TY  - BOOK
AU  - Fatemi, Omid
AU  - Yuriditsky, Eugene
TI  - 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)
SN  - 0002-9149
KW  - *Atrial Fibrillation/ep [Epidemiology]
KW  - *Blood Glucose/me [Metabolism]
KW  - *Diabetes Mellitus, Type 2/dt [Drug Therapy]
KW  - *Glycemic Index/ph [Physiology]
KW  - *Hemoglobin A, Glycosylated/me [Metabolism]
KW  - *Hypoglycemic Agents/ad [Administration & Dosage]
KW  - Adult
KW  - Aged
KW  - Atrial Fibrillation/bl [Blood]
KW  - Atrial Fibrillation/et [Etiology]
KW  - Canada/ep [Epidemiology]
KW  - Diabetes Mellitus, Type 2/bl [Blood]
KW  - Diabetes Mellitus, Type 2/co [Complications]
KW  - Dose-Response Relationship, Drug
KW  - Double-Blind Method
KW  - Electrocardiography
KW  - Female
KW  - Follow-Up Studies
KW  - Hemoglobin A, Glycosylated/de [Drug Effects]
KW  - Humans
KW  - Incidence
KW  - Male
KW  - Middle Aged
KW  - Prevalence
KW  - Prospective Studies
KW  - Risk Factors
KW  - Survival Rate/td [Trends]
KW  - United States/ep [Epidemiology]
KW  - MedStar Heart & Vascular Institute
KW  - Comparative Study
KW  - Journal Article
KW  - Multicenter Study
KW  - Randomized Controlled Trial
KW  - Research Support, N.I.H., Extramural
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
N2  - 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.Copyright � 2014 Elsevier Inc. All rights reserved
UR  - http://dx.doi.org/10.1016/j.amjcard.2014.07.045
ER  -