Considerations and treatment options for patients with comorbid atrial fibrillation and diabetes mellitus

ABSTRACT

Introduction: Atrial fibrillation (AF) and diabetes mellitus (DM) are common worldwide and their incidence is increasing, representing a significant public health and economic burden as well as an increase in individual increased morbidity and mortality risk profiles. Both conditions are closely related, as patients with DM are at increased risk of incident AF, and AF patients with DM are at higher risk of cardiovascular events compared to non-AF patients.

Areas covered: This review article aims to provide an overview of the current evidence linking DM and AF, as well as the impact of obesity, weight loss and stroke on these coexisting conditions. Second, the effects of new oral anti hyperglycaemic medications on cardiovascular risk will be considered.

Expert opinion: In conclusion, coexisting AF and DM represent a high risk population of patients requiring aggressive risk factor identification and treatment optimisation. The multifactorial interplay between these conditions requires individual assessment of patient risk profiles with the aim of minimising the impact of each modifiable risk factor.

KEYWORDS:

• Anticoagulation
• atrial fibrillation
• diabetes
• empagliflozin
• obesity
• stroke

Article highlights

• The coexistence of AF and DM identifies patients with high cardiovascular risk necessitating aggressive risk factor management and reduction.

• In coexisting AF and DM lipid-lowering therapy in the form of statins improves the overall cardiovascular risk profile with the further theorized benefit of anti-inflammatory properties.

• The exact mechanisms associating DM and AF remain unclear.

• Obesity increases the risk of AF and is a potential modifiable risk factor for its development.

• Patients with AF and DM have a high stroke risk, which should be assessed and managed with anticoagulation according to established risk scores.

• The risk of AF in DM is multifactorial and complex, requiring individual assessment of patient profiles and implemented strategies to minimize the impact of each risk factor to reduce overall risk.

• Empagliflozin is a new oral-antidiabetic medication shown to reduce cardiovascular and all-cause mortality in high risk patients, such as those with AF and DM.

This box summarizes key points contained in the article.

Declaration of interest

GYH Lip is a consultant for Bayer/Janssen, Bristol-Myers Squibb/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Microlife and Daiichi-Sankyo; a speaker for Bayer, Bristol-Myers Squibb/Pfizer, Medtronic, Boehringer Ingelheim, Microlife, Roche and Daiichi-Sankyo. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed

Additional information

Funding

This paper was not funded.