Cryptogenic stroke and diabetes: a probable link between silent atrial fibrillation episodes and cerebrovascular disease

Abstract

Diabetes mellitus is a risk factor for cardiovascular and cerebrovascular events independently of other factors such as age, sex, BMI and blood pressure. Diabetes plays an important role in the pathogenesis of atrial fibrillation because it causes alterations to the autonomic nervous system. It may also be associated with an increased prevalence of asymptomatic episodes of atrial fibrillation, which cause cerebrovascular disease more often than chronic atrial fibrillation. The presence of silent cerebral ischemia doubles the risk of stroke in the general population independently of other cardiovascular risk factors; therefore, early detection of these episodes is important to determine preventive measures against the first cerebrovascular disease.

Keywords::

• atrial fibrillation
• autonomic nervous system
• cerebrovascular disease
• cryptogenic stroke
• diabetes
• silent atrial fibrillation episodes
• Type 2 diabetes mellitus

Financial & competing interests disclosure

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Diabetes mellitus is a risk factor for cardiovascular and cerebrovascular events independently of other factors such as age, sex, BMI and blood pressure.

• Diabetes is a well-recognized stimulus for atrial fibrillation (AF).

• It appears that cardiac nervous autonomic dysfunction may have a pathogenic role in the AF of diabetic patients.

• It may also be associated with an increased prevalence of asymptomatic episodes of AF, which cause cerebrovascular disease more than chronic AF.

• It is important for an early detection of these episodes to determine preventive measures against the first cerebrovascular disease.