Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jan 15, 2024; 15(1): 24-33
Published online Jan 15, 2024. doi: 10.4239/wjd.v15.i1.24
Prediabetes: An overlooked risk factor for major adverse cardiac and cerebrovascular events in atrial fibrillation patients
Rupak Desai, Nishanth Katukuri, Sumaja Reddy Goguri, Azra Kothawala, Naga Ruthvika Alle, Meena Kumari Bellamkonda, Debankur Dey, Sharmila Ganesan, Minakshi Biswas, Kuheli Sarkar, Pramoda Prattipati, Shaylika Chauhan
Rupak Desai, Independent Researcher, Independent Researcher, Atlanta, GA 30079, United States
Nishanth Katukuri, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55902, United States
Sumaja Reddy Goguri, Department of Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Telangana 505001, India
Azra Kothawala, Department of Medicine, Jawaharlal Nehru Medical College, Belgaum 590010, India
Naga Ruthvika Alle, Department of Medicine, Narayana Medical College, Andhra Pradesh, Nellore 524003, India
Meena Kumari Bellamkonda, Department of Medicine, Dr Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijaywada 521286, India
Debankur Dey, Department of Medicine, Medical College Kolkata, Kolkata 700073, India
Sharmila Ganesan, Department of Medicine, P.E.S. Institute of Medical Sciences and Research, Andhra Pradesh 517425, India
Minakshi Biswas, Department of Medicine, Shaheed Ziaur Rahman Medical College, Bogra 5800, Bangladesh
Kuheli Sarkar, Department of Medicine, College of Medicine and J.N.M Hospital, Kalyani 741235, India
Pramoda Prattipati, Department of Medicine, Jawaharlal Nehru Medical College India, Karnataka, Belagavi 590010, India
Shaylika Chauhan, Department of Internal Medicine, Geisinger Health System, Wikes-Barre, PA 18702, United States
Author contributions: Desai R investigation writing-original draft, visualization, writing-review and editing, investigation, formal analysis, administration, supervision; Katukuri N, Goguri SR, Kothawala A, Alle NR, Bellamkonda MK, Dey D, Ganesan S, Biswas M, Sarkar K, Prattipati P, writing-original draft; writing-review and editing, investigation, visualization; Chauhan S conceptualization, methodology, resources, writing original, draft; writing-review and editing, administration, supervision; all authors have read and approved the final manuscript.
Institutional review board statement: Not applicable, data is obtained from a publicly available data set, patient identifiers are not used.
Informed consent statement: Informed consent statement was not needed because the study was carried out on a publicly available data set without patient identifiers.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at drshaylikachauhan@gmail.com. Participants consent was not obtained but the presented data are anonymized and risk of identification is low.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shaylika Chauhan, FACP, MD, Clinical Assistant Professor (Honorary), Department of Internal Medicine, Geisinger Health System, No. 1000 E Mountain Blvd, Wikes-Barre, PA 18702, United States. drshaylikachauhan@gmail.com
Received: September 25, 2023
Peer-review started: September 25, 2023
First decision: October 10, 2023
Revised: October 22, 2023
Accepted: December 15, 2023
Article in press: December 15, 2023
Published online: January 15, 2024
Processing time: 108 Days and 14 Hours
Abstract
BACKGROUND

Prediabetes is a well-established risk factor for major adverse cardiac and cerebrovascular events (MACCE). However, the relationship between prediabetes and MACCE in atrial fibrillation (AF) patients has not been extensively studied. Therefore, this study aimed to establish a link between prediabetes and MACCE in AF patients.

AIM

To investigate a link between prediabetes and MACCE in AF patients.

METHODS

We used the National Inpatient Sample (2019) and relevant ICD-10 CM codes to identify hospitalizations with AF and categorized them into groups with and without prediabetes, excluding diabetics. The primary outcome was MACCE (all-cause inpatient mortality, cardiac arrest including ventricular fibrillation, and stroke) in AF-related hospitalizations.

RESULTS

Of the 2965875 AF-related hospitalizations for MACCE, 47505 (1.6%) were among patients with prediabetes. The prediabetes cohort was relatively younger (median 75 vs 78 years), and often consisted of males (56.3% vs 51.4%), blacks (9.8% vs 7.9%), Hispanics (7.3% vs 4.3%), and Asians (4.7% vs 1.6%) than the non-prediabetic cohort (P < 0.001). The prediabetes group had significantly higher rates of hypertension, hyperlipidemia, smoking, obesity, drug abuse, prior myocardial infarction, peripheral vascular disease, and hyperthyroidism (all P < 0.05). The prediabetes cohort was often discharged routinely (51.1% vs 41.1%), but more frequently required home health care (23.6% vs 21.0%) and had higher costs. After adjusting for baseline characteristics or comorbidities, the prediabetes cohort with AF admissions showed a higher rate and significantly higher odds of MACCE compared to the non-prediabetic cohort [18.6% vs 14.7%, odds ratio (OR) 1.34, 95% confidence interval 1.26-1.42, P < 0.001]. On subgroup analyses, males had a stronger association (aOR 1.43) compared to females (aOR 1.22), whereas on the race-wise comparison, Hispanics (aOR 1.43) and Asians (aOR 1.36) had a stronger association with MACCE with prediabetes vs whites (aOR 1.33) and blacks (aOR 1.21).

CONCLUSION

This population-based study found a significant association between prediabetes and MACCE in AF patients. Therefore, there is a need for further research to actively screen and manage prediabetes in AF to prevent MACCE.

Keywords: Prediabetes; Atrial fibrillation; Cardiovascular disease risk; Major adverse cardiovascular and cerebrovascular events; Stroke; Mortality

Core Tip: In our study, we've shed light on a critical yet often overlooked connection between prediabetes and major adverse cardiac and cerebrovascular events (MACCE) in atrial fibrillation (AF) patients. Our research revealed that AF patients with prediabetes are at significantly higher risk of experiencing MACCE, highlighting the importance of identifying and managing prediabetes in this population. This finding emphasizes the need for proactive screening and targeted interventions to reduce the burden of MACCE in AF patients with prediabetes. Further research and dedicated efforts are essential to enhance care and outcomes for these individuals.