Relation of Diabetes Mellitus to Incident Dementia in Patients With Atrial Fibrillation (from the Atherosclerosis Risk in Communities Study)

Ashwini Jiayaspathi, Lin Yee Chen, Elizabeth Selvin, Rebecca F. Gottesman, David S. Knopman, Thomas H. Mosley, Faye L. Norby, Alvaro Alonso

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

The association of diabetes mellitus (DM), an established risk factor for dementia in the general population, with incident dementia in patients with atrial fibrillation (AF) has not been explored. We performed a cohort study where we identified subjects with incident AF in the Atherosclerosis Risk in Communities cohort (1987 to 2017) and determined their DM status, fasting blood glucose before AF diagnosis and hemoglobin A1c levels using information from the closest previous study visit. Incident dementia was expert adjudicated using information from cognitive assessments, informant interviews and hospitalization surveillance. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) of incident dementia for each level of exposure using Cox models and adjusting for potential confounders. We analyzed 3,020 patients with AF in the Atherosclerosis Risk in Communities cohort (808 with DM) and 530 had incident dementia after a mean follow-up of 5.3 years after AF diagnosis. After multivariable adjustment, patients with AF with prevalent DM had higher rates of dementia than those without DM, HR 1.45 (95% CI 1.16 to 1.80). A value of hemoglobin A1c ≥6.5% was associated with a HR 1.29 (95% CI 0.97 to 1.71) of dementia. However, fasting blood glucose was not associated with rates of dementia independent of DM status. In conclusion, DM was associated with higher rates of dementia in patients with AF. DM prevention and control could be a promising avenue for reducing risk of dementia in AF.

Original languageEnglish (US)
Pages (from-to)51-57
Number of pages7
JournalAmerican Journal of Cardiology
Volume165
DOIs
StatePublished - Feb 15 2022

Bibliographical note

Funding Information:
The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute (NHLBI) (Bethesda, Maryland) contracts HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004IV. Neurocognitive data are collected by U012U01HL096812, 2U01HL096814, 2U01HL096899, 2U01HL096902, 2U01HL096917 from the National Institute of Health (Bethesda, Maryland) (NHLBI, National Institute of Neurological Disorders and Stroke [Bethesda, Maryland], National Institute on Aging [Bethesda, Maryland] and National Institute on Deafness and Other Communication Disorders [Bethesda, Maryland]), and with previous brain magnetic resonance imaging examinations funded by R01-HL70825 from the NHLBI. Dr. Alonso was supported by NHLBI grant K24HL148521, National Institute on Aging grant P30AG066511, and American Heart Association (Dallas, Texas) grant 16EIA26410001. Dr. Selvin was supported by National Institute of Health grants K24 HL152440 and R01DK089174.

Funding Information:
This article was partially prepared while Dr. Rebecca Gottesman was employed at the Johns Hopkins University School of Medicine. Alvaro Alonso declares financial support provided by National Institutes of Health and the American Heart Association. Elizabeth Selvin declares financial support provided by National Institutes of Health. The opinions expressed in this article are the authors’ own and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the US government.

Publisher Copyright:
© 2021 Elsevier Inc.

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