Association of Antihyperglycemic Therapy with Risk of Atrial Fibrillation and Stroke in Diabetic Patients

Abstract

Type 2 diabetes mellitus (DM) is associated with an increased risk of cardiovascular disease (CVD). Atrial fibrillation (AF) and stroke are both forms of CVD that have major consequences in terms of disabilities and death among patients with diabetes; however, they are less present in the preoccupations of scientific researchers as a primary endpoint of clinical trials. Several publications have found DM to be associated with a higher risk for both AF and stroke; some of the main drugs used for glycemic control have been found to carry either increased, or decreased risks for AF or for stroke in DM patients. Given the risk for thromboembolic cerebrovascular events seen in AF patients, the question arises as to whether stroke and AF occurring with modified incidences in diabetic individuals under therapy with various classes of antihyperglycemic medications are interrelated and should be considered as a whole. At present, the medical literature lacks studies specifically designed to investigate a cause–effect relationship between the incidences of AF and stroke driven by different antidiabetic agents. In default of such proof, we reviewed the existing evidence correlating the major classes of glucose-controlling drugs with their associated risks for AF and stroke; however, supplementary proof is needed to explore a hypothetically causal relationship between these two, both of which display peculiar features in the setting of specific drug therapies for glycemic control.

The Role of High Triglycerides Level in Predicting Cognitive Impairment: A Review of Current Evidence

“…The cohort was a subsample of the Three-City Study and included 7087 participants aged ≥65 years with 4 years of follow-up [ 56 ]. High TG level was the only component of metabolic syndrome that was significantly associated with the incidence of all-cause and vascular dementia, while diabetes, but not impaired fasting glycemia, was significantly associated with all-cause and vascular dementia [ 56 , 65 ].…”

Sodium-glucose cotransporter-2 inhibitors protect against atrial fibrillation in patients with heart failure

“…SGLT-2 inhibitors suppress the active reabsorption of sodium and glucose at the level of the proximal renal tubule, and this may lead to a reduction in blood pressure, blood glucose, and body weight (18). In the cardiovascular outcome trials, dapagliflozin was shown to reduce the worsening of HF events in patients with HF (12), while empagliflozin reduced the risk of cardiovascular death or hospitalization for HF (13).…”

Triglyceride-Rich Lipoproteins and Their Remnants as Silent Promoters of Atherosclerotic Cardiovascular Disease and Other Metabolic Disorders: A Review

“…On top of these findings, a growing body of evidence connects triglycerides and TRLs to diabetes and other metabolic diseases. At the same time, diabetes mellitus is linked to an increased risk of CVD and thromboembolic cerebrovascular events [ 56 ]. Advantageously, the triglyceride-to-HDL ratio is a surrogate not only of ASCVD but also of incident type 2 diabetes mellitus (T2DM).…”