Medical therapies for prevention of cardiovascular and renal events in patients with atrial fibrillation and diabetes mellitus
Open accessAbstract
Atrial fibrillation (AF), type 2 diabetes mellitus (DM), and chronic kidney disease (CKD) are three global epidemics with significant effects on morbidity and mortality. Diabetes is a risk factor for AF, and a risk factor for thromboembolism, comorbidity, and mortality when AF is present. The pathophysiology of diabetes-related AF and interrelationships with cardiovascular events and renal events is not fully understood but is in part related to structural, electrical, electromechanical, and autonomic remodelling. The current practice guidelines offer limited recommendations on the management of patients with AF (or risk of AF) and diabetes with its own heterogeneity for the prevention of cardiovascular and renal events. This document discusses possible clinical approaches for these patients. In the last decade, there have been major improvements for the prevention of stroke in AF patients with direct oral anticoagulants, which are preferable to vitamin K antagonists for stroke prevention in DM. Because of the increased risk rate for several cardiovascular adverse events in diabetic patients, a similar relative risk reduction generally translates into greater absolute risk reduction in the diabetic population. Recent trials with non-insulin diabetes drugs using glucagon-like peptide-1 agonists and sodium-glucose cotransporter-2 inhibitors showed a significant reduction for the risk of major adverse cardiovascular events in patients with type 2 DM. Sodium-glucose cotransporter-2 inhibitors also showed a large reduction in hospitalization for heart failure and renal events, which need to be more completely evaluated in patients with AF. Mechanisms, risks, and optimal management of AF patients with DM who have or are under risk of developing heart failure or CKD are also discussed in this document. The benefits of medical therapies for these patients still need to be put into perspective, and gaps in evidence on some of these issues are likely to be addressed in future years.
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The risk of conduction disturbances and need for pacemaker therapy may be higher in patients with type 2 diabetes than in controls.
“The risk of conduction disturbances and need for pacemaker therapy may also be higher in patients with T2DM than in controls, although the general management for these issues should not differ from that for other patients.578,579”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [579]
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2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes.
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- Authors
- Fauchier, L., Boriani, G., de Groot, J. R., Kreutz, R., Rossing, P., & Camm, A. J.
- Affiliations
- Université de Tours (FR)
- University of Modena and Reggio Emilia (IT)
- Department of Cardiology, Amsterdam University Medical Centres/University of Amsterdam, Amsterdam, The Netherlands
- Humboldt-Universität zu Berlin (DE)
- University of Copenhagen (DK)
- St George's, University of London (GB)
- Corresponding author
- Fauchier, Laurent
- Venue
- EP Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-08-19
- Volume
- 23
- Issue
- 12
- Pages
- 1873-1891
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W3194761758
- Cited by
- 22
- References
- 166
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 4 · 2023: 7 · 2022: 4
- FWCI
- 2.51
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Licence
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- Funders
- Steno Diabetes Center Copenhagen (SDCC 3.A Complications)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- atrial fibrillation, type 2 diabetes, chronic kidney disease, cardiovascular event prevention, stroke prevention, direct oral anticoagulants, vitamin K antagonists, GLP-1 receptor agonists, SGLT2 inhibitors, heart failure hospitalization, cardiovascular risk reduction
- MeSH terms
- Sodium-Glucose Transporter 2 Inhibitors, Anticoagulants, Atrial Fibrillation, Diabetes Mellitus, Diabetes Mellitus, Type 2, Humans, Risk Factors, Thromboembolism, Stroke
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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