title: Evaluation of the association between diabetic retinopathy and the incidence of atrial fibrillation: A nationwide population-based study.
abstract: BACKGROUND
  Atrial fibrillation (AF) is prevalent among type 2 diabetic patients. However, the association between diabetic retinopathy (DR) and AF is controversial.
  
  
  METHODS
  We included 40,500 patients with type 2 diabetes (≥40years, mean age 62±11years, 53% men) without AF from the Korean National Insurance Service-National Sample Cohort (2002-2007). Subjects were classified without DR (non-DR, n=30,178), with DR (DR, n=8920), and with proliferative DR (PDR, n=1402).
  
  
  RESULTS
  During a mean 5.9-year follow-up, 1261 (3.1%) patients were newly diagnosed as having AF (4.9, 6.0, and 8.3 per 1000 person-years in the non-DR, DR, and PDR groups, respectively). In multivariate Cox proportional hazard models, patients in the DR and PDR groups had a significantly higher risk of AF than those in the non-DR group (DR group: hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.00-1.30; PDR group: HR 1.46, 95% CI 1.13-1.87); p for trend <0.001). The risk of AF increased in patients with DR and end-stage renal disease (ESRD) (HR 2.39, 95% CI 1.31-3.96, p<0.001) and in those with PDR and ESRD (HR 3.59, 95% CI 1.96-5.97, p<0.001) compared to those without DR and ESRD.
  
  
  CONCLUSIONS
  The presence and severity of DR was significantly associated with the incidence of AF. Also, the presence of ESRD had an impact on the incidence of AF in patients with DR.
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors: So-Ryoung
authors: SR
authors: Lee
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: choiek17@snu.ac.kr.
authors: Eue-Keun
authors: EK
authors: Choi
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors: Tae-Min
authors: TM
authors: Rhee
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors: Hyun-Jung
authors: HJ
authors: Lee
authors: Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
authors: Woo-Hyun
authors: WH
authors: Lim
authors: Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors: Si-Hyuck
authors: SH
authors: Kang
authors: Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Kyung-Do
authors: KD
authors: Han
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors: Myung-Jin
authors: MJ
authors: Cha
authors: Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors: Youngjin
authors: Y
authors: Cho
authors: Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors: Il-Young
authors: IY
authors: Oh
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors: Seil
authors: S
authors: Oh
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors
keywords: Atrial fibrillation; Diabetic retinopathy; End-stage renal disease; Microvascular complications; Population-based study; Type 2 diabetes