Obese men with type 2 diabetes face an increased risk of AFib
When patients with type 2 diabetes are obese or severely obese, they may be at a greater risk of atrial fibrillation (AFib), according to new findings published in JACC: Clinical Electrophysiology.
The authors turned to data from the ACCORD study, a previously completed randomized trial focused on glycemic control, blood pressure control and lipid control. Among more than 10,000 patients with a history of type 2 diabetes and a high risk of cardiovascular disease, 8.4% had a normal weight, 29% were overweight, 53.1% were obese and 9.5% were severely obese.
Overall, the team found that overweight patients did not have an increased risk of AFib. Obese and severely obese patients did have an increased risk of AFib—but that trend was only present in male patients.
“Our findings of a sex and BMI interaction with regard to AFib risk suggest that the arrhythmogenic effects of adiposity in diabetes may differ by sex, such that men with higher BMI have a substantially increased risk of AFib, whereas women with higher BMI may not,” wrote lead author Matthew J. Singleton, MD, a cardiologist at Wake Forest School of Medicine in Winston-Salem, North Carolina, and colleagues. “One possible explanation for these findings is that, for any given degree of obesity, men have a much higher risk of obstructive sleep apnea that women. Obstructive sleep apnea has potent arrhythmogenic effects and is strongly associated with incident AFib, so a differential sensitivity to obstructive sleep apnea between men and women may explain why obesity is more strongly associated with incident AFib in men.”
These findings are especially important, the authors added, because they suggest “guidance about maintenance of ideal body weight and the effects of obesity could be personalized based on a patient’s sex.”
“With emerging data suggesting that some hypoglycemic agents may lower the risk of AFib, matching the right patient with the right therapy to both control diabetes and lower the risk of downstream complications such as AFib will be increasingly important,” they wrote. “In addition, inclusion of interaction terms for sex and BMI in models may improve risk prediction.”
There were certain limitations to the this research. Data was incomplete on the race of study participants, for instance, and it is possible these findings don’t apply to patients with type 2 diabetes and a low risk of cardiovascular disease.
The full analysis is available here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.