Diabetic patients with atrial fibrillation obtained greater absolute benefits from blood pressure-lowering treatment than did those without in a study of more than 11,000 patients with type 2 diabetes.
The study findings suggest that an estimated 5 years of active blood pressure-lowering treatment would prevent one cardiovascular death among every 42 patients with atrial fibrillation (AF) at baseline, compared with one death among 120 patients without AF. “These findings … indicate that detection of AF in a patient with diabetes should prompt more aggressive treatment of all cardiovascular risk factors,” said Dr. Xin Du of the University of Sydney, and associates (Eur. Heart J. 2009 March 12 [doi:10.1093/eurheartj/ehp055
Atrial fibrillation (AF) was present at baseline in 847 (7.6%) of the 11,140 patients with type 2 diabetes who participated in the Action in Diabetes and Vascular Disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study, which was jointly funded by the National Health and Medical Research Council of Australia and Servier, France.
The patients with AF were older and heavier, had higher blood pressure levels and urinary albumin-creatinine ratios, and had lower estimated glomerular filtration rates than patients without AF.
Over a mean follow-up of 4.3 years, 879 patients died. Of those deaths, 468 (53%) were due to cardiovascular causes and 15% of the total deaths occurred in patients with AF. Patients with AF at baseline had significantly higher rates of both all-cause and cardiovascular mortality, at 3.9% and 2.4%, respectively, than did those who did not have AF, whose all-cause and cardiovascular mortality rates were 1.7% and 0.9%, respectively. After adjustment for covariates, those hazard ratios were 1.61 and 1.77, respectively.
Among patients who were on oral anticoagulants at baseline, the adjusted hazard ratios associated with AF were 2.16 for all-cause mortality and 2.32 for cardiovascular death. The association between AF and cardiovascular death was significantly stronger in women compared with men, the investigators said.
During follow-up, active treatment with a fixed combination of perindopril and indapamide reduced blood pressure by 5.3/2.3 mm Hg more than did placebo in those with AF and by 5.9/2.3 mm Hg more than placebo in patients without AF, the researchers said.
This study “highlights the importance of actively evaluating diabetic patients for the presence of AF to identify those at particularly high risk of cardiovascular events,” said the authors, several of whom other than Dr. Du have received lecture fees or grant support from, or served on an advisory board for, Servier.