Central obesity as a potential causal risk factor for atrial fibrillation: evidence from Mendelian randomization study

Deng, Yingjian; Li, Linlin; Li, Qiang; Guo, Jincun; Cai, Binni; Zhou, Faguang; Chang, Dong

doi:10.1093/europace/euae061

Europace

2024

DOI: 10.1093/europace/euae061

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Central obesity as a potential causal risk factor for atrial fibrillation: evidence from Mendelian randomization study

Yingjian Deng,

Linlin Li,

Qiang Li

et al.

Abstract: Graphical Abstract Graphical Abstract ( A ) Overview and assumptions of the Mendelian randomization study. Assumption 1: the genetic variants should be strongly associated with the risk factor; Assumption 2: the genetic variants should not be associated with confounders; Assumption 3: the genetic variants should affect the outcome only through the risk factor. ( B ) The effects of waist circumference, hip circu… Show more

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2024

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Albiglutide and atrial fibrillation in patients with Type 2 diabetes and established cardiovascular disease: insights from the Harmony Outcomes trial

Krychtiuk,

Marquis-Gravel,

Murphy

et al. 2024

European Journal of Preventive Cardiology

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Introduction Atrial fibrillation and flutter (AF) are common in patients with type 2 diabetes and are associated with worse outcomes. Methods Harmony Outcomes was a multicenter, event-driven, double-blind, placebo-controlled trial comparing the effects of albiglutide, a glucagon-like peptide-1 (GLP1) receptor agonist, with placebo on a composite of major adverse cardiac events (MACE; non-fatal myocardial infarction; non-fatal stroke and cardiovascular death) in 9,463 patients aged >40years with type-2 diabetes and established cardiovascular disease. Herein, the cardiovascular effects of albiglutide in patients with and without AF, as well as the effects on AF events during follow-up, were analyzed. Results Patients with a history of AF (8.9%) exhibited a higher event rate for the primary composite MACE endpoint during 1.6 years of follow-up (12.7 vs. 6.3 events/100 person-years, adjusted hazard ratio (aHR)1.41 (95% Confidence Interval (CI)1.14-1.74, p=0.001). Treatment with albiglutide reduced the occurrence of the primary endpoint irrespective of history of AF at baseline (history of AF: aHR0.83 (0.58–1.19), no history of AF: aHR0.77 (0.66–0.90); pinteraction=0.71). During follow-up, 239 patients (2.5%) experienced an AF event. Overall, Albiglutide was associated with numerically fewer AF events (108 vs 131; HR 0.82 (0.63–1.06, p=0.12), irrespective of baseline history of AF (pinteraction=0.92). Conclusions In patients with type 2 diabetes, treatment with albiglutide, compared to placebo, reduced the risk of cardiovascular events irrespective of history of AF. Further, albiglutide treatment did not increase AF adverse events but was associated with a trend to a lower rate of AF events during follow-up without reaching statistical significance

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Albiglutide and atrial fibrillation in patients with Type 2 diabetes and established cardiovascular disease: insights from the Harmony Outcomes trial

Krychtiuk,

Marquis-Gravel,

Murphy

et al. 2024

European Journal of Preventive Cardiology

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Glucagon‐like peptide‐1 receptor agonist semaglutide reduces atrial fibrillation incidence: A systematic review and meta‐analysis

Saglietto,

Falasconi,

Penela

et al. 2024

Eur J Clin Investigation

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BackgroundGlucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) are new anti‐hyperglycaemic drugs with proven cardiovascular (CV) benefit in diabetic and non‐diabetic patients at high CV risk. Despite a neutral class effect on arrhythmia risk, data on semaglutide suggest a possible drug‐specific benefit in reducing atrial fibrillation (AF) occurrence.ObjectiveTo perform a meta‐analysis of randomized clinical trials (RCTs) to assess the risk of incident AF in patients treated with semaglutide compared to placebo.Methods and ResultsTen RCTs were included in the analysis. Study population encompassed 12,651 patients (7285 in semaglutide and 5366 in placebo arms), with median follow‐up of 68 months. A random effect meta‐analytic model was adopted to pool relative risk (RR) of incident AF. Semaglutide reduces the risk of AF by 42% (RR .58, 95% CI .40–.85), with low heterogeneity across the studies (I2 0%). At subgroup analysis, no differences emerged between oral and subcutaneous administration (oral: RR .53, 95% CI .23–1.24, I2 0%; subcutaneous: RR .59, 95% CI .39–.91, I2 0%; p‐value .83). In addition, meta‐regression analyses did not show any potential influence of baseline study covariates, in particular the proportion of diabetic patients (p‐value .14) and body mass index (BMI) (p‐value .60).ConclusionsSemaglutide significantly reduces the occurrence of incident AF by 42% as compared to placebo in individuals at high CV risk, mainly affected by type 2 diabetes mellitus. This effect appears to be consistent independently of the route of administration of the drug (oral or subcutaneous), the presence of underlying diabetes and BMI.

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Central obesity as a potential causal risk factor for atrial fibrillation: evidence from Mendelian randomization study

Cited by 2 publications

References 11 publications

Albiglutide and atrial fibrillation in patients with Type 2 diabetes and established cardiovascular disease: insights from the Harmony Outcomes trial

Albiglutide and atrial fibrillation in patients with Type 2 diabetes and established cardiovascular disease: insights from the Harmony Outcomes trial

Glucagon‐like peptide‐1 receptor agonist semaglutide reduces atrial fibrillation incidence: A systematic review and meta‐analysis

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