Obesity modifies the association between abnormal glucose metabolism and atrial fibrillation in older adults: a community-based longitudinal and prospective cohort study
Xinyi Yu, Xin Wang, Siyi Dun, Hua Zhang, Yanli Yao, Zhendong Liu, Juan Wang, Weike Liu
Abstract
To investigate the modifying role of obesity in the association between abnormal glucose metabolism and atrial fibrillation (AF) risk in older individuals. From April 2007 to November 2011, 11663 participants aged ≥60 years were enrolled in Shandong area. Glucose metabolic status were determined using fasting plasma glucose and hemoglobin A1c levels, obesity determined using body mass index (BMI), waist-to-hip ratio (WHR), and visceral fat area (VFA). Obesity-associated metabolic activities were assessed using adiponectin-to-leptin ratio (ALR), galectin-3, and triglyceride-glucose index (TyG). New-onset AF was diagnosed by ICD-10. During an average of 11.1 years of follow-up, 1343 participants developed AF. AF risks were higher in those with prediabetes, uncontrolled diabetes, and well-controlled diabetes than with normoglycemia. The hazard ratios were decreased by 14.79%, 40.29%, and 25.23% in those with prediabetes, 31.44%, 53.56%, and 41.90% in those with uncontrolled diabetes, and 21.16%, 42.38%, and 27.59% in those with well-controlled diabetes after adjusting for BMI, WHR, and VFA, respectively. The population attributable risk percentage of general obesity, central obesity, and high VFA for new-onset AF were 10.43%, 34.78%, and 31.30%, respectively. ALR, galectin-3, and TyG significantly mediated the association of BMI, WHR, and VFA with AF risk (all P adj . <0.001). Obesity mediates the association between abnormal glucose metabolism and AF risk in older individuals. WHR is an effective modifier than BMI and VFA for moderating the association. ALR, TyG, and galectin-3 mediate the moderating effect of obesity on the association between abnormal glucose metabolism and AF risk. • Obesity modifies the association between abnormal glucose metabolism and the risk of atrial fibrillation in older individuals. • Keeping appropriate proportion of body fat distribution is important for decreasing the risk of AF in those with abnormal glucose metabolism. • Metabolic activities mediate the moderating effect of obesity on the association between abnormal glucose metabolism and the risk of atrial fibrillation.