Thiazolidinediones can prevent new onset atrial fibrillation in patients with non-insulin dependent diabetes

Background: Accumulative evidence suggested that oxidative stress and inflammation were involved in the pathogenesis of atrial fibrillation (AF). Thiazolidinediones (TZDs), agonists of peroxisome proliferator-activated receptor gamma (PPAR-γ), have been proven to have anti-inflammatory and anti-oxidant effects in addition to their anti-diabetic activity. The goal of this nationwide, population based cohort study was to evaluate whether the use of TZDs will protect diabetic patients from AF. Methods: The study population was comprised of 12,065 non-insulin dependent diabetic patients identified from the "National Health Insurance Research Database" released by the Taiwan National Health Research Institutes. Among the study patients, a total of 4137 patients with TZD use were recognized as the study cohort and 7928 patients without TZD use were included as the comparison cohort. The study endpoint was defined as AF occurrence during the follow up period. Results: During the follow up of 63 ± 25 months, 194 patients (1.6% of the study population) developed AF: 49 from the study cohort (1.2% of the TZD group) and 145 from the comparison cohort (1.8% of the non-TZD group). After an adjustment for the baseline characteristics and medications, the TZDs independently protected diabetic patients from new-onset AF with a hazard ratio of 0.69 (95% confidence interval = 0.49-0.91, p value = 0.028). Conclusion: In this cohort study, we demonstrated that TZDs had obvious protective effects on the development of AF in diabetic patients. Drugs acting as ligands to the PPAR-γ may be potential up-stream therapies for AF prevention.