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
ARTICLE HIGHLIGHTS
Research background

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

Research motivation

Earlier studies have demonstrated that AF is relatively common in diabetic patients, and it should be regarded as a marker for adverse cardiovascular outcomes in T2DM.

Research objectives

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

Research methods

This study evaluated adult T2DM patients from 831 public hospitals in Thailand in the year 2013. The association between T2DM with incident AF and visual impairment were assessed using multivariate logistic regression.

Research results

A total of 27281 T2DM patients with available eye examination data were included in this analysis. The prevalence of incident AF in T2DM patients 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 to those without AF.

Research conclusions

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

Research perspectives

Overlapping diabetes and AF leads to an increased risk of thromboembolic events. However, the independent contribution of T2DM and AF to the prevalence of visual impairments has not been evaluated. Therefore, it may be useful to screen for visual impairment and its etiologies in T2DM patients with incident AF.