The Association Between Fasting Plasma Glucose And The New-onset Atrial Atrial Fibrillation With Unstable Angina

BACKGROUDS:From the 1920s, with the increase of the incidence of atrial fibrillation and atrial fibrillation associated with the onset of prolonged duration, it is recognized that the need for treatment of atrial fibrillation. Dangerous symptoms mainly include atrial fibrillation arrhythmia, palpitation, heart palpitations, and of which severe complications can be life threatening.The most important mechanism of the atrial fibrillation is which can increase the hazard of thromboembolismA variety of serious complications of atrial fibrillation embolism is such a variety of risk assessment models have emerged.The most mainstream of atrial fibrillation risk assessment model should be the CHA2DS2-VASc score which published in 2010 European Society of Cardiology (ESC).Recently Emily clinical Research Center at Duke University, Dr. C. O Brien summarizes the new atrial fibrillation and other bleeding risk score-ORBIT scoring system, and the campared with the ATRIA HAS-BLED score in the fitting and effectiveness by calibration curve finding that different rates of reliability were:ORBIT full model score> ORBIT simplified score> ATRIA score> HAS-BLED score [2].With the incidence of atrial fibrillation increases year by year, unfuturelitely confined treatment of atrial fibrillation, mainly from the restoration and maintenance of sinus rhythm, ventricular rate control and prevention of thromboembolism in three aspects. Drug treatment is mainly to control and radiofrequency catheter ablation, the latter due to fewer side effects but the recurrence rate is still high. This makes the study of atrial fibrillation at high risk of controllable factors into the mainstream of contemporary studies of atrial fibrillation, by the past more than three centuries, scientists have identified advanced age, hypertension, coronary heart disease, diabetes, gender, etc. all contribute to atrial fibrillation risk factors occurred in recent years, the study focused on the inflammatory cells and related factors, such as C-reactive protein (C-reactive protein, CRP), TNF-a, interleukin (interleukin,Ⅱ) and has made considerable progress, confirmed with atrial fibrillation, persistent and recurrent closely related. In which the relationship between diabetes and atrial fibrillation opinions, one of the more influential study comes Framingham study [1], Wilhelmsen study [50], Mohammad-Reza study [51], RAMS study [53], VALUE study [54], etc., where Mohammad-Reza, a total of 845,748 cases included in the study, in which patients with diabetes 293.124,552,624 were non-diabetic patients, the researchers found that patients with atrial fibrillation occurrence probability of the diabetic group was significantly higher (15.0% VS10.3%, P<0.01), logistic regression found that diabetes is an independent risk factor for atrial fibrillation [OR= 2.13,95% CI [2.10-.16] P<0.0001]. This is by far the largest sample included in a retrospective study, which showed that diabetes is an independent risk factor for atrial fibrillation.AIMS:Diabetes have been associated with an increase risk of atrial fibrillation(AF), but there are few studies related to new-onset atrial fibrillation and fasting blood glucose levels the values of fasting plasma glucose(FPG).To elucidate the potential mechanisms between FPG and new-onset atrial fibrillation with unstable angina.METHOUDS:FPG and other cardiometabolic risk factors were reviewed in a cohort of 222 individuals who were treated in Shandong Provincial Hospital since January 1,2009 to July 1,2015 with a explicit diagnosis of coronary heart disease by coronary angiography.Exclusion criteria:loss of fasting blood glucose data;history of structural heart disease, rheumatic heart disease; severe liver function (AST increased more than 3 times) and renal insufficiency (Ccr>265umol/L); thyroid disease.To count the patient’s medical history data and related biochemical indexes, and then divided them into 3 groups according to the fasting blood glucose.Then associations between FPG and NE-AF were estimated by logistic models.RESULTS:1.The study included patients from January 1,2009 to July 1,2015 in the provincial hospital with unstable angina.We collected 222 cases,153 cases of patients were male,(68.9%)and 67 cases female (31.1%).The mean age 60.2±9.7 years.2.With the increase in fasting blood glucose, there was no clear significant difference in age, body mass index (BMI), sex, left ventricular ejection fraction (LVEF), systolic blood pressure, diastolic blood pressure, previous history of myocardial infarction, high density lipoprotein (HDL- cholestrol), low-density lipoprotein (LDL-cholestrol), total triglyceride (triglyceride) variables.But history of hypertension (hypertension),glomerular filtration rate (eGFR) were changed (p <0.2);the incidence of new-onset atrial fibrillation, there are significant differences (p<0.001).3.According to an average of 35 weeks of follow-up, overall end events observed in our patients with unstable angina,new atrial fibrillation were analyzed and compared, with a total of 41 cases of end events.The end events in patients presenting higher fasting blood glucose values were significantly higher than patients without high fasting blood glucose levels (p<0.01)4.The OR for new-onset atrial fibrillation per lmmol/L increase baseline of FPG was 1.01(95%CI 1.11,1.23) with adjudication for age,systolic BP,BMI,gender.5.According fasting blood glucose level, we divided samples into three groups of Min (1.84-5.14), Mid (5.15-6.09), Max (6.11-17.60).Finally we draw up Event-free survival curve according to the average of 35 weeks follow-up, from which we can infer with elevated fasting blood glucose the incidence of atrial fibrillation was observed significantly increased.CONCLUSIONS:1. Unstable angina are performed a higher incidence of atrial fibrillation (18.64%).2. With the increase in fasting blood glucose,there was no significant difference in gender, age,body mass index, left ventricular ejection fraction, systolic blood pressure, diastolic blood pressure, previous history of myocardial infarction, HDL, LDL, triglycerides and other variables.But history of hypertension (hypertension),glomerular filtration rate (eGFR) were changed (p<0.2);the incidence of new-onset atrial fibrillation, there are significant differences (p<0.001).3.logistic Multiple regression analysis showed in the unstable angina patients, fasting blood glucose level is an independent risk factor for new-onset atrial fibrillation.4.COX survival curve analysis showed that the higher fasting blood glucose level is, the higher the probability of occurrence of atrial fibrillation performed (HR 1.4395% CI [1.27-1.60] p<0.001).