Some Mental Health Conditions Add to the Atrial Fibrillation Risk from Diabetes, Study Finds

Depression, insomnia and anxiety increase the risk of atrial fibrillation in those with diabetes, according to a Korean study. These mental health conditions can affect the autonomic nervous system that regulates the heart. Bipolar disorder and schizophrenia did not increase the risk.

Mental disorders are a risk factor for new-onset atrial fibrillation (AF) in patients with diabetes, according to findings from a large cohort study of more than 2.5 million people.

The risk was significantly increased for patients with depression, insomnia and anxiety, wrote lead author Dr. Nan Yang Bae, from the Department of Internal Medicine at Seoul National University Hospital in the Republic of Korea, and her co-investigators.

The authors reported that bipolar disorder and schizophrenia were not significantly associated with the risk of AF.

They published their results in November in the journal Cardiovascular Diabetology.

It has already been established previously that patients with diabetes or mental disorders are at risk for AF, but the researchers in this study were able to determine that the combination of the two increases the risk of AF, especially in younger adults. They said this merited efforts to raise awareness of these risks.

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“The relative risk of mental disorders for new-onset AF was accentuated in the younger age group (HR [95% CI]: 1.47, in those of age < 40 години; 1,29, 40-64 години; и 1,16, > 65 years; Q < .001),” they wrote.

The researchers drew their data from the National Health Information Database of the Republic of Korea. Patients who underwent examinations between 2009 and 2012 were enrolled and followed up until December 2018.

“The incidence of AF in patients with diabetes is reported to be 14.9%, and AF predicts a worse prognosis in patients with DM (diabetes mellitus),” the authors write. Diabetes significantly increases the risk of macro- and microvascular complications and death from all causes. Mental disorders are associated with an increased risk of stroke and bleeding in AF.

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Diabetes requires chronic treatment and people with the disease have higher rates of depression and insomnia and other mental disorders. Among the patients with mental disorders in this study, 68.1% had anxiety and 40.0% had insomnia. These were the most common. The incidence of depression in this population was 37.9%. depression, insomnia and anxiety

The researchers wrote that mental disorders contribute to the development of AF by affecting the autonomic nervous system, which regulates heart rhythm. “Stressful situations like depression and anxiety cause autonomic imbalance.”

In addition, inflammatory cytokines increase in stressful conditions and are associated with the risk of AF. Furthermore, sleep problems (apnea) disrupt the autonomic nervous system and lead to an increase in downstream cortisol, which increases the risk for AF.

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Psychotropic drugs also play a role in arrhythmia by disrupting autonomic nervous system regulation and causing AF, they wrote.

Comorbidities such as hypertension, chronic kidney disease, and heart failure were significant risk factors for increased risk of AF in diabetic patients.

; “However, the risk was more pronounced in those without hypertension, CKD (chronic kidney disease), or heart failure,” the researchers wrote.

Patients with mental disorders had more comorbidities, including dyslipidemia, obstructive sleep apnea, and thyroid disease, than those without mental disorders.

Also, the percentage of current smokers and heavy drinkers was higher among patients without mental disorders than with (30.5% vs. 17.5% and 11.9% vs. 6.4%, respectively), the authors noted.


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