ArticleClinical research in cardiology : official journal of the German Cardiac Society2026
Prediabetes and the risk of atrial fibrillation and heart failure: a propensity-matched analysis in a real-world cohort.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAlthough diabetes is a recognized risk factor for atrial fibrillation (AF) and heart failure (HF), the cardiovascular consequences of prediabetes remain unclear, particularly regarding AF subtypes and HF development.
objectiveThis study aimed to evaluate the association of prediabetes with new-onset AF, including subtype specificity, and its association with HF development using an international, real-world cohort.
methodsWe analyzed de-identified electronic health records from the TriNetX network, including adults aged 18-79 years without prior AF or atrial flutter. Prediabetes was defined as hemoglobin A1c (HbA1c) 5.7-6.4% or a documented diagnosis; normoglycemic controls had normal HbA1c (≤ 5.6%). Propensity score matching (1:1) was applied to match the cohorts. Primary outcome was new-onset AF, stratified by paroxysmal and persistent AF. Secondary outcome was HF incidence. Follow-up extended from 90 days to 5 years post-index.
resultsAfter matching, 207,385 patients were included in each cohort. During the follow-up period, prediabetes was associated with a modestly increased risk of new-onset AF (risk ratio [RR] 1.154, 95% confidence interval [CI] 1.035-1.286, P=0.010), primarily driven by persistent AF (RR 1.411, 95% CI 1.085-1.835, P=0.010), while paroxysmal AF incidence was unaffected. Prediabetes was also associated with increased HF incidence among individuals without established AF (RR 1.296, 95% CI 1.119-1.500, P=0.001) but not in those with concomitant AF.
conclusionPrediabetes was associated with a modestly increased risk of new-onset AF, particularly persistent AF, and was associated with HF development among individuals without established arrhythmia.
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