Diabetes mellitus and atrial fibrillation-from pathophysiology to treatment

Leopoulou, Marianna; Theofilis, Panagiotis; Kordalis, Athanasios; Papageorgiou, Nikolaos S.; Sagris, Μarios; Oikonomou, Evangelos; Tousoulis, Dimitris

doi:10.4239/wjd.v14.i5.512

Cited by 14 publications

(14 citation statements)

References 146 publications

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“…The notably high percentage (50.36%) of AF in our diabetic population is concerning. It is well-known that diabetes mellitus (DM) is an independent factor for developing AF, with a prevalence twice as high compared to those without DM 2,11,12 . The mechanisms involved in AF development in DM include three interrelated phenomena generated by DM: in ammation, oxidative stress, and glycemic uctuations.…”

Section: Discussionmentioning

confidence: 99%

“…The mechanisms involved in AF development in DM include three interrelated phenomena generated by DM: in ammation, oxidative stress, and glycemic uctuations. These lead to myocardial remodeling (atrial, in this case) at three levels: electrical (conduction abnormalities), structural (dilation and brosis), and autonomic (autonomic imbalance) 11,12 . Therefore, proper screening in diabetic patients is essential to detect silent or mildly symptomatic AF for timely management and prevention of cardiovascular events, particularly ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

“…It also induces changes in the structure and function of atrial cardiomyocytes, leading to brosis, and autonomic imbalance [18,19,20,21]. All of this, combined with myocardial in ammation and brosis, which can be caused by DM [known as diabetic cardiomyopathy], further increases the likelihood of developing AF [11,12,22].…”

Section: Discussionmentioning

confidence: 99%

“…This reduction remained consistent regardless of the presence of atherosclerotic cardiovascular disease or heart failure. It is suggested that the bene ts could be related to the promotion of natriuresis and diuresis, as well as other positive cardiovascular effects of SGLT2i, implying the possibility that dapagli ozin offers additional bene ts by reducing the risk of AF/a utter events in patients with type 2 DM [12,22,26]. However, it is essential to note that the medications provided by the systems of medical insurance in Peru are usually conventional.…”

Section: Discussionmentioning

confidence: 99%

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Associated Factors to Atrial Fibrillation in Diabetics at a Peruvian Northern Hospital

Vilela-Farfán,

Rodriguez-Saldaña,

Fiestas-Cordova

et al. 2024

Preprint

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Studies have demonstrated that patients with diabetes mellitus have higher risk of developing Atrial Fibrillation compared to those without Diabetes Mellitus. The aim of this research was to identify the factors associated with AF in diabetic patients in Piura, Peru. A cross-sectional study included diabetic patients over 18 years old, treated in the internal medicine department for hospitalization, emergencies, and referrals. Conducted at a Hospital, located in Piura in northern Peru. A frequency of 50.36% of diabetic patients with AF was determined. For the adjusted model, age, alcoholism, and elevated glycosylated hemoglobin levels were considered for inclusion, in addition to gender due to biological reasoning to suspect an association with AF. Only age (Adjusted Prevalence Ratio (aPR): 0.97; 95% CI: 0.968-0.987; p-value < 0.001) and alcoholism (aPR: 1.44; 95% CI: 1.132-1.835; p-value = 0.003) were found as associated factors. Being younger and having alcoholism were significantly associated with the onset of atrial fibrillation in diabetic patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Associated Factors to Atrial Fibrillation in Diabetics at a Peruvian Northern Hospital

Vilela-Farfán,

Rodriguez-Saldaña,

Fiestas-Cordova

et al. 2024

Preprint

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“…AF combined with DM poses significant risks, notably increasing the likelihood of thromboembolic events, heart failure, and mortality [ 3 , 4 ]. AF can lead to blood clot formation, exacerbated by DM's metabolic and vascular changes, heightening the risk of strokes and embolic events [ 3 - 5 ].…”

Section: Introductionmentioning

confidence: 99%

The Synergistic Relationship Between Atrial Fibrillation and Diabetes Mellitus: Implications for Cardiovascular and Metabolic Health

Mohsin,

Zeyad,

Khalid

et al. 2023

Cureus

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Type 2 diabetes mellitus (T2DM) and atrial fibrillation (AF) are widespread chronic conditions that profoundly impact public health. While the intricate mechanisms linking these two diseases remain incompletely understood, this review sets out to comprehensively analyze the current evidence about their pathophysiology, epidemiology, diagnosis, prognosis, and treatment. We reveal that T2DM can influence the electrical and structural properties of the atria through multiple pathways, including oxidative stress, inflammation, fibrosis, connexin remodeling, glycemic variability, and autonomic dysfunction. Moreover, it significantly influences AF's clinical course, elevating the risk of heart failure, stroke, and cardiovascular mortality. Our review also explores treatment options for individuals with T2DM and AF, encompassing antidiabetic and antiarrhythmic drugs and non-pharmacological interventions, such as cardioversion catheter ablation and direct current cardioversion. This review depicts an insight into the clinical interplay between T2DM and AF. It deepens our comprehension of the fundamental mechanisms, potential therapeutic interventions, and their implications for patient care. This comprehensive resource benefits researchers seeking to deepen their knowledge in this domain. Ultimately, our findings pave the way for more effective strategies in managing AF within the context of T2DM.

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Type 2 diabetes mellitus and cardiovascular health: Evidence of causal relationships in a European ancestry population

Ruan,

Zhou,

et al. 2024

ESC Heart Failure

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AimsType 2 diabetes mellitus (T2DM) is associated with increased cardiovascular disease (CVD) risk, but whether T2DM directly causes adverse cardiac remodelling is uncertain. We performed a comprehensive Mendelian randomization (MR) analysis to investigate the causal relevance of T2DM to CVD outcomes and cardiac structure/function.Methods and resultsBidirectional two‐sample MR was conducted using summary‐level data from European‐ancestry genome‐wide association studies. The T2DM GWAS data included 80 154 cases and 853 816 controls from the DIAGRAM consortium. Outcomes included coronary artery disease (CAD), myocardial infarction (MI), stroke, heart failure, atrial fibrillation, and various quantitative cardiac imaging traits assessed by magnetic resonance imaging. MR analysis revealed causal associations between genetic predisposition to T2DM and increased risk of CAD (odds ratio [OR] 1.104, 95% confidence interval [CI] 1.078–1.130, P = 2.59e‐16), MI (OR 1.129, 95% CI 1.094–1.166, P = 6.02e‐14) and stroke (OR 1.086, 95% CI 1.064–1.109, P = 1.02e‐14). These associations were validated in the FinnGen cohort (CAD: OR 1.117, 95% CI 1.075–1.158, P = 1.56e‐9; MI: OR 1.132, 95% CI 1.083–1.184, P = 4.27e‐8; stroke: OR 1.138, 95% CI 1.107–1.170, P = 3.52e‐20). Multivariable MR show consistent findings (CAD: OR 1.063, 95% CI 1.031–1.097, P = 1.11e‐4; MI: OR 1.088, 95% CI 1.042–1.135, P = 1.12e‐4; stroke: OR 1.066, 95% CI 1.032–1.101, P = 1.18e‐4) after adjusting for cardiometabolic traits. T2DM was causally associated with higher left ventricular mass index (β = 0.473, 95% CI 0.193 to 0.752, P = 0.001), lower indexed right atrial minimum (β = −0.048, 95% CI −0.073 to −0.022, P = 2.1e‐5), and maximum (β = −0.042, 95% CI −0.065 to −0.019, P = 4.12e‐5) areas. The effects on right atrial size remained significant after adjusting for risk factors (minimum area: β = −0.041, 95% CI −0.072 to −0.010, P = 0.009; maximum area: β = −0.039, 95% CI −0.069 to −0.008, P = 0.012). Both apolipoprotein A1 and SBP are important mediators in the causal relationship between T2DM and left ventricular mass index. No reverse causal associations were identified.ConclusionsOur MR study demonstrates that genetic liability to T2DM plays causal roles in CAD, MI, stroke, and cardiac structure changes including left ventricular hypertrophy and reduced right atrial dimensions. These findings provide genetic evidence supporting glycaemic control in T2DM to mitigate cardiovascular complications and adverse cardiac remodelling.

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Diabetes mellitus and atrial fibrillation-from pathophysiology to treatment

Cited by 14 publications

References 146 publications

Associated Factors to Atrial Fibrillation in Diabetics at a Peruvian Northern Hospital

Associated Factors to Atrial Fibrillation in Diabetics at a Peruvian Northern Hospital

The Synergistic Relationship Between Atrial Fibrillation and Diabetes Mellitus: Implications for Cardiovascular and Metabolic Health

Type 2 diabetes mellitus and cardiovascular health: Evidence of causal relationships in a European ancestry population

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