Reevaluation of risk factors for time to subsequent events after first stroke occurrence using a new weighted all-cause effect measure

Abstract Background : Risk factors for stroke include atrial fibrillation, hypertension, diabetes mellitus, smoking, and high cholesterol. However, the role of these factors on subsequent cardiovascular events or death is less clear due to therapeutic measures. We therefore aim to get insights into the persistence of known risk factors on subsequent stroke or death one year after the first stroke and to illustrate how the new weighted all-cause hazard ratio can ease the interpretation of competing time-to-event endpoints with different clinical relevance. Methods : This study evaluates the one year follow-up of 470 first ever stroke cases identified in the area of Ludwigshafen, Germany, with 23 deaths and 34 subsequent stroke events. The recently introduced weighted all-cause hazard ratio was used which allows a weighting of the competing endpoints in a composite endpoint. We extended this approach to allow adjustment for covariates. The investigated risk factors were atrial fibrillation, hypertension, diabetes mellitus, smoking, and hypercholesterolemia adjusting for age and sex. Results : None of these meanwhile treated risk factors of which some have been modified after first stroke remained to be associated with subsequent death or stroke. Cause-specific effects point sometimes into opposite directions. Conclusions : Using the new weighted hazard ratio, we can support that well established risk factors for the occurrence of an index stroke are no good predictors of further disease progress defined by death or recurrent stroke. It has been demonstrated that the new weighted hazard ratio provides interpretation advantages over the common all-cause hazard ratio.

Download Full-text

Reevaluation of risk factors for time to subsequent events after first stroke occurrence using a new weighted all-cause effect measure

10.21203/rs.2.19014/v3 ◽

2020 ◽

Author(s):

Ann-Kathrin Ozga ◽

Bernhard Rauch ◽

Frederick Palm ◽

Christian Urbanek ◽

Armin Grau ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Atrial Fibrillation ◽

Recurrent Stroke ◽

Treatment Options ◽

Composite Endpoint ◽

Hazard Ratio ◽

Variable Degree ◽

One Year ◽

The Impact

Abstract Background: Risk diseases and risk factors for stroke include atrial fibrillation, hypertension, diabetes mellitus, smoking, and elevated LDL-cholesterol. Due to modern treatment options, the impact of these risk diseases on subsequent cardiovascular events or death after a first stroke is less clear and needs to be elucidated. We therefore aimed to get insights into the persistence of adverse prognostic effects of these risk diseases and risk factors on subsequent stroke or death events one year after the first stroke by using the new weighted all-cause hazard ratio.Methods: This study evaluates the one year follow-up of 470 first ever stroke cases identified in the area of Ludwigshafen, Germany, with 23 deaths and 34 subsequent stroke events. For this purpose, the recently introduced “weighted all-cause hazard ratio” was used, which allows a weighting of the competing endpoints within a composite endpoint. Moreover, we extended this approach to allow an adjustment for covariates. Results: None of these risk factors and risk diseases, most probably being treated after the first stroke, remained to be associated with a subsequent death or stroke [weighted hazard ratios (95% confidence interval) for diabetes mellitus, atrial fibrillation, high cholesterol, hypertension, and smoking are 0.4 (0.2 - 0.9), 0.8 (0.4 - 2.2), 1.3 (0.5 - 2.5), 1.2 (0.3 - 2.7), 1.6 (0.8 - 3.6), respectively]. However, when analyzed separately in terms of death and stroke, the risk factors and risk diseases under investigation affect the subsequent event rate to a variable degree.Conclusions: Using the new weighted hazard ratio, established risk factors and risk diseases for the occurrence of a first stroke do not remain to be significant predictors for subsequent events like death or recurrent stroke. It has been demonstrated that the new weighted hazard ratio can be used for a more adequate analysis of cardiovascular risk and disease progress. The results have to be confirmed within a larger study with more events.

Download Full-text

Reevaluation of risk factors for time to subsequent events after first stroke occurrence using a new weighted all-cause effect measure

10.21203/rs.2.19014/v2 ◽

2020 ◽

Author(s):

Ann-Kathrin Ozga ◽

Bernhard Rauch ◽

Frederick Palm ◽

Christian Urbanek ◽

Armin Grau ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Atrial Fibrillation ◽

Recurrent Stroke ◽

Composite Endpoint ◽

Hazard Ratio ◽

Diabetic Patients ◽

High Cholesterol ◽

Disease Progress ◽

One Year

Abstract Background : Risk factors for stroke include atrial fibrillation, hypertension, diabetes mellitus, smoking, and high cholesterol. However, the role of these factors on subsequent cardiovascular events or death is less clear due to therapeutic measures. We therefore aim to get insights into the persistence of known risk factors on subsequent stroke or death one year after the first stroke and to illustrate how the new weighted all-cause hazard ratio can ease the interpretation of competing time-to-event endpoints with different clinical relevance. Methods : This study evaluates the one year follow-up of 470 first ever stroke cases identified in the area of Ludwigshafen, Germany, with 23 deaths and 34 subsequent stroke events. The recently introduced weighted all-cause hazard ratio was used which allows a weighting of the competing endpoints in a composite endpoint. We extended this approach to allow adjustment for covariates. The investigated risk factors were those listed above. Results : None of these risk factors, most probably being treated after the first stroke, remained to be associated with subsequent death or stroke [weighted hazard ratios (95% confidence interval) for diabetes mellitus, atrial fibrillation, high cholesterol, hypertension, and smoking are 0.4 (0.2, 0.9), 0.8 (0.4, 2.2), 1.3 (0.5, 2.5), 1.2 (0.3, 2.7), 1.6 (0.8, 3.6), respectively]. Cause-specific effects sometimes point into opposite directions. Conclusions : Using the new weighted hazard ratio, we can support that well established risk factors for the occurrence of an index stroke are no good predictors of further disease progress defined by death or recurrent stroke, e.g. in our study diabetic patients even showed a decreased risk for recurrent stroke. It has been demonstrated that the new weighted hazard ratio provides interpretation advantages over the common all-cause hazard ratio and can thus be used for a more adequate analysis of cardiovascular risk and disease progress. The results have to be confirmed within a larger study with more events.

Download Full-text

Reevaluation of risk factors for time to subsequent events after first stroke occurrence using a new weighted all-cause effect measure

10.21203/rs.2.19014/v4 ◽

2020 ◽

Author(s):

Ann-Kathrin Ozga ◽

Bernhard Rauch ◽

Frederick Palm ◽

Christian Urbanek ◽

Armin Grau ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Atrial Fibrillation ◽

Recurrent Stroke ◽

Treatment Options ◽

Composite Endpoint ◽

Hazard Ratio ◽

Variable Degree ◽

One Year ◽

The Impact

Download Full-text

Abstract P699: Trends in Ischemic Stroke Risk Factors and Outcomes in a Rural Population in the United States

Stroke ◽

10.1161/str.52.suppl_1.p699 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Durgesh Chaudhary ◽

Ayesha Khan ◽

Shima Shahjouei ◽

Mudit Gupta ◽

Clare Lambert ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Rural Population ◽

The United States ◽

Stroke Recurrence ◽

Stroke Mortality ◽

One Year ◽

The One

Introduction: The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the trends in stroke risk factors and outcomes among a rural population in the United States between 2004 and 2018. Methods: We built a comprehensive stroke database called “Geisinger NeuroScience Ischemic Stroke (GNSIS)” for this study. Clinical data were extracted from multiple sources, including electronic health records and quality data. Results: Our cohort comprised of 8,561 consecutive ischemic stroke patients (mean age: 70.1±13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The rate of hypertension, diabetes, dyslipidemia, and history of stroke increased significantly over the fifteen years window. The one-year recurrence and mortality rates were 6.3% and 15.8%, respectively. Although the one-year stroke recurrence increased from 2004 to 2018 (Cochran-Armitage test Z = -3.66, p<0.001), the one-year stroke mortality rate decreased significantly (Cochran-Armitage test Z = 2.39, p=0.008). Age >65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Fine-Gray competing risk model, diabetes mellitus and age <65 years was found to be associated with one-year ischemic stroke recurrence. In the logistic regression, chronic kidney disease (CKD), diabetes, and prior ischemic stroke were predictors of one-year recurrence while age >65 years, atrial fibrillation or flutter, CKD, heart failure, prior hemorrhagic and ischemic stroke, history of neoplasm, myocardial infarction, and rheumatic diseases were predictors of one-year mortality. Conclusion: Although stroke mortality has decreased, stroke recurrence and several vascular risk factors have significantly increased in our rural population between 2004-2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes mellitus and age less than 65 years were predictors of ischemic stroke recurrence.

Download Full-text

Experiences With Intravenous Thrombolysis in Acute Ischemic Stroke by Elderly Patients–A “Real World Scenario”

Frontiers in Neurology ◽

10.3389/fneur.2021.721337 ◽

2021 ◽

Vol 12 ◽

Author(s):

Máté Héja ◽

István Fekete ◽

László Horváth ◽

Sándor Márton ◽

Klára Edit Fekete

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Elderly Patients ◽

Intravenous Thrombolysis ◽

Stroke Severity ◽

Complication Rates ◽

Symptomatic Intracerebral Hemorrhage ◽

Intravenous Alteplase ◽

One Year ◽

The One

Objectives: This retrospective single-center study aimed to investigate the risk factors, outcomes and complication rates in patients older vs. younger than 80 years treated with intravenous alteplase.Methods: Data of 1,253 thrombolysed patients were analyzed between January 1, 2004 and August 31, 2016. Vascular risk factors, stroke severity based on the NIHSS score, functional outcome using modified Rankin Scale (mRS), mortality and symptomatic intracerebral hemorrhage (SICH) were compared between two subgroups (<80 and ≥80 years).Results: 1,125 patients were included, 199 (17.6%) among them were aged over 80 years, majority (63.3%) were female (p < 0.00001). Mean age was 68.2 ± 12.4 years, i.e., 64.7 ± 10.8 years and 84.3 ± 3.4 years in the younger and the older groups, respectively (p < 0.001). Atrial fibrillation and pre-stroke anticoagulation among patients over 80 years was more likely (p < 0.0005 and p = 0.02, respectively). NIHSS scores on admission and at 24 h were higher in elderly patients (p < 0.0001). ASPECT score at 24 h was less favorable in elderly patients (p = 0.007) and was associated with worse outcome. At 3 months, 59.8% of the patients from the older group had an unfavorable outcome (p < 0.0001), however 34.7% had independent outcome. The one-year- survival was significantly worse in the older group (p < 0.0001). The incidence of SICH was lower among older patients. In a logistic regression model, atrial fibrillation, heart failure, diabetes mellitus and smoking were proven as a significant independent risk factors for worse outcome.Conclusion: Although, the outcomes were less favorable in patients over 80 years of age, our results support the feasibility of using intravenous thrombolysis among patients over 80 years of age.

Download Full-text

RISK FACTORS IN PATIENTS WITH ISCHEMIC STROKE ACCORDING TO THE HOSPITAL REGISTRY IN NALCHIK

Ulyanovsk Medico-biological Journal ◽

10.34014/2227-1848-2019-2-34-41 ◽

2019 ◽

pp. 34-41

Author(s):

A.A. Bykova ◽

V.M. Alifirova ◽

N.G. Brazovskaya

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Arterial Hypertension ◽

Mortality Risk ◽

Recurrent Stroke ◽

Clinical Hospital ◽

Hospital Registry ◽

The City

The problem of stroke is currently one of the most urgent both in our country and abroad. Every year more than 6 million people are down with stroke worldwide. In the United States stroke is the third leading cause of mortality, in Europe it is the second, and in Russia – the first. In Russia, 450 000 patients are diagnosed with stroke annually. The prevalence of this disease among able-bodied people under 65 increases the cost of the health care budget [1–3]. Currently, ischemic strokes (IS) prevail, their proportion is 80 %. In 2 % of patients, a recurrent stroke develops by the end of the first year after the previous one, in 30 % of patients it happens by the end of the fifth year. In case of a recurrent stroke, the mortality rate increases by 1.5 times. The main task is stroke prevention in order to reduce morbidity, mortality and disability [4]. The purpose of the paper is to study IS risk factors (RF), their frequency, contribution to the disease development and prediction of outcomes of acute cerebrovascular events. Materials and Methods. The authors studied the prevalence of risk factors in 696 patients. They used the hospital registry in the patient cohort in the Kabardino-Balkar Republic (KBR), the city of Nalchik, during 2016–2017. They analyzed the data from the current registration of IS over the period of two years in patients over 25 years of age, hospitalized to the primary vascular department of the City clinical hospital No. 1 and the Regional Vascular Center of the Republican Clinical Hospital. In general, the authors analyzed 696 cases of ischemic stroke in patients over 25 years of age, and created an electronic data bank. Results. By means of hospital registry method the most significant risk factors for ischemic stroke were identified in the studied patient cohort. Their effect on the lethal outcome was determined. Conclusions. The authors identified the risk factors that increased the mortality risk. These are chronic heart failure, atrial fibrillation, asequence, cardiac arrhythmias, diabetes mellitus, and dyslipidemia. Smoking, arterial hypertension, angina pectoris alone do not affect the mortality risk. Keywords: ischemic stroke, risk factors, atrial fibrillation, arterial hypertension, diabetes mellitus. Проблема инсульта в настоящее время является одной из приоритетных как у нас в стране, так и во всем мире. Ежегодно в мире инсультом заболевает более 6 млн чел. Церебральный инсульт в США является третьей по частоте причиной смерти, в Европе – второй, в России – первой. В России инсульт случается у 450 тыс. пациентов в год. Распространенность этого заболевания среди лиц трудоспособного возраста до 65 лет повышает затраты бюджета здравоохранения [1–3]. Преобладают ишемические инсульты (ИИ), доля которых составляет 80 %. У 2 % пациентов повторный инсульт развивается к концу первого года с момента инсульта, у 30 % – к концу пятого. При повторном инсульте отмечается повышение показателя смертности в 1,5 раза. Основополагающей задачей является профилактика инсульта в целях снижения заболеваемости, смертности и инвалидизации [4]. Цель исследования – изучить частоту встречаемости факторов риска (ФР) ИИ, их вклад в развитие заболевания и прогнозирование исходов острых нарушений мозгового кровообращения. Материалы и методы. Изучена распространенность факторов риска у 696 пациентов по данным госпитального регистра в когорте больных по Кабардино-Балкарской Республике (КБР) на примере г. Нальчик за период 2016–2017 гг. Использованы данные, полученные при текущей регистрации случаев ИИ на протяжении двух лет у лиц старше 25 лет, госпитализированных в первичное сосудистое отделение городской клинической больницы № 1 и Региональный сосудистый центр Республиканской клинической больницы. Проанализировано 696 случаев ИИ у лиц старше 25 лет, создан электронный банк данных. Результаты. В исследуемой когорте больных методом госпитального регистра определены наиболее значимые факторы риска ишемического инсульта. Определено их влияние на развитие смертельного исхода. Выводы. Были выявлены факторы риска, которые повышают риск развития смертельного исхода. Такими являются хроническая сердечная недостаточность, фибрилляция предсердий, нарушения проводимости и нарушения сердечного ритма, сахарный диабет, дислипидемия. Курение, артериальная гипертония, стенокардия изолированно не оказывают влияния на риск развития смертельного исхода. Ключевые слова: ишемический инсульт, факторы риска, фибрилляция предсердий, артериальная гипертония, сахарный диабет.

Download Full-text

Prevalence and prognostic impact of left ventricular systolic dysfunction after acute myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.1796 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T.J Jernberg ◽

E.O Omerovic ◽

E.H Hamilton ◽

K.L Lindmark ◽

L.D Desta ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Myocardial Infarction ◽

Atrial Fibrillation ◽

Risk Factor ◽

Reperfusion Therapy ◽

Left Ventricular ◽

Funding Source ◽

Additional Risk Factor ◽

Additional Risk

Abstract Background Left ventricular dysfunction after an acute myocardial infarction (MI) is associated with poor outcome. The PARADISE-MI trial is examining whether an angiotensin receptor-neprilysin inhibitor reduces the risk of cardiovascular death or worsening heart failure (HF) in this population. The aim of this study was to examine the prevalence and prognosis of different subsets of post-MI patients in a real-world setting. Additionally, the prognostic importance of some common risk factors used as risk enrichment criteria in the PARADISE-MI trial were specifically examined. Methods In a nationwide myocardial infarction registry (SWEDEHEART), including 87 177 patients with type 1 MI between 2011–2018, 3 subsets of patients were identified in the overall MI cohort (where patients with previous HF were excluded); population 1 (n=27 568 (32%)) with signs of acute HF or an ejection fraction (EF) <50%, population 2 (n=13 038 (15%)) with signs of acute HF or an EF <40%, and population 3 (PARADISE-MI like) (n=11 175 (13%)) with signs of acute HF or an EF <40% and at least one risk factor (Age ≥70, eGFR <60, diabetes mellitus, prior MI, atrial fibrillation, EF <30%, Killip III-IV and STEMI without reperfusion therapy). Results When all MIs, population 1 (HF or EF <50%), 2 (HF or EF <40%) and 3 (HF or EF <40% + additional risk factor (PARADISE-MI like)) were compared, the median (IQR) age increased from 70 (61–79) to 77 (70–84). Also, the proportion of diabetes (22% to 33%), STEMI (38% to 50%), atrial fibrillation (10% to 24%) and Killip-class >2 (1% to 7%) increased. After 3 years of follow-up, the cumulative probability of death or readmission because of heart failure in the overall MI population and in population 1 to 3 was 17.4%, 26.9%, 37.6% and 41.8%, respectively. In population 2, all risk factors were independently associated with death or readmission because of HF (Age ≥70 (HR (95% CI): 1.80 (1.66–1.95)), eGFR <60 (1.62 (1.52–1.74)), diabetes mellitus (1.35 (1.26–1.44)), prior MI (1.16 (1.07–1.25)), atrial fibrillation (1.35 (1.26–1.45)), EF <30% (1.69 (1.58–1.81)), Killip III-IV (1.34 (1.19–1.51)) and STEMI without reperfusion therapy (1.34 (1.21–1.48))) in a multivariable Cox regression analysis. The risk increased with increasing number of risk factors (Figure 1). Conclusion Depending on definition, post MI HF is present in 13–32% of all MI patients and is associated with a high risk of subsequent death or readmission because of HF. The risk increases significantly with every additional risk factor. There is a need to optimize management and improve outcomes for this high risk population. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Novartis

Download Full-text

Impact of atrial fibrillation pattern on outcomes after left atrial appendage closure: lessons from the prospective LAARGE registry

Clinical Research in Cardiology ◽

10.1007/s00392-021-01874-3 ◽

2021 ◽

Author(s):

Shinwan Kany ◽

Johannes Brachmann ◽

Thorsten Lewalter ◽

Ibrahim Akin ◽

Horst Sievert ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial Appendage ◽

Systemic Embolism ◽

Long Term Outcomes ◽

Increased Risk ◽

History Of ◽

One Year ◽

The One

Abstract Background Non-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death. Methods Comparison of procedural details and long-term outcomes in patients (pts) with paroxysmal AF (PAF) against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC (LAARGE). Results A total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The total CHA2DS2-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), while HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was comparable. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77). In the three-month echo follow-up, LA thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak > 5 mm (0.0% vs 7.1%, p = 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA2DS2-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95% CI 1.02–2.72, p = 0.041). Conclusion Atrial fibrillation type did not impair periprocedural safety or in-hospital MACE patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality. Graphic abstract

Download Full-text

Association of proteinuria and incident atrial fibrillation in patients with diabetes mellitus: a population-based senior cohort study

Scientific Reports ◽

10.1038/s41598-021-96483-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Juntae Kim ◽

Pil-Sung Yang ◽

Byoung-Eun Park ◽

Tae Soo Kang ◽

Seong-Hoon Lim ◽

...

Keyword(s):

Diabetes Mellitus ◽

Atrial Fibrillation ◽

Confidence Interval ◽

Population Based ◽

Hazard Ratio ◽

Diabetic Patients ◽

Dependent Manner ◽

Dipstick Test ◽

Patients With Diabetes ◽

Urine Dipstick Test

AbstractDiabetes mellitus (DM) is considered an independent risk factor for atrial fibrillation (AF). The excess risk in relation to the presence of proteinuria has not been well elucidated. Our aim was to determine the association between the incidence of AF and proteinuria in diabetic population. A total of 240,499 individuals aged ≥ 60 years from the Korea National Health Insurance Service-Senior cohort from 2004 to 2014 were included. 4.2% of individuals with DM and 3.7% of controls were diagnosed with AF during a median follow-up period of 7.2 years. Amongst controls (participants without proteinuria and DM), DM only, proteinuria only, and DM with proteinuria groups, the crude incidences of AF were 0.58, 0.70, 0.96, 1.24 per 100 person-years respectively. Compared with controls, the weighted risk of AF was increased by 11% (hazard ratio = 1.11, 95% confidence interval = 1.02–1.20, P = .001), 48% (hazard ratio = 1.48, 95% confidence interval = 1.30–1.69, P < .001), and 66% (hazard ratio = 1.66, 95% confidence interval = 1.26–2.18, P < .001) in the DM only, proteinuria only, and DM with proteinuria groups, respectively (P for trend < .001). Degree of proteinuria in diabetic patients was associated with a significantly higher rate of incident AF in dose dependent manner. Thus, assessing proteinuria by a simple urine dipstick test could provide a useful adjunct to risk assessment for AF in elderly population with DM.

Download Full-text

Mechanism of and Therapeutic Strategy for Atrial Fibrillation Associated with Diabetes Mellitus

The Scientific World JOURNAL ◽

10.1155/2013/209428 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 18

Author(s):

Yubi Lin ◽

Hairui Li ◽

Xianwu Lan ◽

Xianghui Chen ◽

Aidong Zhang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Atrial Fibrillation ◽

Catheter Ablation ◽

Sinus Rhythm ◽

Renin Angiotensin System ◽

Hypoglycemic Agents ◽

Angiotensin System ◽

Low Levels ◽

Upstream Therapy

Diabetes mellitus (DM) is one of the most important risk factors for atrial fibrillation (AF) and is a predictor of stroke and thromboembolism. DM may increase the incidence of AF, and when it is combined with other risk factors, the incidence of stroke and thromboembolism may also be higher; furthermore, hospitalization due to heart failure appears to increase. Maintenance of well-controlled blood glucose and low levels of HbA1c in accordance with guidelines may decrease the incidence of AF. The mechanisms of AF associated with DM are autonomic remodeling, electrical remodeling, structural remodeling, and insulin resistance. Inhibition of the renin-angiotensin system is suggested to be an upstream therapy for this type of AF. Studies have indicated that catheter ablation may be effective for AF associated with DM, restoring sinus rhythm and improving prognosis. Catheter ablation combined with hypoglycemic agents may further increase the rate of maintenance of sinus rhythm and reduce the need for reablation.

Download Full-text