The imminent epidemic of atrial fibrillation and its concomitant diseases – Myocardial infarction and heart failure - A cause for concern

Abstract

Atrial fibrillation (AF) is increasingly common in the general population. It often coincides with myocardial infarction (MI) and heart failure (HF) which are also diseases in older adults. All three conditions share common cardiovascular risk factors. While hypertension and obesity are central risk factors for all three diseases, smoking and diabetes appear to have less impact on AF. To date, age is the single most important risk factor for AF in the general population. Further, epidemiological studies suggest a strong association of AF to MI and HF. The underlying pathophysiological mechanisms are complex and not fully understood. Both MI and HF can trigger development of AF, mainly by promoting structural and electrical atrial remodeling. On the other hand, AF facilitates HF and MI development via multiple mechanisms, resulting in a vicious circle of cardiac impairment and adverse cardiovascular prognosis. Consequently, to prevent and treat the coincidence of AF and HF or MI a strict optimization of cardiovascular risk factors is required.

Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge

“…Borschel and Schnabel 4 have recently raised concerns about the imminent epidemic of AF. 4 Age is the most important risk factor for AF in the general population and it is expected to continuously increase both in incidence and prevalence as a consequence of continuous increase of life expectancy worldwide and improvements in handling acute cardiac conditions. 12 Our results confirm that worldwide incidence and prevalence of AF show an increasing trend, which can be even sharper than expected in previous reports.…”

“…1 It has been estimated that 6–12 million people worldwide will suffer this condition in the US by 2050 and 17.9 million people in Europe by 2060. 2,3 AF shares strong epidemiological associations with other conditions such as heart valve disease, diabetes mellitus, arterial hypertension, and overweight/obesity, 4 as well as with metabolic syndrome and its components sleep apnea and inflammation. 5 Genetic factors can also be involved, 6 and more recent data have focused on modifiable lifestyle factors such as alcohol consumption and physical exercise.…”

Vascular disease in patients with atrial fibrillation. A report from Polish participants in the EORP‐AF General Long‐Term Registry

“…Of note, HF and diabetes mellitus were independent predictors of MAE amongst patients with VD. This close association with HF and previous history of clinically evident atherosclerotic disease (diabetes mellitus) for both occurrence of VD and MAE amongst AF patients, reemphasises that all these factors may be intimately related, perhaps also from a pathophysiological perspective 17 …”

Risk of Coronary Events in Atrial Fibrillation

“…Большое число случаев сочетания ФП и ИБС может быть следствием общности ФР развития указанных состояний [9].…”

“…В то же время эмболические и геморрагические осложнения приводили лишь к 5,7 и 5,6 % смертей соответственно [8]. Очевидно, что профилактика коронарных событий в популяции больных с ФП требует детального изучения и обсуждения [9].…”