Abstract 15201: Association Between Diabetic Peripheral Neuropathy and Atrial Fibrillation - A Community Based Case Control Study
Background: Diabetes Mellitus (DM) as a risk factor of atrial fibrillation (AF) has remained controversial. Emerging evidence indicates that endothelial and vascular dysfunction is associated with AF complications. Since there is a close but complex interaction between nerves and blood vessels, we hypothesized that in patients with Type 2 DM, the presence of peripheral neuropathy (PN) is associated with an increased risk in AF development.
Methods: Using electronic medical records of the Mayo Clinic AF Database and the Rochester Epidemiology Project, we identified 780 cases of newly diagnosed AF patients and 1,032 controls with no history of AF, matched by age and gender on 1:1 or 1:2 basis, between 1980 and 2000. Multivariate logistic regression analysis was carried out to calculate Odds ratios and adjust for potentially confounding variables
Result: In retrospective analysis, the prevalence of diabetic neuropathy was significantly higher in case compared to control (9.0% vs. 5.0%, p =.002), odds ratio 1.75, 95% confidence interval of 1.21-2.53, p=.003. There was no statistical difference in mean value of HbA1C (8.43±2.09 in control vs. 8.66±2.50 in case, p=0.5) or in fasting blood sugar level (162.1±84.0 mg/dl in control vs. 152.7±68.1 mg/dl in case, p=0.37) with values closest to the date of AF diagnosis. After multivariate analysis that included the major risk factors of AF such as hypertension, obesity (BMI>30), valvular heart disease and congestive heart failure, the association between AF and PN in DM remained significant with an odds ratio of 1.68, 95% confidence interval of 1.16-2.49, p=0.007.
Conclusion: Type 2 DM peripheral neuropathy is associated with increased risk of AF. Blood glucose level alone does not explain this association. The underlying mechanisms can be multifactorial but may include inflammation, tissue hypoxia, autonomic dysfunction, autoimmunity, and oxidative stress. These factors may lead to micro vascular dysfunction and micro-vasculitidis, producing nerve damages and myocardial remodeling that facilitate the development of AF. This novel observation demonstrating an association between two major diseases may provide mechanistic insights and deserves further examination to look into underlying pathophysiology.
- © 2013 by American Heart Association, Inc.