糖尿病、血糖控制与心房颤动风险
Diabetes mellitus, glycemic control, and risk of atrial fibrillation.
作者信息
Dublin Sascha, Glazer Nicole L, Smith Nicholas L, Psaty Bruce M, Lumley Thomas, Wiggins Kerri L, Page Richard L, Heckbert Susan R
机构信息
Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101-1448, USA.
出版信息
J Gen Intern Med. 2010 Aug;25(8):853-8. doi: 10.1007/s11606-010-1340-y. Epub 2010 Apr 20.
BACKGROUND
Diabetes may be an independent risk factor for atrial fibrillation. However, results from prior studies are in conflict, and no study has examined diabetes duration or glycemic control.
OBJECTIVE
To examine the association of diabetes with risk of atrial fibrillation and to describe risk according to diabetes duration and glycemic control.
DESIGN
A population-based case-control study.
PARTICIPANTS
Within a large, integrated healthcare delivery system, we identified 1,410 people with newly-recognized atrial fibrillation from ICD-9 codes and validated cases by review of medical records. 2,203 controls without atrial fibrillation were selected from enrollment lists, stratified on age, sex, hypertension, and calendar year.
MAIN MEASURES
Information on atrial fibrillation, diabetes and other characteristics came from medical records. Diabetes was defined based on physician diagnoses recorded in the medical record, and pharmacologically treated diabetes was defined as receiving antihyperglycemic medications. Information about hemoglobin A1c levels came from computerized laboratory data.
KEY RESULTS
Among people with atrial fibrillation, 252/1410 (17.9%) had pharmacologically treated diabetes compared to 311/2203 (14.1%) of controls. The adjusted OR for atrial fibrillation was 1.40 (95% CI 1.15-1.71) for people with treated diabetes compared to those without diabetes. Among those with treated diabetes, the risk of developing atrial fibrillation was 3% higher for each additional year of diabetes duration (95% CI 1-6%). Compared to people without diabetes, the adjusted OR for people with treated diabetes with average hemoglobin A1c <or=7 was 1.06 (95% CI 0.74-1.51); for A1c >7 but <or=8, 1.48 (1.09-2.01); for A1c >8 but <or=9, 1.46 (1.02-2.08); and for A1c >9, 1.96 (1.22-3.14).
CONCLUSIONS
Diabetes was associated with higher risk of developing atrial fibrillation, and risk was higher with longer duration of treated diabetes and worse glycemic control. Future research should identify and test approaches to reduce the risk of atrial fibrillation in people with diabetes.
背景
糖尿病可能是心房颤动的一个独立危险因素。然而，先前研究的结果相互矛盾，且尚无研究探讨糖尿病病程或血糖控制情况。
目的
研究糖尿病与心房颤动风险之间的关联，并根据糖尿病病程和血糖控制情况描述风险。
设计
一项基于人群的病例对照研究。
参与者
在一个大型综合医疗服务系统中，我们根据国际疾病分类第九版（ICD - 9）编码识别出1410例新确诊的心房颤动患者，并通过查阅病历对病例进行了验证。从登记名单中选取2203例无心房颤动的对照者，按年龄、性别、高血压和日历年份进行分层。
主要测量指标
心房颤动、糖尿病及其他特征信息来自病历。糖尿病根据病历中医生的诊断定义，药物治疗的糖尿病定义为接受降糖药物治疗。糖化血红蛋白水平信息来自计算机化实验室数据。
关键结果
心房颤动患者中，252/1410（17.9%）接受了药物治疗的糖尿病，而对照组为311/2203（14.1%）。与无糖尿病者相比，接受治疗的糖尿病患者发生心房颤动的校正比值比为1.40（95%可信区间1.15 - 1.71）。在接受治疗的糖尿病患者中，糖尿病病程每增加一年，发生心房颤动的风险高3%（95%可信区间1 - 6%）。与无糖尿病者相比，平均糖化血红蛋白水平≤7的接受治疗的糖尿病患者校正比值比为1.06（95%可信区间0.74 - 1.51）；糖化血红蛋白水平>7但≤8者为1.48（1.09 - 2.01）；糖化血红蛋白水平>8但≤9者为1.46（1.02 - 2.08）；糖化血红蛋白水平>9者为1.96（1.22 - 3.14）。
结论
糖尿病与发生心房颤动的较高风险相关，且治疗糖尿病病程越长、血糖控制越差，风险越高。未来研究应确定并测试降低糖尿病患者心房颤动风险的方法。
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