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)
Open accessAbstract
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.
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Intensive glycaemic control does not affect the rate of new-onset AF.
“Unfortunately, intensive glycaemic control does not affect the rate of new-onset AF”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [284]
Diabetes is a risk factor for stroke and other complications in AF.
“Diabetes is a risk factor for stroke and other complications in AF.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [284]
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- Authors
- Fatemi, O., Yuriditsky, E., Tsioufis, C., Tsachris, D., Morgan, T., Basile, J., Bigger, T., Cushman, W., Goff, D., Soliman, E. Z., Thomas, A., & Papademetriou, V.
- Affiliations
- MedStar Washington Hospital Center (US)
- National and Kapodistrian University of Athens (GR)
- Atrium Health Wake Forest Baptist (US)
- Medical University of South Carolina (US)
- Columbia University Irving Medical Center (US)
- University of Tennessee Health Science Center (US)
- Colorado School of Public Health (US)
- Henry Ford Health (US)
- Georgetown University (US)
- Corresponding author
- Yuriditsky, Eugene
- ORCID
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2014-10
- Volume
- 114
- Issue
- 8
- Pages
- 1217-1222
- ISSN
- 0002-9149 (ISSN-L)
- PMC
- PMC4291278
- OpenAlex
- W2020081546
- Cited by
- 173
- References
- 28
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 12 · 2023: 16 · 2022: 18 · 2021: 21 · 2020: 20 · 2019: 15 · 2018: 17 · 2017: 14 · 2016: 13 · 2015: 9
- FWCI
- 8.22
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01hc95184-24-0-1, n01hc95182-23-0-1)
- National Heart, Lung, and Blood Institute (N01 HC095184, N01 HC095182, Y01 HC001010, Y01 HC009035)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- atrial fibrillation, type 2 diabetes, tight glycemic control, HbA1c, cardiovascular outcomes, all-cause mortality, myocardial infarction, heart failure, atrial fibrillation risk factors, ACCORD trial
- MeSH terms
- Adult, Aged, Atrial Fibrillation, Blood Glucose, Canada, Diabetes Mellitus, Type 2, Dose-Response Relationship, Drug, Double-Blind Method, Electrocardiography, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Male, Middle Aged, Prospective Studies, Risk Factors, United States, Incidence, Prevalence, Survival Rate, Glycemic Index
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