81-8.98) and 20.0 (19.9-20.2) in the background population and 0.13 (0.09-0.20), 2.10 (2.00-2.20), 8.41 (8.10-8.74) and 20.1 (19.4-20.8) in the diabetes group, respectively. The adjusted incidence rate ratios in the diabetes group with the background population as reference were 2.34 (1.52-3.60), 1.52 (1.47-1.56), 1.20 (1.18-1.23) and 0.99 (0.97-1.01) in the four age groups, respectively.
  
  
  CONCLUSIONS
  Diabetes is an independent risk factor for developing atrial fibrillation/flutter, most pronounced in young diabetes patients. Routine screening for atrial fibrillation/flutter in diabetes patients might be beneficial and have therapeutic implications, especially in younger diabetes patients.
  Diabetes increases the risk of developing atrial fibrillation and especially young diabetes patients have a high relative risk. Increased focus on detecting atrial fibrillation in young diabetes patients might prove beneficial, and both anticoagulation treatment and anti-arrhythmic treatment strategies should be considered as soon as possible.
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Denmark Faculty of Health and Medical Sciences, University of Copenhagen, Denmark jannikjannik@gmail.com.
authors.forename: Jannik L
authors.initials: JL
authors.lastname: Pallisgaard
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Denmark.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Schjerning
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Denmark.
authors.forename: Tommi B
authors.initials: TB
authors.lastname: Lindhardt
authors.affiliation: Department of Cardiology, North Zealand Hospital, Denmark.
authors.forename: Kristina
authors.initials: K
authors.lastname: Procida
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Denmark The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
authors.forename: Morten L
authors.initials: ML
authors.lastname: Hansen
authors.affiliation: Institute of Health, Science and Technology, Aalborg University, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Denmark Faculty of Health and Medical Sciences, University of Copenhagen, Denmark The National Institute of Public Health, University of Southern Denmark, Denmark The Danish Heart Foundation, Denmark.
authors.forename: Gunnar H
authors.initials: GH
authors.lastname: Gislason
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D055815:Young Adult
keywords: Atrial fibrillation; diabetes mellitus; stroke; young patients