Atrial fibrillation and prediabetes: A liaison that merits attention!

Abstract

Atrial fibrillation (AF) and prediabetes share common pathophysiological mechanisms with endothelial dysfunction and inflammation playing a key role. The resultant vicious cycle which sets in culminates in a higher atherogenicity and thermogenicity of the vascular system resulting in increased major adverse cardiac or cerebrovascular event (MACCE) events. However, the same has not convincingly been verified in real-world settings. In the recent retrospective study by Desai et al amongst AF patients being admitted to hospitals following MACCE, prediabetes emerged as an independent risk factor for MACCE after adjusting for all confounding variables. However, certain questions like the role of metformin, quantifying the risk for MACCE amongst prediabetes compared to diabetes, the positive impact of reversion to normoglycemia remain unanswered. We provide our insights and give future directions for dedicated research in this area to clarify the exact relationship between the two.

Keywords: Atrial fibrillation; Major adverse cardiac or cerebrovascular event; Pre-diabetes; Diabetes; Stroke; Heart failure; Dysglycemia; Metformin

Core Tip: Atrial fibrillation (AF) and prediabetes share common pathophysiological mechanisms with endothelial dysfunction and inflammation playing a key role. A vicious cycle is thus set up culminating in higher atherogenicity and thermogenicity of the vascular system. Desai et al retrospectively studied the impact of prediabetes amongst AF patients being admitted to hospitals following a major adverse cardiac or cerebrovascular event (MACCE). They found prediabetes to an independent risk factor for MACCE after adjusting for all confounding variables. In this letter, we appraise the study, critically analyze its clinical value and highlight the key limitations.