Additive effect of the metabolic syndrome score to the conventional CHADS2 score for the thromboembolic risk stratification of patients with atrial fibrillation

Metabolic syndrome, atrial fibrillation, and stroke: Tackling an emerging epidemic

“…39 Diabetes and hypertension both increase a patient's risk of developing AF. 40 Indeed, diabetes is a strong independent risk factor for the development of AF. 41,42 Mechanistically, insulin 8 resistance results in a pro-inflammatory environment within the myocardium, principally driven by elevations in levels of interleukin-1, C-reactive protein and reactive oxygen species.…”

“…40 In the National Health and Nutrition Examination Survey, metabolic syndrome was associated with a doubling of stroke risk after adjustment for age, sex, race and cigarette smoking status (odds ratio (OR) 2.16, 95% CI 1.48 -3.16, p= 0.0002). 63 This relationship was supported in a subsequent study (OR 2.41, 95% CI, 1.12 -5.32, p=0.025), 64 although this increased stroke risk may at least in part be explained by the higher risk of AF.…”

“…63 were all independently associated with risk of thromboembolic events in patients with AF. 40 Recognising the burden of risk associated with the metabolic syndrome, it has been suggested that patients with AF and metabolic syndrome should have their stroke risk assessed using a modification to the widely accepted CHADS 2 and CHA 2 DS 2 -VASc scoring systems, CHADS 2 -MS. 40 By including additional metabolic syndrome risk factors, this system was proposed to identify additional patients who would derive a net benefit from anticoagulation.…”

“…70 These effects are compounded by an association between metabolic syndrome and markers of cardiac dysfunction, which are themselves associated with increased stroke risk. 40,71,72 Evidence-based interventions to manage stroke risk…”

“…Though one must remain mindful of the danger of bleeding, it seems that the great majority of patients with both metabolic syndrome and AF stand to benefit from anticoagulation. 40,94 For decades Vitamin K Antagonist (VKA)-based therapies such as warfarin were the only effective means for achieving anticoagulation via the oral route. 95 In large clinical trials warfarin treatment to a target international normalised ratio (INR) of 2.5 has been shown to reduce stroke risk by up to 64%.…”