Should atrial fibrillation be considered a vascular disease? The need for a comprehensive vascular approach

ABSTRACT

Introduction

Atrial fibrillation (AF) cannot be considered an isolated disease. Patients with AF should be managed using a comprehensive approach that is not limited to stroke prevention.

Areas covered

In this manuscript, the potential role of AF as a vascular disease that is managed as part of a holistic approach was reviewed.

Expert opinion

The residual risk of stroke in patients with AF reaches 1–2% annually, despite appropriate anticoagulation therapy. Additionally, patients with AF may develop cognitive impairment through stroke-independent pathways. Furthermore, patients with AF may have a higher risk of developing atherosclerotic vascular disease in various vascular beds and chronic kidney disease; conversely, patients with atherosclerotic disease may have an increased risk of developing AF. AF should be considered a truly systemic vascular disease, since it brings together several hemodynamic and systemic changes, including inflammation, oxidative stress, activation of the renin-angiotensin-aldosterone and sympathetic systems, as well as a prothrombotic state and endothelial dysfunction. In this regard, patients with AF should be treated based on a holistic approach that is not limited to oral anticoagulation but includes complete vascular protection.

KEYWORDS:

• Atherosclerosis
• atrial fibrillation
• chronic kidney disease
• coronary artery disease
• diabetes
• peripheral artery disease
• vascular disease

Article highlights

• AF promotes systemic hemodynamic and non-hemodynamic changes that translate into a substantial increase in the risk of thromboembolic complications and vascular outcomes.

• AF shares many pathophysiological features with other vascular conditions, such as ischemic heart disease, peripheral artery disease, diabetes, and chronic kidney disease.

• AF should be considered a true systemic vascular disease.

• The aim of the management of AF should be focused not only on stroke prevention, but on providing a complete vascular protection.

• AF should be treated using a holistic vascular approach, beyond anticoagulation.

Declaration of interests

C Escobar has received honoraria as a speaker from Astra-Zeneca, Novartis, Boehringer Ingelheim, Vifor Pharma, Rovi and Bayer.

A Pose Reino reports consulting fees and/or lectures honoraria from Astra, Boehringer, Bayer, Pfizer, Daiichi Sankyo, Sanofi, Amgen, Novartis, Menarini and Ferrer.

P Diez-Villanueva has received honoraria for presentations from Bayer, Boehringer-Ingelheim, Daiichi Sankyo, and Pfizer-BMS.

L Facila has received honoraria for lectures from Novartis, Bayer, Boehringer-Lilly, AstraZeneca, Vifor and for participation in advisory board from Bayer, Novartis and AstraZeneca and has received fees from Novo Nordisk, Boehringer, AstraZeneca, Bayer, Esteve, Eli Lilly.

R Freixa-Pamias has received honoraria for presentations from Bayer, Boehringer-Ingelheim, Daiichi Sankyo, and Pfizer-BMS.

A Valle has received honoraria for presentations from Bayer, Boehringer-Ingelheim, Daiichi Sankyo, and Pfizer-BMS.

M Almendro reports consulting fees and/or lectures honoraria from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Eli Lilly, GlaxoSmithKline, Daiichi-Sankyo, Rovi Pharmaceuticals, and Sanofi Aventis, and grants support from AstraZeneca.

C Bonanad Lozano reports lectures honoraria from Pfizer/BMS, Novartis, Daiichi-Sankyo, AstraZeneca, Sanofi, Amgen, Ferrer, Boehringer-Ingelheim and consulting fees from Daiichi-Sankyo, AstraZeneca, Sanofi, Amgen, Menarini, Pfizer/BMS, Boehringer-Ingelheim, Bayer, Novartis.

D Vivas has received honoraria for lectures from Bayer, Boehringer, AstraZeneca, Daiichi-Sankyo, and for participation in advisory board from Bayer, Boehringer, Daiichi-Sankyo and AstraZeneca.

C Suárez has received speaker and/or advisory fees from Bayer, Pfizer/BMS, 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.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Acknowledgments

Writing and editorial assistance was provided by Content Ed Net, with funding from Bayer Hispania SL.

SUPPLEMENTARY MATERIAL

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14779072.2023.2272652

Additional information

Funding

This paper was funded by Bayer Hispania SL.