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The diabetes-atrial fibrillation paradox
  1. Eugene S J Tan1,
  2. Wan Ting Tay2,
  3. Tiew-Hwa Katherine Teng2,
  4. Arthur Mark Richards1,3,4,
  5. Robert N Doughty5,
  6. Carolyn S P Lam2,6,7,8
  1. 1 National University Heart Centre, Singapore
  2. 2 National Heart Centre Singapore, Singapore
  3. 3 Christchurch Heart Institute, University of Otago, New Zealand
  4. 4 Cardiovascular Research Institute, National University Health System, Singapore
  5. 5 Heart Health Research Group, University of Auckland, New Zealand
  6. 6 Duke-NUS Graduate Medical School, Singapore
  7. 7 University Medical Centre Groningen, Netherlands
  8. 8 The George Institute for Global Health, Australia
  1. Correspondence to Dr. Carolyn S P Lam; carolyn.lam{at}duke-nus.edu.sg

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To the Editor We appreciate the editorial by Burden and Timpson1 highlighting collider bias as a potential explanation for our findings of a differential association between diabetes and atrial fibrillation (AF) by ethnicity as well as by heart failure (HF) type.2 Collider bias applies in aetiologic research where causal associations between two independent variables are spuriously created due to stratification by a causally related health outcome. First we point out that ours was not aetiologic research, and we specifically acknowledged that our observational study design does not allow ascertainment of causality. We nonetheless agree that the diabetes–AF paradox was one of our most intriguing observations, raising questions that, while not answered by …

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