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Original research
Microvascular disease, modifiable risk factor profiles and incident arrhythmias in type 2 diabetes
  1. Guo-Chong Chen1,
  2. Daniel Nyarko Hukportie2,
  3. Wei-Dong Fan3,
  4. Jie-Qiong Lyu1,
  5. Hai-Peng Wang4,
  6. Liqiang Qin1,
  7. Xian-Bo Wu3,
  8. Fu-Rong Li5
  1. 1 Department of Nutrition and Food Hygiene, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China
  2. 2 College of Community Health Nursing, Winneba - Central Region, Ghana
  3. 3 Southern Medical University School of Public Health, Guangzhou, Guangdong, China
  4. 4 Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
  5. 5 School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
  1. Correspondence to Professor Xian-Bo Wu, Southern Medical University School of Public Health, Guangzhou, Guangdong, 510515, China; wuxb1010{at}; Dr Fu-Rong Li, Southern University of Science and Technology School of Public Health and Emergency Management, Shenzhen, Guangdong, 518055, China; furong_l{at}


Background To assess the roles of diabetic microvascular disease and modifiable risk factors and their combination in the development of arrhythmias.

Methods We included participants with type 2 diabetes (T2D) who were free of arrhythmias during recruitment in the UK Biobank study. The associations of microvascular disease states (defined by the presence of retinopathy, peripheral neuropathy or chronic kidney disease), four modifiable arrhythmic risk factors (body mass index, smoking, systolic blood pressure and glycosylated haemoglobin) and their joint associations with incident arrhythmias were examined.

Results Among the 25 632 participants with T2D, 1705 (20.1%) of the 8482 with microvascular disease and 2017 (11.8%) of the 17 150 without microvascular disease developed arrhythmias during a median follow-up of 12.3 years. Having any of the three microvascular diseases was associated with a 48% increase in the hazard of developing arrhythmias. Incorporating microvascular disease states into a model alongside 11 traditional risk factors significantly enhanced arrhythmia prediction. Furthermore, individuals with microvascular disease who had optimal levels of zero to one, two, three or four arrhythmic risk factors showed an HR of 2.05 (95% CI 1.85, 2.27), 1.67 (95% CI 1.53, 1.83), 1.35 (95% CI 1.22, 1.50) and 0.91 (95% CI 0.73, 1.13), respectively, compared with those without microvascular disease.

Conclusions Although microvascular disease, a non-traditional risk factor, was associated with incident arrhythmias in individuals with T2D, having optimal levels of risk factors may mitigate this risk.

  • Atrial Fibrillation
  • Arrhythmias, Cardiac
  • Diabetes Mellitus

Data availability statement

Data are available upon reasonable request. The data sets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Data availability statement

Data are available upon reasonable request. The data sets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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  • G-CC and DNH contributed equally.

  • Contributors X-BW and F-RL conceived and analysed the data. G-CC and DNH wrote the manuscript. J-QL, H-PW, LQ and W-DF contributed to the discussion and reviewed/edited the manuscript. All authors contributed to the article and approved the submitted version. F-RL is the guarantor.

  • Funding This study was supported by the National Natural Science Foundation of China (12126602, 82030102 and 82173607), the R&D Project of Pazhou Lab (Huangpu) under Grant 2023K0610, the Shenzhen Science and Technology Innovation Committee (no: ZDSYS20200810171403013), the Guangdong Basic and Applied Basic Research Foundation (2021A1515011684), Open Project of the Guangdong Provincial Key Laboratory of Tropical Disease Research (2020B1212060042), Guangzhou Science and Technology Project (202102080597), the SUSTech Presidential Postdoctoral Fellowship, the Ministry of Science and Technology of China (2022YFC3702703), the Gusu Leading Talent Plan for Scientific and Technological Innovation and Entrepreneurship (ZXL2023345), and the Chinese Postdoctoral Science Foundation (2022M721463). The funders had no role in the study design, management, analysis, interpretation, manuscript preparation, review and approval.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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