Evaluation of the association between diabetic retinopathy and the incidence of atrial fibrillation: A nationwide population-based study

Background: Atrial fibrillation (AF) is prevalent among type 2 diabetic patients. However, the association between diabetic retinopathy (DR) and AF is controversial. Methods: We included 40,500 patients with type 2 diabetes (>= 40 years, mean age 62 +/- 11 years, 53% men) without AF from the Korean National Insurance Service-National Sample Cohort (2002-2007). Subjects were classified without DR (non-DR, n = 30,178), with DR (DR, n = 8920), and with proliferative DR (PDR, n = 1402). Results: During a mean 5.9-year follow-up, 1261 (3.1%) patients were newly diagnosed as having AF (4.9, 6.0, and 8.3 per 1000 person-years in the non-DR, DR, and PDR groups, respectively). In multivariate Cox proportional hazard models, patients in the DR and PDR groups had a significantly higher risk of AF than those in the non-DR group (DR group: hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.00-1.30; PDR group: HR 1.46, 95% CI 1.13-1.87); p for trend <0.001). The risk of AF increased in patients with DR and end-stage renal disease (ESRD) (HR 2.39, 95% CI 1.31-3.96, p < 0.001) and in those with PDR and ESRD (HR 3.59, 95% CI 1.96-5.97, p < 0.001) compared to those without DR and ESRD. Conclusions: The presence and severity of DR was significantly associated with the incidence of AF. Also, the presence of ESRD had an impact on the incidence of AF in patients with DR. (C) 2016 Elsevier Ireland Ltd. All rights reserved.