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

Hajhosseiny, Reza; Matthews, Gareth K.; Lip, Gregory Y. H.

doi:10.1016/j.hrthm.2015.06.038

Cited by 39 publications

(31 citation statements)

References 140 publications

(151 reference statements)

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“…Undernutrition, as a component of cardiac cachexia syndrome, may potentially be linked to the risk of AF; however, these relationships are less well documented, mainly due to the exclusion of underweight patients from analysis concerning associations between obesity and CVD [2,6]. The proposed pathophysiological mechanisms linking overnutrition status with risk of AF are: (a) the effect of chronic inflammatory status associated with an imbalance in pro-and anti-inflammatory substances (adipokines, mainly adiponectin, and cytokines) produced by extra-cardiac, cardiac, and perivascular fatty tissue [6][7][8][9][10]; (b) left atrial enlargement [11]; (c) a decreased effect of atrial natriuretic factor, the blood concentration of which is inversely related to body mass index (BMI) [12]; (d) electromechanical dysfunction and adiponectin levels, both of which are positively correlated with BMI [11,13]; (e) haemodynamic changes associated with obesity, and related increased pre-and afterload [13]; (f) autonomic nervous system imbalance and/or sympathetic overactivity in the course of coexisting coronary artery disease or heart failure [11,14,15]; (g) obstructive sleep apnoea [15]; (h) diabetes mellitus, insulin resistance [11]; (i) metabolic syndrome [16,17]; and (j) gastroesophageal reflux disease [18]. Whereas, undernutrition may lead to cardiac arrhythmia via the following: (a) a decrease in fatty and fat-free body mass (sarcopaenia) due to the importance of muscle mass as a regulator of autonomic nervous system and metabolic balances; (b) an increase in pro-inflammatory cytokines, such as interleukin-6 and tumour necrosis factor-alpha, particularly in patients with cardiac cachexia; (c) a decrease in lipoprotein levels and their activity binding pro-inflammatory cytokines and endotoxins; (d) energetic deficit; (e) lipolysis acceleration; and (f) deficiency in electrolytes, antioxidants, vitamins, and proteinaceous components responsible for building the heart [19].…”

Section: Introductionmentioning

confidence: 99%

The associations between atrial fibrillation and parameters of nutritional status assessment in the general hospital population — a cross-sectional analysis of medical documentation

Budzyński

Anaszewicz

2017

Kardiol Pol

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A b s t r a c tBackground: Atrial fibrillation (AF) and nutrition status abnormalities are two of the most significant epidemics in current health care. Aim:The aim of this study was to determine the relationship between the prevalence and outcome of AF, and the parameters of nutritional status among consecutive, real-life patients hospitalised in a university hospital. Methods:Analysis of the medical documentation of 4930 consecutive patients aged ≥ 18 years hospitalised for more than one day with diagnoses of cardiovascular disorders. Results:Patients admitted with a diagnosis of AF (n = 512) compared to their counterparts without AF less frequently had an NRS-2002 score ≥ 3, normal range of body mass index (BMI), higher blood haemoglobin, and lower low density lipoprotein cholesterol (LDL-C) concentration. In logistic regression analysis, the risk of a hospitalisation due to AF was negatively related to BMI, NRS-2002 score, and the value of the difference between ideal and actual body mass. Urgent admission and having an NRS--2002 score ≥ 3 remained the only significant variables determining the risk of in-hospital death. Blood concentration of LDL-C and urgent admission were the only significant variables determining risk of 30-day rehospitalisation in the studied population. Conclusions:Inpatients with AF had a lower prevalence of normal body mass. Patients with an AF diagnosis had different risk factors for in-hospital death and 30-day rehospitalisation than their counterparts with diagnosis of cardiovascular diseases but without AF; however, the parameters of nutritional status played an important role in both patient groups. The obesity and cholesterol paradoxes were also observed.

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Section: Introductionmentioning

confidence: 99%

The associations between atrial fibrillation and parameters of nutritional status assessment in the general hospital population — a cross-sectional analysis of medical documentation

Budzyński

Anaszewicz

2017

Kardiol Pol

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“…Retinopathy has been assumed to be a surrogate marker for microvascular dysfunction, which plays a pivotal role in the development of metabolic syndrome and cardiovascular disease333435. Recently, metabolic syndrome has been assumed to be an important risk factor for AF development3637. Autonomic neuropathy, oxidative stress, myocardial fibrosis, and microvascular dysfunction could be the underlying pathophysiologic mechanism for this association3839.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Association Between Retinal Vein Occlusion and the Risk of Atrial Fibrillation Development: A 12-Year, Retrospective Nationwide Cohort Study

Rim

Lee

et al. 2016

Sci Rep

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We aimed to evaluate the risk of atrial fibrillation (AF) development following retinal vein occlusion (RVO). We performed a nationwide propensity score-matched cohort study by retrospectively reviewing a database from the Korean National Health Insurance Service, comprising approximately 1 million random subjects. RVO and AF were diagnosed based on the Korean Classification of Disease codes. The RVO group was composed of patients with an initial diagnosis of RVO made between 2003 and 2007 (n = 1,801), excluding those who were diagnosed in 2002. The comparison group was composed of randomly selected patients (5 for each patient with RVO, n = 8,930) who were matched to the RVO group according to sociodemographic factors and the year of enrollment. Each sampled patient was tracked until 2013. The predictive value of RVO for AF was analyzed using Cox regression analysis with a hazard ratio (HR) and confidence interval (CI). AF developed in 6.5% of patients in the RVO group and 4.0% of those in the comparison group (p < 0.001). RVO was associated with a greater risk of AF development after adjusting for possible confounders (HR, 1.35; 95% CI, 1.09–1.67). An association between RVO and subsequent AF development was found after adjusting for possible confounding factors.

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“…20 Furthermore, the metabolic syndrome has become common in Latin America and is strongly associated with the development of AF and the risk of future stroke. 21 These risk factors not only impact the prognosis of AF, but also predispose to future cardiovascular events, including ischemic stroke. 22,23 As a result, a rising number of stroke deaths have been recorded in the region, which is estimated to increase over the next few decades.…”

Section: Methodsmentioning

confidence: 99%

Stroke Prevention in Atrial Fibrillation: Focus on Latin America

Massaro¹,

Lip²

2016

Arquivos Brasileiros De Cardiologia

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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with an estimated prevalence of 1-2% in North America and Europe. The increased prevalence of AF in Latin America is associated with an ageing general population, along with poor control of key risk factors, including hypertension. As a result, stroke prevalence and associated mortality have increased dramatically in the region. Therefore, the need for effective anticoagulation strategies in Latin America is clear. The aim of this review is to provide a contemporary overview of anticoagulants for stroke prevention.The use of vitamin K antagonists (VKAs, eg, warfarin) and aspirin in the prevention of stroke in patients with AF in Latin America remains common, although around one fifth of all AF patients receive no anticoagulation. Warfarin use is complicated by a lack of access to effective monitoring services coupled with an unpredictable pharmacokinetic profile. The overuse of aspirin is associated with significant bleeding risks and reduced efficacy for stroke prevention in this patient group. The non-VKA oral anticoagulants (NOACbs) represent a potential means of overcoming many limitations associated with VKA and aspirin use, including a reduction in the need for monitoring and a reduced risk of hemorrhagic events.The ultimate decision of which anticoagulant drug to utilize in AF patients depends on a multitude of factors. More research is needed to appreciate the impact of these factors in the Latin American population and thereby reduce the burden of AF-associated stroke in this region.

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

Cited by 39 publications

References 140 publications

The associations between atrial fibrillation and parameters of nutritional status assessment in the general hospital population — a cross-sectional analysis of medical documentation

The associations between atrial fibrillation and parameters of nutritional status assessment in the general hospital population — a cross-sectional analysis of medical documentation

Evaluation of the Association Between Retinal Vein Occlusion and the Risk of Atrial Fibrillation Development: A 12-Year, Retrospective Nationwide Cohort Study

Stroke Prevention in Atrial Fibrillation: Focus on Latin America

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