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)

Omid Fatemi, Eugene Yuriditsky, Costas Tsioufis, Demetrios Tsachris, Timothy Morgan, Jan Basile, Thomas Bigger, William Cushman, David Goff, Elsayed Z. Soliman, Abraham Thomas, Vasilios Papademetriou

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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.

Original languageEnglish (US)
Pages (from-to)1217-1222
Number of pages6
JournalAmerican Journal of Cardiology
Volume114
Issue number8
DOIs
StatePublished - Oct 15 2014

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Atrial Fibrillation
Type 2 Diabetes Mellitus
Incidence
Diabetes Mellitus
Glycosylated Hemoglobin A
Confidence Intervals
Group Psychotherapy
Mortality
Heart Failure
Blood Pressure
Morbidity
Heart Rate
Myocardial Infarction
Weights and Measures

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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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). / Fatemi, Omid; Yuriditsky, Eugene; Tsioufis, Costas; Tsachris, Demetrios; Morgan, Timothy; Basile, Jan; Bigger, Thomas; Cushman, William; Goff, David; Soliman, Elsayed Z.; Thomas, Abraham; Papademetriou, Vasilios.

In: American Journal of Cardiology, Vol. 114, No. 8, 15.10.2014, p. 1217-1222.

Research output: Contribution to journalArticle

Fatemi, Omid ; Yuriditsky, Eugene ; Tsioufis, Costas ; Tsachris, Demetrios ; Morgan, Timothy ; Basile, Jan ; Bigger, Thomas ; Cushman, William ; Goff, David ; Soliman, Elsayed Z. ; Thomas, Abraham ; Papademetriou, Vasilios. / 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). In: American Journal of Cardiology. 2014 ; Vol. 114, No. 8. pp. 1217-1222.
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AU - Tsioufis, Costas

AU - Tsachris, Demetrios

AU - Morgan, Timothy

AU - Basile, Jan

AU - Bigger, Thomas

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