Arrhythmias and conduction disturbances
Relation of Elevated Serum Uric Acid Levels to Incidence of Atrial Fibrillation in Patients With Type 2 Diabetes Mellitus

https://doi.org/10.1016/j.amjcard.2013.04.012Get rights and content

The association between serum uric acid (SUA) levels and atrial fibrillation (AF) is currently poorly known. We examined the association between SUA levels and risk of incident AF in patients with type 2 diabetes mellitus. We followed for 10 years a random sample of 400 type 2 diabetic outpatients, who were free from AF at baseline. A standard 12-lead electrocardiography was undertaken annually and a diagnosis of incident AF was confirmed in affected participants by a single cardiologist. Over 10 years, there were 42 incident AF cases (cumulative incidence of 10.5%). Elevated SUA level was associated with an increased risk of incident AF (odds ratio 2.43, 95% confidence interval 1.8 to 3.4, p <0.0001 for each 1-SD increase in SUA level). Adjustments for age, gender, body mass index, hypertension, chronic kidney disease, electrocardiographic features (left ventricular hypertrophy and PR interval), and use of diuretics and allopurinol did not attenuate the association between SUA and incident AF (adjusted odds ratio 2.44, 95% confidence interval 1.6 to 3.9, p <0.0001). Further adjustment for variables that were included in the 10-year Framingham Heart Study–derived AF risk score did not appreciably weaken this association. Results remained unchanged even when SUA was modeled as a categorical variable (stratifying by either SUA median or hyperuricemia), and when patients with previous coronary heart disease or heart failure were excluded from analysis. In conclusion, our findings suggest that elevated SUA levels are strongly associated with an increased incidence of AF in patients with type 2 diabetes mellitus even after adjustment for multiple clinical risk factors for AF.

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Methods

We followed for 10 years a sample of 400 Caucasian patients with type 2 diabetes, who were clinically free from AF at baseline. As detailed in Figure 1, these participants were selected by a simple random sampling technique from the whole cohort (n = 1,718) of type 2 diabetic outpatients, who regularly attended the diabetes clinic at the “Sacro Cuore” Hospital of Negrar (Verona) during 2000 to 2001 after excluding patients who did not meet the inclusion criteria for the study.

The sample size of

Results

The 400 randomly selected participants did not significantly differ from the initially eligible sample of 1,718 outpatients with type 2 diabetes in terms of age (64 ± 10 vs 66 ± 4 years), male gender (59% vs 60%), diabetes duration (6 ± 7 vs 8 ± 4 years), HbA1c (7.6 ± 1.6% vs 7.4 ± 1.0%), hypertension (70% vs 74%), obesity (44% vs 47%), and previous CHD (9% vs 11%) and congestive HF (2% vs 3.5%).

Mean (±SD) SUA level was 308 ± 83 μmol/L (median: 300 μmol/L, range: 120 to 580 μmol/L) for all

Discussion

Elevated SUA is an emerging risk factor for cardiovascular morbidity and mortality1, 2 and may contribute to the development and progression of CKD.16

Recent epidemiologic studies suggest that elevated SUA is also significantly associated with an increased prevalence of AF in nondiabetic subjects.5, 6, 7, 8 More interestingly, the investigators of the Atherosclerosis Risk in Communities study, a multiethnic cohort of 15,382 AF-free United States adults, have reported that elevated SUA was

Disclosures

The authors have no conflicts of interest to disclose.

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