ATRIAL FIBRILLATION: THROMBOEMBOLIC RISK FACTORS IN DIABETES MELLITUS
Received for publication: 15th of May, 2013
Revised: 5th of June, 2013
SUMMARY: (Hide the summary)
The purpose of this study is the analysis of thromboembolic risk factors in atrial fibrillation (heart failure, hypertension, age over 75 years, female gender, stroke and vascular disease) in pacients with diabetes mellitus. We studied the pacients who were hospitalized with atrial fibrillation during one year and we divided them in two groups: with diabetes mellitus(DM) and non DM. The incidence of hypertension and stoke is significant higher at pacients with diabetes while female gender, heart failure and vascular disease presented percentage values higher among diabetics but not statistically significant.
atrial fibrillation, diabetes mellitus, thromboembolic risk.
Atrial fibrillation (AF) is the most common form of arrhythmia occuring in 1-2% of the general population and is likely to increase to at least double in the next 50 years. At the same time diabetes has become a pandemic disease. Globally, as of 2010 an estimated 285 million people had diabetes with type 2 making up about 90% of the cases, Its incidence is increasing rapidly, and by 2030 this number is estimated to almost double.
Population-based studies suggested that DM is an independent risk factor for atrial fibrillation and olso one of the most common concomitant disease in pacients with AF. DM and AF share common antecedents such as obesity, hypertension, atherosclerosis and both are marked predictors for stroke and mortality.
METHOD AND RESULTS
The next study was made on a group of 420 hospitalized pacients with atrial fibrillation in 2011. We followed the frequency of thromboembolic risk factors ( heart failure, hypertension, age over 75 years, female gender, stroke and vascular disease) in pacients with diabetes mellitus.
Distribution of permanent AF was significantly higher than paroxistic and persistent AF , more than half of these patients (57%) were diagnosed with this type of AF. The gender distribution was almost equal and there were no statistical significant differences (the percentages were 48% men and 52% women).
In the investigated group of patients, we recorded a high proportion of DM (27%) (Fig. 1.) and the incidence was higher for the female gender. Among these pacients, 9% were treated with insulin therapy.
In the group of pacients with AF and diabetes (DM) a proportion of 89% were diagnosed with heart failure.
The proportion of pacients with AF and heart failure but without diabetes (non DM) were 87%(Fig.2). Even though, in percentage terms there were differences, those are not statistically significant(p=0,78). Incidence of hypertension(Fig.3.) and stroke (Fig 4.) in pacients with DM was significantly higher (p <0,05) than pacients non DM.
There were no statistically differences in the 2 groups of pacients (with DM and non DM) regarding other risk factors, such as female gender (p=0,22) and vascular disease, (p=0,072) even though the percentage was higher in diabetic pacients.Regarding age over 75 years, we did not record any statistical differences (p=0,90).
Moreover, the percentage of this risk factor was higher in pacients without diabetes.
Fig .1. Distribution of DM among pacients with FA.
Fig 2. Incidence of heart failure(HF).
Fig 3. Incidence of hypertension.
Fig 4. Incidence of stroke.
A high percentage of pacients with atrial fibrillation have diabetes mellitus, more than a quarter of the pacients have both diseases.
Distribution of permanent AF was significantly higher than paroxistic and persistent AF , more than half of these patients were diagnosed with this type of AF. The gender distribution was almost equal( 48% for male and 52% for female).
There are statistical differences regarding the presence of thromboembolic risk factors such as hypertension and stroke. In the same time, risk factors as female gender, heart failure and vascular disease were more frequent in diabetic pacients.
Percentage of pacients older than75 years was higher in the non DM group probably because life expectancy in DM is less than 75 years.
- Eugene Braunwald, Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 2004
- Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed, 2007
- D. Kasper: Harrison's Principles of Internal Medicine, 18th Edition,2011
- V. Fuster , Guidelines for the Management of Patiens with Atrial Fibrillation, European Society of Cardiology, 2006
- J. Camm, Guidelines for the Management of Pacients with Atrial Fibrillation, European Society of Cardiology, 2010