Atrial fibrillation and type 2 diabetes: Prevalence, etiology, pathophysiology and effect of anti‐diabetic therapies

Bell, David S. H.; Goncalves, Edison

doi:10.1111/dom.13512

Cited by 111 publications

(95 citation statements)

References 86 publications

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“…This could lead to early initiation of appropriate effective therapy, including antithrombotic therapy, to reduce the risk of stroke and death. Currently, there is no evidence that anti-diabetic therapies with glucagon-like peptide 1 (GLP-1) agonists, sodium-glucose cotransporter-2 (SGLT2) inhibitors nor dipeptidyl peptidase-4 (DPP4) inhibitor affect the development of atrial fibrillation [28].…”

Section: Discussionmentioning

confidence: 99%

Risk of atrial fibrillation in persons with type 2 diabetes and the excess risk in relation to glycaemic control and renal function: a Swedish cohort study

Ahmadi

Svensson

Pivodic

et al. 2020

Cardiovasc Diabetol

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Background: To examine the incidence of atrial fibrillation in individuals with type 2 diabetes compared with ageand sex-matched controls from the general population and its variation in relation to glycaemic control and renal function. Methods:A total of 421,855 patients with type 2 diabetes from the Swedish National Diabetes Registry and 2,131,223 controls from the Swedish Population Registry, matched for age, sex and county, were included and followed from Results: Overall, 8.9% of individuals with type 2 diabetes and 7.0% of controls were diagnosed with atrial fibrillation during follow-up, unadjusted incidence risk ratio (IRR) 1.35 (95% 1.33-1.36). Women < 55 years old with type 2 diabetes had an IRR of 2.36 (95% CI 2.10-2.66), in relation to controls, whereas the corresponding value for men < 55 years old with type 2 diabetes was IRR 1.78 (95% CI 1.67-1.90). In the fully adjusted Cox regression, the risk of type 2 diabetes on incident atrial fibrillation was 28% greater vs controls, hazard ratio (HR) 1.28 (95% CI 1.26-1.30), p < 0.0001. The excess risk of atrial fibrillation in individuals with type 2 diabetes increased with worsening glycaemic control and renal complications. For individuals with HbA1c ≤ 6.9% (≤ 52 mmol/mol) and normoalbuminuria the excess risk vs controls was still increased, adjusted HR 1.16 (95% CI 1.14-1.19); p < 0.0001. Conclusions:Individuals with type 2 diabetes had an overall 35% higher risk of atrial fibrillation compared to ageand sex-matched controls from the general population. The excess risk for atrial fibrillation increased with renal complications or with poor glycaemic control. Individuals with type 2 diabetes with good glycaemic control and normoalbuminuria had slightly increased risk.

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Section: Discussionmentioning

confidence: 99%

Risk of atrial fibrillation in persons with type 2 diabetes and the excess risk in relation to glycaemic control and renal function: a Swedish cohort study

Ahmadi

Svensson

Pivodic

et al. 2020

Cardiovasc Diabetol

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“…Interestingly, DM has been reported to be associated with not only arrhythmogenesis such as the incidence of AF but also with the risk of heart failure 37,38) . Thus, DM has a close association with arrhythmia and heart failure.…”

Section: Possibility Of Sglt-2 Inhibitors That Reduce P-wave Indicesmentioning

confidence: 99%

The Effect of Dapagliflozin Treatment on Epicardial Adipose Tissue Volume and P-Wave Indices: An Ad-hoc Analysis of The Previous Randomized Clinical Trial

Sato

Aizawa

Yuasa

et al. 2020

JAT

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Aim: Epicardial adipose tissue (EAT) may be associated with arrhythmogenesis. P-wave indices such as P-wave dispersion and P-wave variation indicated a slowed conduction velocity within the atria. This study investigated the effect of dapagliflozin on EAT volume and P-wave indices.Methods: In the present ad hoc analysis, 35 patients with type 2 diabetes mellitus and coronary artery disease were classified into dapagliflozin group (n 18) and conventional treatment group (n 17). At baseline, EAT volume, HbA1c and plasma level of tumor necrotic factor-(TNF-) levels, echocardiography, and 12-lead electrocardiogram (ECG) were performed. EAT volume was measured using computed tomography. Using 12-lead ECG, P-wave indices were measured. dapagliflozin group only (-9.2 8.7 vs. 5.9 19.9 ms, p 0.01; -3.5 3.5 vs. 1.7 5.9 ms, p 0.01). The change in P-wave dispersion correlated with changes in EAT volume and plasma level of TNF-. In multivariate analysis, the change in EAT volume was an independent determinant of the change in P-wave dispersion. Conclusion: Dapagliflozin reduced plasma level of TNF-, EAT volume, and P-wave indices, such as P-wave dispersion. The changes in P-wave indices were especially associated with changes in EAT volume. The number and date of registration: UMIN000035660, 24/Jan/2019 Results: At baseline, EAT volumes in the dapagliflozin and conventional treatment groups were 113 20 and 110 27 cm 3 , respectively. Not only HbA1c and plasma level of TNF-but also echocardiography findings including left atrial dimension and P-wave indices were comparable between the two groups. After 6 months, plasma level of TNFas well as EAT volume significantly decreased in the dapagliflozin group only. P-wave dispersion and P-wave variation significantly decreased in the

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“…Atrial fibrillation (AF) represents the most frequent arrhythmia affecting the general population with a progressive increase in prevalence with increasing age of > 10% in the population > 80 years of age [1,2]. The prevalence of AF is higher in patients with preexisting cardiovascular disease [3] and/or diabetes mellitus [4], or chronic kidney disease (CKD) [5]. In most patients, the therapeutic approach consists of the administration of an oral anti coagulant aimed at preventing the most feared complications of AF, represented by systemic thromboembolism and ischemic stroke [6].…”

Section: Introductionmentioning

confidence: 99%

Adverse Drug Reactions during Real-Life Use of Direct Oral Anticoagulants in Italy: An Update Based on Data from the Italian National Pharmacovigilance Network

et al. 2020

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Background: The availability of direct oral anticoagulants (DOAC) in clinical practice has transformed the health care provided to patients for the prevention and treatment of thromboembolism. Safety and efficacy data guide clinicians in the choice of the drug used. To date, no evidence is available from head-to-head trials comparing different DOAC with regard to safety and efficacy; information is mainly derived from several meta-analyses and real-life studies. Conclusions from these studies are inconsistent and unsatisfactory. The evaluation of self-reported adverse drug reactions (ADR) available from databases of drug-regulatory agencies such as the Italian Medicines Agency (AIFA) pharmacovigilance database represents a novel aid to guide decision-making. Objective: To analyze potential suspected ADR of DOAC using a previously described risk index (RI) in daily clinical practice in Italy. Methods: The National Pharmacovigilance Network database (from the AIFA website) was searched in order to retrieve information on all ADR related to oral anticoagulants occurring from 2013 to 2018. The ADR RI for each drug was calculated, where an RI = 1 indicates a balance between the percentage of ADR share and the percentage of market share for each DOAC; and an RI < 1 indicates a rate of ADR lower than the rate of market share (safer DOAC). The following DOAC molecules were considered: dabigatran, rivaroxaban, apixaban, and edoxaban. Results: The results showed that rivaroxaban is the DOAC with the lowest RI among the 4 molecules available today in Italy. Conclusions: Based on the RI, we identified rivaroxaban as the DOAC having the best safety profile.The studies analyzed meet the requirements regulatory authorities (e.g., EMA) usually demand of pharmaceutical companies for primary endpoint completion (e.g., assessment of drug safety).

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Atrial fibrillation and type 2 diabetes: Prevalence, etiology, pathophysiology and effect of anti‐diabetic therapies

Cited by 111 publications

References 86 publications

Risk of atrial fibrillation in persons with type 2 diabetes and the excess risk in relation to glycaemic control and renal function: a Swedish cohort study

Risk of atrial fibrillation in persons with type 2 diabetes and the excess risk in relation to glycaemic control and renal function: a Swedish cohort study

The Effect of Dapagliflozin Treatment on Epicardial Adipose Tissue Volume and P-Wave Indices: An Ad-hoc Analysis of The Previous Randomized Clinical Trial

Adverse Drug Reactions during Real-Life Use of Direct Oral Anticoagulants in Italy: An Update Based on Data from the Italian National Pharmacovigilance Network

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