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

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.

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

2019 ◽  
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 ◽  
Specific Effects ◽  
Index Stroke ◽  
One Year ◽  
The One

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.

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

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.

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

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.

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

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.

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

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.

scholarly journals When Uncontrolled Diabetes Mellitus and Severe COVID-19 Converge: The Perfect Storm for Mucormycosis

2021 ◽  
Vol 7 (4) ◽  
pp. 298
Author(s):  
Teny M. John ◽  
Ceena N. Jacob ◽  
Dimitrios P. Kontoyiannis
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Clinical Features ◽  
The Other ◽  
Diabetic Patients ◽  
Epidemiological Factors ◽  
Uncontrolled Diabetes ◽  
Diagnostic Certainty ◽  
Patients With Diabetes ◽  
Perfect Storm

Mucormycosis (MCR) has been increasingly described in patients with coronavirus disease 2019 (COVID-19) but the epidemiological factors, presentation, diagnostic certainty, and outcome of such patients are not well described. We review the published COVID-19-associated mucormycosis (CAMCR) cases (total 41) to identify risk factors, clinical features, and outcomes. CAMCR was typically seen in patients with diabetes mellitus (DM) (94%) especially the ones with poorly controlled DM (67%) and severe or critical COVID-19 (95%). Its presentation was typical of MCR seen in diabetic patients (mostly rhino-orbital and rhino-orbital-cerebral presentation). In sharp contrast to reported COVID-associated aspergillosis (CAPA) cases, nearly all CAMCR infections were proven (93%). Treating physicians should have a high suspicion for CAMCR in patients with uncontrolled diabetes mellitus and severe COVID-19 presenting with rhino-orbital or rhino-cerebral syndromes. CAMR is the convergence of two storms, one of DM and the other of COVID-19.

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

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) &lt;50%, population 2 (n=13 038 (15%)) with signs of acute HF or an EF &lt;40%, and population 3 (PARADISE-MI like) (n=11 175 (13%)) with signs of acute HF or an EF &lt;40% and at least one risk factor (Age ≥70, eGFR &lt;60, diabetes mellitus, prior MI, atrial fibrillation, EF &lt;30%, Killip III-IV and STEMI without reperfusion therapy). Results When all MIs, population 1 (HF or EF &lt;50%), 2 (HF or EF &lt;40%) and 3 (HF or EF &lt;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 &gt;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 &lt;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 &lt;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

scholarly journals Fermented pork fat (Sa-um) and lifestyle risk factors as potential indicators for type 2 diabetes among the Mizo population, Northeast India

2021 ◽  
Vol 40 (1) ◽  
Author(s):  
Freda Lalrohlui ◽  
Souvik Ghatak ◽  
John Zohmingthanga ◽  
Vanlal Hruaii ◽  
Nachimuthu Senthil Kumar
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cox Regression ◽  
Control Group ◽  
Diabetic Patients ◽  
Lifestyle Habits ◽  
Pork Fat

AbstractOver the last few decades, Mizoram has shown an increase in cases of type 2 diabetes mellitus; however, no in-depth scientific records are available to understand the occurrence of the disease. In this study, 500 patients and 500 healthy controls were recruited to understand the possible influence of their dietary and lifestyle habits in relation with type 2 diabetes mellitus. A multivariate analysis using Cox regression was carried out to find the influence of dietary and lifestyle factors, and an unpaired t test was performed to find the difference in the levels of biochemical tests. Out of 500 diabetic patients, 261 (52.3%) were males and 239 (47.7%) were females, and among the control group, 238 (47.7%) were males and 262 (52.3%) were females. Fermented pork fat, Sa-um (odds ratio (OR) 18.98), was observed to be a potential risk factor along with tuibur (OR 0.1243) for both males and females. Creatinine level was found to be differentially regulated between the male and female diabetic patients. This is the first report of fermented pork fat and tobacco (in a water form) to be the risk factors for diabetes. The unique traditional foods like Sa-um and local lifestyle habits like tuibur of the Mizo population may trigger the risk for the prevalence of the disease, and this may serve as a model to study other populations with similar traditional practices.

Prevalence of Toenail Onychomycosis in Patients with Type 2 Diabetes Mellitus and Evaluation of Risk Factors

2011 ◽  
Vol 101 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Aynur Gulcan ◽  
Erim Gulcan ◽  
Sukru Oksuz ◽  
Idris Sahin ◽  
Demet Kaya
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Fasting Blood Glucose ◽  
Diabetic Patients ◽  
Essential Components ◽  
Patients With Diabetes ◽  
Epidemiologic Risk

Background: We sought to determine the frequency of toenail onychomycosis in diabetic patients, to identify the causative agents, and to evaluate the epidemiologic risk factors. Methods: Data regarding patients’ diabetic characteristics were recorded by the attending internal medicine clinician. Clinical examinations of patients’ toenails were performed by a dermatologist, and specimens were collected from the nails to establish the onycomycotic abnormality. All of the specimens were analyzed by direct microscopy and culture. Results: Of 321 patients with type 2 diabetes mellitus, clinical onychomycosis was diagnosed in 162; 41 of those diagnoses were confirmed mycologically. Of the isolated fungi, 23 were yeasts and 18 were dermatophytes. Significant correlations were found between the frequency of onychomycosis and retinopathy, neuropathy, obesity, family history, and duration of diabetes. However, no correlation was found with sex, age, educational level, occupation, area of residence, levels of hemoglobin A1c and fasting blood glucose, and nephropathy. The most frequently isolated agents from clinical specimens were yeasts. Conclusions: Long-term control of glycemia to prevent chronic complications and obesity and to promote education about the importance of foot and nail care should be essential components in preventing onychomycosis and its potential complications, such as secondary foot lesions, in patients with diabetes mellitus. (J Am Podiatr Med Assoc 101(1): 49–54, 2011)

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

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
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.

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