Division of Cardiology, Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.
Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Cardiovasc Diabetol. 2021 Nov 24;20(1):226. doi: 10.1186/s12933-021-01415-2.
Atrial fibrillation (AF) is prevalent in patients with type 2 diabetes mellitus (T2DM). Obesity commonly accompanies T2DM, and increases the risk of AF. However, the dose-relationship between body mass index (BMI) and AF risk has seldom been studied in patients with diabetes.
This cohort study utilized a database from National Taiwan University Hospital, a tertiary medical center in Taiwan. Between 2014 and 2019, 64,339 adult patients with T2DM were enrolled for analysis. BMI was measured and categorized as underweight (BMI < 18.5), normal (18.5 ≤ BMI < 24), overweight (24 ≤ BMI < 27), obesity class 1 (27 ≤ BMI < 30), obesity class 2 (30 ≤ BMI < 35), or obesity class 3 (BMI ≥ 35). Multivariate Cox regression and spline regression models were employed to estimate the relationship between BMI and the risk of AF in patients with T2DM.
The incidence of AF was 1.97 per 1000 person-years (median follow-up, 70.7 months). In multivariate Cox regression, using normal BMI as the reference group, underweight (HR 1.52, 95% CI 1.25-1.87, p < 0.001) was associated with a significantly higher risk of AF, while overweight was associated with significantly reduced risk of AF (HR 0.82, 95% CI 0.73-0.89, p < 0.001). Kaplan-Meier analysis showed AF risk was highest in the underweight group, followed by obesity class 3, while the overweight group had the lowest incidence of AF (log-rank test, p < 0.001). The cubic restrictive spline model revealed a "J-shaped" or "L-shaped" relationship between BMI and AF risk.
Underweight status confers the highest AF risk in Asian patients with T2DM.
心房颤动（AF）在 2 型糖尿病（T2DM）患者中较为常见。肥胖症通常伴随 T2DM，增加了 AF 的风险。然而，在糖尿病患者中，体重指数（BMI）与 AF 风险之间的剂量关系很少被研究。
本队列研究利用了来自中国台湾大学医院的一个三级医疗中心的数据库。在 2014 年至 2019 年间，共纳入了 64339 名成年 T2DM 患者进行分析。测量了 BMI 并进行分类，包括体重不足（BMI<18.5）、正常（18.5≤BMI<24）、超重（24≤BMI<27）、肥胖 1 级（27≤BMI<30）、肥胖 2 级（30≤BMI<35）或肥胖 3 级（BMI≥35）。采用多变量 Cox 回归和样条回归模型来估计 T2DM 患者 BMI 与 AF 风险之间的关系。
AF 的发生率为 1.97 例/1000 人年（中位随访时间为 70.7 个月）。在多变量 Cox 回归中，以正常 BMI 为参照组，体重不足（HR 1.52，95%CI 1.25-1.87，p<0.001）与 AF 风险显著升高相关，而超重与 AF 风险显著降低相关（HR 0.82，95%CI 0.73-0.89，p<0.001）。Kaplan-Meier 分析显示，在体重不足组 AF 风险最高，其次是肥胖 3 级组，而超重组的 AF 发生率最低（对数秩检验，p<0.001）。三次限制样条模型显示 BMI 与 AF 风险之间呈“J 形”或“L 形”关系。
在亚洲 T2DM 患者中，体重不足状态与最高的 AF 风险相关。
