Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Aug 26, 2021; 13(8): 372-380
Published online Aug 26, 2021. doi: 10.4330/wjc.v13.i8.372
Associations of new-onset atrial fibrillation and severe visual impairment in type 2 diabetes: A multicenter nationwide study
Wisit Kaewput, Charat Thongprayoon, Ram Rangsin, Tarun Bathini, Michael A Mao, Wisit Cheungpasitporn
Wisit Kaewput, Ram Rangsin, Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
Charat Thongprayoon, Wisit Cheungpasitporn, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
Tarun Bathini, Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, United States
Michael A Mao, Department of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, United States
Author contributions: Kaewput W, Thongprayoon C and Cheungpasitporn W contributed to conceptualization; Kaewput W contributed to conceptualization data curation; Kaewput W, Thongprayoon C and Cheungpasitporn W contributed to formal analysis; Kaewput W and Thongprayoon C contributed to investigation; Kaewput W, Thongprayoon C and Cheungpasitporn W contributed to methodology; Rangsin R contributed to project administration; Rangsin R, Bathini T, Mao MA and Cheungpasitporn W contributed to supervision; Kaewput W and Thongprayoon C contributed to validation; Kaewput W, Thongprayoon C and Mao MA contributed to writing–original draft; Kaewput W, Thongprayoon C, Rangsin R, Bathini T, Mao MA and Cheungpasitporn W contributed to writing, review and editing.
Institutional review board statement: This study was approved by both the Institutional Review Board of the Royal Thai Army Medical Department and the Ethical Review Committee for Research in Human Subjects, the Ministry of Public Health of Thailand (IRB# S007h/54).
Informed consent statement: All patients were recruited from the outpatient clinic. Written informed consent was obtained from patients before enrolment.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: No additional data are available.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wisit Cheungpasitporn, FACP, FASN, FAST, Associate Professor, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States. wcheungpasitporn@gmail.com
Received: March 31, 2021
Peer-review started: April 1, 2021
First decision: May 11, 2021
Revised: May 20, 2021
Accepted: July 19, 2021
Article in press: July 19, 2021
Published online: August 26, 2021
Processing time: 145 Days and 13.4 Hours
Abstract
BACKGROUND

Many studies have demonstrated an association between type 2 diabetes mellitus (T2DM) and atrial fibrillation (AF). However, the potential independent contributions of T2DM and AF to the prevalence of visual impairment have not been evaluated.

AIM

To determine whether such an association between T2DM and incident AF with visual impairment exists, and if so, the prevalence and magnitude of this association.

METHODS

We conducted a nationwide cross-sectional study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools. This study had evaluated adult T2DM patients from 831 public hospitals in Thailand in the year 2013. T2DM patients were categorized into two groups: patients without and with incident AF. T2DM patients without AF were selected as the reference group. The association between incident AF and visual impairment among T2DM patients was assessed using multivariate logistic regression.

RESULTS

A total of 27281 T2DM patients with available eye examination data were included in this analysis. The mean age was 60.7 ± 10.5 years, and 31.2% were male. The incident AF was 0.2%. The prevalence of severe visual impairment in all T2DM patients, T2DM patients without AF, and T2DM patients with incident AF were 1.4%, 1.4%, and 6.3%, respectively. T2DM patients with incident AF were associated with an increased OR of 3.89 (95%CI: 1.17-13.38) for severe visual impairment compared with T2DM patients without AF.

CONCLUSION

T2DM patients with incident AF were independently associated with increased severe visual impairment. Therefore, early eye screening should be provided for these high-risk individuals.

Keywords: Type 2 diabetes mellitus, Atrial fibrillation, Visual impairment, Retinopathy, Blindness

Core Tip: The independent contributions of diabetes mellitus and atrial fibrillation (AF) to the prevalence of visual impairments have not been evaluated. AF is relatively common in diabetic patients and should be regarded as a marker of adverse outcomes for cardiovascular diseases in type 2 diabetes mellitus (T2DM). In this study, we explored whether an association between T2DM with incident AF and visual impairment exists, and if so, the prevalence and magnitude of this association. We found a nearly three-fold higher prevalence of severe visual impairment in T2DM patients with incident AF compared to those without AF [OR of 3.89 (95%CI: 1.17-13.38)]. It may be useful to increase screening for visual impairments in T2DM patients with incident AF. The results of our study could encourage public health initiatives for the prevention of vision impairment by early eye screening in these high-risk individuals.