Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; Bjørknes University College, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
J Diabetes Complications. 2018 May;32(5):501-511. doi: 10.1016/j.jdiacomp.2018.02.004. Epub 2018 Feb 17.
Diabetes and elevated blood glucose have been associated with increased risk of atrial fibrillation in a number of epidemiological studies, however, the findings have not been entirely consistent. We conducted a systematic review and meta-analysis to clarify the association.
We searched the PubMed and Embase databases for studies of diabetes and blood glucose and atrial fibrillation up to July 18th 2017. Cohort studies were included if they reported relative risk (RR) estimates and 95% confidence intervals (CIs) of atrial fibrillation associated with a diabetes diagnosis, prediabetes or blood glucose. Summary RRs were estimated using a random effects model.
Thirty four studies were included in the meta-analysis of diabetes, pre-diabetes or blood glucose and atrial fibrillation. Thirty two cohort studies (464,229 cases, >10,244,043 participants) were included in the analysis of diabetes mellitus and atrial fibrillation. The summary RR for patients with diabetes mellitus versus patients without diabetes was 1.30 (95% CIs: 1.03-1.66), however, there was extreme heterogeneity, I = 99.9%) and evidence of publication bias with Begg's test, p < 0.0001. After excluding a very large and outlying study the summary RR was 1.28 (95% CI: 1.22-1.35, I = 90%, n = 31, 249,772 cases, 10,244,043 participants). The heterogeneity was mainly due to differences in the size of the association between studies and the results persisted in a number of subgroup and sensitivity analyses. The summary RR was 1.20 (95% CI: 1.03-1.39, I = 30%, n = 4, 2392 cases, 58,547 participants) for the association between prediabetes and atrial fibrillation. The summary RR was 1.11 (95% CI: 1.04-1.18, I = 61%, n = 4) per 20 mg/dl increase of blood glucose in relation to atrial fibrillation (3385 cases, 247,447 participants) and there was no evidence of nonlinearity, p = 0.34.
This meta-analysis suggest that prediabetes and diabetes increase the risk of atrial fibrillation by 20% and 28%, respectively, and there is a dose-response relationship between increasing blood glucose and atrial fibrillation. Any further studies should clarify whether the association between diabetes and blood glucose and atrial fibrillation is independent of adiposity.
多项流行病学研究表明，糖尿病和血糖升高与心房颤动风险增加相关，但研究结果并不完全一致。我们进行了一项系统评价和荟萃分析以阐明这种关联。
我们检索了 PubMed 和 Embase 数据库，以获取截至 2017 年 7 月 18 日的有关糖尿病和血糖与心房颤动的研究。如果队列研究报告了与糖尿病诊断、前驱糖尿病或血糖相关的心房颤动的相对风险（RR）估计值和 95%置信区间（CI），则纳入研究。使用随机效应模型估计汇总 RR。
共纳入 34 项关于糖尿病、前驱糖尿病或血糖与心房颤动的荟萃分析研究。纳入了 32 项队列研究（464229 例病例，>10244033 名参与者）来分析糖尿病与心房颤动的关系。与无糖尿病患者相比，糖尿病患者的汇总 RR 为 1.30（95%CI：1.03-1.66），但是存在极高的异质性（I=99.9%），且贝叶斯检验存在发表偏倚，p<0.0001。排除一项非常大和异常的研究后，汇总 RR 为 1.28（95%CI：1.22-1.35，I=90%，n=31，249772 例病例，10244033 名参与者）。这种异质性主要是由于研究之间关联大小的差异所致，且在多项亚组和敏感性分析中结果仍然一致。与前驱糖尿病相关的汇总 RR 为 1.20（95%CI：1.03-1.39，I=30%，n=4，2392 例病例，58547 名参与者）。与血糖升高（每 20mg/dl 增加 20mg/dl）相关的汇总 RR 为 1.11（95%CI：1.04-1.18，I=61%，n=4），与心房颤动相关，且无非线性关系，p=0.34。
本荟萃分析提示前驱糖尿病和糖尿病分别使心房颤动的风险增加 20%和 28%，且血糖升高与心房颤动之间存在剂量-反应关系。任何进一步的研究都应阐明糖尿病和血糖与心房颤动之间的关联是否独立于肥胖。
