Association of metabolic syndrome with non-thromboembolic adverse cardiac outcomes in patients with atrial fibrillation

Polovina, Marija; Hindricks, Gerhard; Maggioni, Aldo P.; Piepoli, Massimo F; Vardas, Panos; Ašanin, Milika; Đikić, Dijana; Đuričić, Nemanja; Milinković, Ivan; Seferović, Petar

doi:10.1093/eurheartj/ehy446

Cited by 20 publications

(15 citation statements)

References 56 publications

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“…Possibly, this may indicate that AF patients with T2DM suffered a larger MI with a devastating effect on left ventricular systolic function and consequent HFrEF. Previous research may support this view by showing a stronger propensity for incident MI or CV death among AF patients with metabolic syndrome (which often precedes overt T2DM) compared to those without . This is also in line with the above‐noted lower relative T2DM‐related risk of adverse outcomes in patients with reduced baseline LVEF, in whom prior burden of vascular disease and interim ACS might have mitigated the absolute effect of T2DM, but at the same time, increased the likelihood of HFrEF.…”

Section: Discussionsupporting

confidence: 76%

“…When patients with new-onset HF were divided by baseline T2DM status and an interim ACS (i.e. with or without ACS preceding new-onset HF), a divergence in distribution of HF phenotypes was observed among the subgroups (Figure 3) 51 This is also in line with the above-noted lower relative T2DM-related risk of adverse outcomes in patients with reduced baseline LVEF, in whom prior burden of vascular disease and interim ACS might have mitigated the absolute effect of T2DM, but at the same time, increased the likelihood of HFrEF. However, more precise interpretation of these findings is largely limited by a small number of events.…”

Section: The Association Between Type 2 Diabetes and New-onset Heart mentioning

confidence: 99%

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Type 2 diabetes increases the long‐term risk of heart failure and mortality in patients with atrial fibrillation

Polovina

Lund

Đikić³

et al. 2019

European J of Heart Fail

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Aims Impact of type 2 diabetes mellitus (T2DM) on non‐thromboembolic outcomes in atrial fibrillation (AF) is insufficiently explored. This prospective cohort study of AF patients aimed (i) to analyse the association between T2DM and heart failure (HF) events (including new‐onset HF), and all‐cause and cardiovascular mortality, (ii) to assess the impact of baseline T2DM treatment on outcomes, and (iii) to explore characteristics of new‐onset HF phenotypes in relation to T2DM status. Methods and results Of 1803 AF patients (515/1288, with/without prior HF), 389 (22%) had T2DM at baseline. After 5 years of median follow‐up, T2DM patients had an 85% greater risk of HF events [adjusted hazard ratio (aHR) 1.85; 95% confidence interval (CI) 1.51–2.28; P < 0.001], including a 45% increased risk for new‐onset HF (1.45; 1.17–2.28; P = 0.015). T2DM conferred a 56% higher all‐cause (1.56, 1.22–2.01; P = 0.003) and a 48% higher cardiovascular mortality (1.48; 1.34–1.93; P = 0.007). Fine–Gray analysis, with mortality as a competing risk, confirmed greater HF risk among T2DM patients. All risks were highest among insulin‐treated patients. The prevalence of new‐onset HF phenotypes was as follows: 67% preserved ejection fraction (HFpEF), 20% mid‐range ejection fraction (HFmrEF) and 13% reduced ejection fraction (HFrEF). On time‐dependent Cox regression, adjusted for baseline characteristics and an interim acute coronary event, T2DM increased aHRs for new‐onset HFpEF (2.38; 1.30–4.58; P <0.001) and the combined HFmrEF/HFrEF (1.77; 1.11–3.62; P = 0.017). Conclusions Atrial fibrillation patients with T2DM have independently increased risk of new‐onset/recurrent HF events, cardiovascular and all‐cause mortality, particularly when insulin‐treated. The prevailing phenotype of new‐onset HF was HFpEF; T2DM conferred higher risk of both HFpEF and HFmrEF/HFrEF.

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Section: Discussionsupporting

confidence: 76%

Section: The Association Between Type 2 Diabetes and New-onset Heart mentioning

confidence: 99%

Type 2 diabetes increases the long‐term risk of heart failure and mortality in patients with atrial fibrillation

Polovina

Lund

Đikić³

et al. 2019

European J of Heart Fail

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“…15 In particular, patients with AF deserve careful assessment, given the high prevalence and increased risk of adverse outcomes in the presence of the metabolic syndrome. 16 In addition, the present study extends current knowledge and promotes further research into potentially modifiable risk factors for common cardiovascular disorders, including AF.…”

supporting

confidence: 66%

Crouching tiger, hidden dragon: insulin resistance and the risk of atrial fibrillation

Polovina

Krljanać

Ašanin

et al. 2020

European Journal of Preventive Cardiology

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“…Previous studies on clinical observation have reported that MetS is associated with AF risk; this association is observed in western populations [18][19][20], and also in Asian countries [21][22][23]. MetS is common in AF patients without overt coronary heart diseases, and is independently correlated with increased risk of cardiac death [24]. In addition, MetS also has an impact on the outcome and recurrence risk of AF after a catheter ablation termination [25,26].…”

Section: Mets Is a Major Risk For Atrial Cardiomyopathy And Afmentioning

confidence: 90%

The Pathogenic Role of Very Low Density Lipoprotein on Atrial Remodeling in the Metabolic Syndrome

Lee

Lin

2020

IJMS

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Atrial fibrillation (AF) is the most common persistent arrhythmia, and can lead to systemic thromboembolism and heart failure. Aging and metabolic syndrome (MetS) are major risks for AF. One of the most important manifestations of MetS is dyslipidemia, but its correlation with AF is ambiguous in clinical observational studies. Although there is a paradoxical relationship between fasting cholesterol and AF incidence, the beneficial benefit from lipid lowering therapy in reduction of AF is significant. Here, we reviewed the health burden from AF and MetS, the association between two disease entities, and the metabolism of triglyceride, which is elevated in MetS. We also reviewed scientific evidence for the mechanistic links between very low density lipoproteins (VLDL), which primarily carry circulatory triglyceride, to atrial cardiomyopathy and development of AF. The effects of VLDL to atria suggesting pathogenic to atrial cardiomyopathy and AF include excess lipid accumulation, direct cytotoxicity, abbreviated action potentials, disturbed calcium regulation, delayed conduction velocities, modulated gap junctions, and sarcomere protein derangements. The electrical remodeling and structural changes in concert promote development of atrial cardiomyopathy in MetS and ultimately lead to vulnerability to AF. As VLDL plays a major role in lipid metabolism after meals (rather than fasting state), further human studies that focus on the effects/correlation of postprandial lipids to atrial remodeling are required to determine whether VLDL-targeted therapy can reduce MetS-related AF. On the basis of our scientific evidence, we propose a pivotal role of VLDL in MetS-related atrial cardiomyopathy and vulnerability to AF.

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Association of metabolic syndrome with non-thromboembolic adverse cardiac outcomes in patients with atrial fibrillation

Cited by 20 publications

References 56 publications

Type 2 diabetes increases the long‐term risk of heart failure and mortality in patients with atrial fibrillation

Type 2 diabetes increases the long‐term risk of heart failure and mortality in patients with atrial fibrillation

Crouching tiger, hidden dragon: insulin resistance and the risk of atrial fibrillation

The Pathogenic Role of Very Low Density Lipoprotein on Atrial Remodeling in the Metabolic Syndrome

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