Atrial fibrillation in diabetes: A cause for concern?

Abstract

Atrial fibrillation (AF) is one of the most common cardiac arrhythmias and is associated with significant morbidity and mortality. It is becoming increasingly evident diabetes is a significant risk factor for the development of AF. The reason for this link is not clearly understood, however it is clear that other co-morbid diseases associated with diabetes such as hypertension and obesity may be implicated or there may be direct arrthymogenic affects of glucose dysregulation on the myocardium. The development of AF in patients with diabetes may be an ominous sign given the increased risk of death from cardiovascular disease and we propose this is an under researched area where treatments may bring benefits over and above those patients without diabetes in terms of morbidity or death from cardiovascular disease.

Share and Cite:

R. Szwejkowski, B. , Rekhraj, S. , D. Morris, A. and D. Struthers, A. (2012) Atrial fibrillation in diabetes: A cause for concern?. Journal of Diabetes Mellitus, 2, 378-385. doi: 10.4236/jdm.2012.24059.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Lloyd-Jones, D.M., Wang, T.J., Leip, E.P., Larson, M.G., Levy, D., Vasan, R.S., et al. (2004) Lifetime risk for development of atrial fibrillation: The Framingham Heart Study. Circulation, 110, 1042-1046. doi:10.1161/01.CIR.0000140263.20897.42
[2] Stewart, S., Murphy, N.F., Walker, A., McGuire, A. and McMurray, J.J. (2004) Cost of an emerging epidemic: An economic analysis of atrial fibrillation in the UK. Heart, 90, 286-292. doi:10.1136/hrt.2002.008748
[3] Benjamin, E., Wolf, P., D’Agostino, R., Silbershatz, H., Kannel, W. and Levy, D. (1998) Impact of atrial fibrillation on the risk of death: The Framingham Heart Study. Circulation, 98, 946-952. doi:10.1161/01.CIR.98.10.946
[4] Stewart, S., Hart, C.L., Hole, D.J. and McMurray, J.J. (2002) A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. American Journal of Medicine, 113, 359-364. doi:10.1016/S0002-9343(02)01236-6
[5] Sugishita, K., Shiono, E., Sugiyama, T. and Ashida, T. (2003) Diabetes influences the cardiac symptoms related to atrial fibrillation. Circulation Journal, 67, 835-888. doi:10.1253/circj.67.835
[6] Gage, B.F., van Walraven, C., Pearce, L., Hart, R.G., Koudstaal, P.J., Boode, B.S.P., et al. (2004) Selecting Patients With Atrial Fibrillation for Anticoagulation: Stroke Risk Stratification in Patients Taking Aspirin. Circulation, 110, 2287-2292.
[7] Gage, B.F., Waterman, A.D., Shannon, W., Boechler, M., Rich, M.W. and Radford, M.J. (2001) Validation of Clinical Classification Schemes for Predicting Stroke: Results From the National Registry of Atrial Fibrillation. Journal of the American Medicine Association, 285, 2864-2870.
[8] Wilhelmsen, L., Rosengren, A. and Lappas, G. (2001) Hospitalizations for atrial fibrillation in the general male population: Morbidity and risk factors. Journal of Internal Medicine, 250, 382-389. doi:10.1046/j.1365-2796.2001.00902.x
[9] Movahed, M., Hashemzadeh, M. and Jamal, M. (2005) Diabetes mellitus is a strong, independent risk for atrial fibrillation and flutter in addition to other cardiovascular disease. International Journal of Cardiology, 105, 315-321. doi:10.1016/j.ijcard.2005.02.050
[10] Nichols, G.A., Reinier, K. and Chugh, S.S. (2009) Independent contribution of diabetes to increased prevalence and incidence of atrial fibrillation. Diabetes Care, 32, 1851-1856. doi:10.2337/dc09-0939
[11] Aksnes, T., Schmieder, R., Kjeldsen, S., Ghani, S., Hua, T. and Julius, S. (2008) Impact of New-Onset Diabetes Mellitus on Development of Atrial Fibrillation and Heart Failure in High-Risk Hypertension (from the VALUE Trial). American Journal of Cardiology, 101, 634-638. doi:10.1016/j.amjcard.2007.10.025
[12] Benjamin, E.J, Wolf, P.A., D’Agostino, R.B., Silbershatz, H., Kannel, W.B. and Levy, D. (1998) Impact of Atrial Fibrillation on the Risk of Death: The Framingham Heart Study. Circulation, 98, 946-952.
[13] Ostgren, C.J., Merlo, J., Rastam, L. and Lindblad, U. (2004) Atrial fibrillation and its association with type 2 diabetes and hypertension in a Swedish community. Diabetes, Obesity and Metabolism, 6, 367-374. doi:10.1111/j.1462-8902.2004.00358.x
[14] Psaty, B.M., Manolio, T.A., Kuller, L.H., Kronmal, R.A, Cushman, M., Fried, L.P., et al. (1997) Incidence of and risk factors for atrial fibrillation in older adults. Circulation, 96, 2455-2461. doi:10.1161/01.CIR.96.7.2455
[15] Johansen, O., Brustad, E., Enger, S. and Tveit, A. (2008) Prevalence of abnormal glucose metabolism in atrial fibrillation: A case control study in 75-year old subjects. Cardiovascular Diabetology, 7, 28. doi:10.1186/1475-2840-7-28
[16] Stritzke, J., Markus, M.R.P., Duderstadt, S., Lieb, W., Luchner, A., Doring, A., et al. (2009) The Aging Process of the Heart: Obesity Is the Main Risk Factor for Left Atrial Enlargement During Aging: The MONICA/KORA (Monitoring of Trends and Determinations in Cardiovascular Disease/Cooperative Research in the Region of Augsburg) Study. Journal of the American College of Cardiology, 54, 1982-1989. doi:10.1016/j.jacc.2009.07.034
[17] Wasada, T., Katsumori, K., Hasumi, S., Kasanuki, H., Arii, H., Saeki, A., et al. (1995) Association of sick sinus syndrome with hyperinsulinemia and insulin resistance in patients with non-insulin-dependent diabetes mellitus: Report of four cases. Internal Medicine, 34, 1174-1177. doi:10.2169/internalmedicine.34.1174
[18] Gandhi, G., Nuttall, G., Abel, M., Mullany, C., Schaff, H., Williams, B., et al. (2005) Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. Mayo Clinic Proceedings, 80, 862-866. doi:10.4065/80.7.862
[19] Lazar, H.L., Chipkin, S.R., Fitzgerald, C.A., Bao, Y., Cabral, H. and Apstein, C.S. (2004) Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. Circulation, 109, 1497-502. doi:10.1161/01.CIR.0000121747.71054.79
[20] Rutter, M.K., Parise, H., Benjamin, E.J., Levy, D., Larson, M.G., Meigs, J.B., et al. (2003) Impact of Glucose Intolerance and Insulin Resistance on Cardiac Structure and Function: Sex-Related Differences in the Framingham Heart Study. Circulation, 107, 448-454.
[21] Lind, L., Berne, C., Andren, B. and Lithell, H. (1996) Relationship between diastolic hypertension and myocardial morphology and function in elderly males with diabetes mellitus. Diabetologia, 39, 1603-1606. doi:10.1007/s001250050621
[22] Sundstrom, J., Lind, L., Nystrom, N., Zethelius, B., Andren, B., Hales, C.N., et al. (2000) Left Ventricular Concentric Remodeling Rather Than Left Ventricular Hypertrophy Is Related to the Insulin Resistance Syndrome in Elderly Men. Circulation, 101, 2595-2600.
[23] Palmieri, V., Bella, J.N., Arnett, D.K., Liu, J.E., Oberman, A., Schuck, M.-Y., et al. (2001) Effect of Type 2 Diabetes Mellitus on Left Ventricular Geometry and Systolic Function in Hypertensive Subjects: Hypertension Genetic Epidemiology Network (HyperGEN) Study. Circulation, 103, 102-107.
[24] Galvan, A.Q., Galetta, F., Natali, A., Muscelli, E., Sironi, A.M., Cini, G., et al. (2000) Insulin Resistance and Hyperinsulinemia: No Independent Relation to Left Ventricular Mass in Humans. Circulation, 102, 2233-2238.
[25] Uusitupa, M., Siitonen, O., Pyorala, K., Mustonen, J., Voutilainen, E., Hersio, K., et al. (1987) Relationship of blood pressure and left ventricular mass to serum insulin levels in newly diagnosed non-insulin-dependent (type 2) diabetic patients and in non-diabetic subjects. Diabetes Research, 4, 19-25.
[26] Verdecchia, P., Reboldi, G., Schillaci, G., Borgioni, C., Ciucci, A., Telera, M.P., et al. (1999) Circulating Insulin and Insulin Growth Factor-1 Are Independent Determinants of Left Ventricular Mass and Geometry in Essential Hypertension. Circulation, 100, 1802-1807.
[27] Young, M.E., McNulty, P. and Taegtmeyer, H. (2002) Adaptation and Maladaptation of the Heart in Diabetes: Part II: Potential Mechanisms. Circulation, 105, 1861-1870.
[28] Collier, A., Matthews, D.M., Young, R.J. and Clarke, B.F. (1987) Transient atrial fibrillation precipitated by hypoglycaemia: Two case reports. Postgraduate Medical Journal, 63, 895-897. doi:10.1136/pgmj.63.744.895
[29] Odeh, M., Oliven, A. and Bassan, H. (1990) Transient atrial fibrillation precipitated by hypoglycemia. Annals of Emergency Medicine, 19, 565-567. doi:10.1016/S0196-0644(05)82191-2
[30] Baxter, M.A., Garewal, C., Jordan, R., Wright, A.D. and Nattrass, M. (1990) Hypoglycaemia and atrial fibrillation. Postgraduate Medical Journal, 66, 981. doi:10.1136/pgmj.66.781.981
[31] Lip, G.Y. and Varughese, G.I. (2005) Diabetes mellitus and atrial fibrillation: Perspectives on epidemiological and pathophysiological links. International Journal of Cardiology 105, 319-321. doi:10.1016/j.ijcard.2005.03.003
[32] Pollock, G., Brady, W.J., Jr., Hargarten, S., DeSilvey, D. and Carner, C.T. (1996) Hypoglycemia manifested by sinus bradycardia: A report of three cases. Academic Emergency Medicine, 3, 700-707. doi:10.1111/j.1553-2712.1996.tb03495.x
[33] Gill, G.V., Woodward, A., Casson, I.F. and Weston, P.J. (2009) Cardiac arrhythmia and nocturnal hypoglycaemia in type 1 diabetes--the “dead in bed” syndrome revisited. Diabetologia, 52, 42-45. doi:10.1007/s00125-008-1177-7
[34] Marques, J.L., George, E., Peacey, S.R., Harris, N.D., Macdonald, I.A., Cochrane, T., et al. (1997) Altered ventricular repolarization during hypoglycaemia in patients with diabetes. Diabetic Medicine, 14, 648-654. doi:10.1002/(SICI)1096-9136(199708)14:8<648::AID-DIA418>3.0.CO;2-1
[35] Robinson, R.T., Harris, N.D., Ireland, R.H., Macdonald, I.A. and Heller, S.R. (2004) Changes in cardiac repolarization during clinical episodes of nocturnal hypoglycaemia in adults with Type 1 diabetes. Diabetologia, 47, 312-315. doi:10.1007/s00125-003-1292-4
[36] (1994) Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Archives of Internal Medicine, 154, 1449-1157. doi:10.1001/archinte.1994.00420130036007
[37] Laakso, M. (1999) Hyperglycemia and cardiovascular disease in type 2 diabetes. Diabetes, 48, 937-942.
[38] Jaffar, A.R. and Assad, M. (2003) Current concepts of cardiovascular diseases in diabetes mellitus. International Journal of Cardiology, 89, 123-134. doi:10.1016/S0167-5273(02)00510-7
[39] Nesto, R.W. (2004) Correlation between cardiovascular disease and diabetes mellitus: Current concepts. American Journal of Medicine, 116, 11S-22S.
[40] Kannel, W.B. (1985) Lipids, diabetes, and coronary heart disease: Insights from the Framingham Study. American Heart Journal, 110, 1100-1107. doi:10.1016/0002-8703(85)90224-8
[41] Milicevic, Z., Raz, I., Beattie, S.D., Campaigne, B.N., Sarwat, S., Gromniak, E., et al. (2008) Natural history of cardiovascular disease in patients with diabetes: Role of hyperglycemia. Diabetes Care, 31, S155-S160.
[42] Goraya, T.Y., Leibson, C.L., Palumbo, P.J., Weston, S.A., Killian, J.M., Pfeifer, E.A., et al. (2002) Coronary atherosclerosis in diabetes mellitus: a population-based autopsy study. Journal of the American College of Cardiology, 40, 946-953. doi:10.1016/S0735-1097(02)02065-X
[43] Hansson, L., Zanchetti, A., Carruthers S.G., Dahlof, B., Elmfeldt, D., Julius, S., et al. (1998) Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: Principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet, 351, 1755-1762. doi:10.1016/S0140-6736(98)04311-6
[44] Cushman, W.C., Evans, G.W., Byington, R.P., Goff, D.C., Jr., Grimm, R.H., Jr., Cutler, J.A., et al. (1575) Effects of intensive blood-pressure control in type 2 diabetes mellitus. The New England Journal of Medicine, 362, 1575-1585.
[45] L’Allier, P.L., Ducharme, A., Keller, P.F., Yu, H., Guertin, M.C. and Tardif, J.C. (2004) Angiotensin-converting enzyme inhibition in hypertensive patients is associated with a reduction in the occurrence of atrial fibrillation. Journal of the American College of Cardiology, 44, 159-164. doi:10.1016/j.jacc.2004.03.056
[46] Disertori, M., Latini, R., Barlera, S., Franzosi, M.G., Staszewsky, L., Maggioni, A.P., et al. (2009) Valsartan for prevention of recurrent atrial fibrillation. The New England Journal of Medicine, 360, 1606-1617. doi:10.1056/NEJMoa0805710
[47] Kalus, J.S., Coleman, C.I. and White, C.M. (2006) The impact of suppressing the renin-angiotensin system on atrial fibrillation. The Journal of Clinical Pharmacology, 46, 21-28. doi:10.1177/0091270005283284
[48] Anand, K., Mooss, A.N., Hee, T.T. and Mohiuddin, S.M. (2006) Meta-analysis: Inhibition of renin-angiotensin system prevents new-onset atrial fibrillation. American Heart Journal, 152, 217-222. doi:10.1016/j.ahj.2006.01.007
[49] Jibrini, M.B., Molnar, J. and Arora, R.R. (2008) Prevention of atrial fibrillation by way of abrogation of the renin-angiotensin system: A systematic review and meta- analysis. The American Journal of Therapeutics, 15, 36- 43. doi:10.1097/MJT.0b013e31804beb59
[50] Korantzopoulos, P., Kokkoris, S., Kountouris, E., Pro- topsaltis, I., Siogas, K. and Melidonis, A. (2008) Regression of paroxysmal atrial fibrillation associated with thiazolidinedione therapy. International Journal of Cardiology, 125, e51-e53. doi:10.1016/j.ijcard.2006.12.063
[51] Qayyum, R. and Adomaityte, J. (2006) Meta-analysis of the effect of thiazolidinediones on serum C-reactive protein levels. American Journal of Cardiology, 97, 655-658. doi:10.1016/j.amjcard.2005.09.105
[52] Da Ros, R., Assaloni, R. and Ceriello, A. (2004) The preventive anti-oxidant action of thiazolidinediones: A new therapeutic prospect in diabetes and insulin resistance. Diabetic Medicine, 21, 1249-1252. doi:10.1111/j.1464-5491.2004.01312.x

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.