Diabetes is an established risk factor for atrial fibrillation (AF). However, whether prediabetes is also a risk factor for AF is unclear. This meta-analysis examined the relationship between prediabetes and AF risk.

EMBASE, MEDLINE, and Publicly Available Contents (from Jan. 1, 1950 to Jan. 29, 2025) were used to comprehensively search for observational studies of the incidence or prevalence of AF among those with prediabetes or normoglycemia. Each relative risk (RR) for prediabetes vs. normoglycemia and the population attributable fraction (PAF) of prediabetes to AF incidence in longitudinal studies and the odds ratio (OR) for prediabetes vs. normoglycemia in cross-sectional studies were pooled with a random-effects model.

Identified were 46 eligible studies. Pooled RR and PAF (95% confidence interval [CI]) were 1.12 (1.06–1.18) and 2.7% (1.4%-4.0%), respectively. Pooled crude RR and crude OR (95% CI) were 1.49 (1.37–1.62) and 1.42 (1.23–1.64), respectively. Higher RR was revealed in populations ≥ 65 years old vs. < 65 years old (P = 0.02) and in Asian vs. non-Asian countries (P = 0.047). Higher PAF was revealed in studies with a population ≥ 65 years old vs. < 65 years old (P < 0.001) and in male-dominant vs. female-dominant studies (P < 0.001). Only by examining the RR for both diabetes and prediabetes vs. normoglycemia, the pooled RR/PAF (95% CI) was 1.12 (1.15–1.20)/1.6% (0.9%-2.3%) for prediabetes and 1.15 (1.10-1.20)/1.0% (0.7%-13%) for diabetes.

Prediabetes is a modest but significant risk factor for AF, comparable to that of diabetes. The impact of prediabetes was strong among the elderly, males, and Asian people.